As with the individual, our society’s collective thought creates reality. The underfunded, broken mental health system is only an expression of our mutual fear and loathing of mental illness and, consequently, those who it affects. Change the belief and we’ll change the reality.
It wasn’t that long ago that a mysterious illness swept like a wildfire through a freewheeling slice of the gay community and a hodgepodge of IV drug abusers, two of the most marginalized populations in society. No one really cared about the carnage of AIDS until it struck middle America’s nerve when Rock Hudson sickened and died. Then Liberace. Then Freddie Mercury. The face of AIDS changed and services and funding grew accordingly. The same must be and can be done for mental illness.
Efforts like Joe Pantoliano’s Efforts like Joe Pantoliano’s
No Kidding, Me Too! which seeks to remove the stigma of mental illness using star power, are on the right track. We just need more of them.
Raising awareness can raise funding. But improved policing of where the money is spent would be well worth the effort. The group I mentioned earlier, the impostors who feign mental illness for a free place to stay need to be redirected elsewhere, such as homeless shelters and case management services. This cannot be accomplished, though, until there is adequate liability protection for physicians and other professionals who dare to just say no to a malingerer, only to have the person walk out and knife themselves, just to prove a point, but unexpectedly die. It may smell of sweet justice, but it reeks in the courtroom when family members suddenly emerge from the woodwork to sue the unlucky physician.
Then there are the politicians and other stakeholders. One look at the internecine dealings behind distribution of California’s “millionaire tax” for mental health services is an embarrassing look at bureaucrats and technocrats gone wild. How long before grabby government hands are dipping into this till to fund everything but mental health in this cash-strapped state? Accountability cuts all ways.
The political will for treatment is another key issue. States like California have created legislation such as Laura’s Law, which provides for mandated outpatient treatment, but without any funding source. We can all do that kind of math: Good law+ no money=hot air. Meanwhile, many patients continue to wind through the system’s Great Revolving Door on a monthly basis, noncompliant with treatment, penniless after spending their SSI checks on drugs, and carrying “insurance” like Medicaid, which doesn’t even pay the direct costs of their care. A dollar reimbursement for $5 worth of care is a great way to devolve to no services.
Until we as a society decide if the mentally ill are really worth treating, we will continue to see ERs, general and psychiatric alike, overflowing with insanity.
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