“Stand Up For The Stupid and Crazy”-A case for supporting public funding of Mental Health Care

Picasso, Girl Before a Mirror
Picasso, Girl Before a Mirror

By: Grainne Rhuad

Love the earth and sun and animals,
Despise riches, give alms to everyone that asks,
Stand up for the stupid and crazy,
Devote your income and labor to others…
And your very flesh shall be a great poem.
~Walt Whitman

Chances are that each of us has been either directly or indirectly affected by Mental Illness at some time in our life. Chances also are that we have paid for treating Mental Illness in one way or another.Whether it be paying for psychotherapy or pharmacotherapy following a particularly bad event in our lives or by our tax dollars going towards treating others who have, or claim to have, a mental illness.

How much should we as a society be responsible for when it comes to Mental Health needs and how much should an individual take responsibility for?

It may not seem like a huge and pressing issue given the fact that we are bailing out our banks, losing soldiers and selling ourselves piece by piece to China and other countries.We are a nation at war with herself with all sorts of issues currently in the pot, religion, morality and personal responsibility.Mental Health becomes a part of this because it has become such a huge national expense.Typically someone who is affected by a Mental Health Diagnosis be itDepression all the way up to the Criminal Psychopath, typically these people find themselves at one time or another reliant on public aid for all or some of their well being.

One argument against public responsibility is that the already fractured middle class does not qualify for any public services although they are the bulk of those who make it possible.Insurance coverage for Drug and Alcohol recovery typically cover 2 weeks to 30 days.This is barely enough time to de-tox.In addition they mostly do not allow for in-patient treatment.After this time period a person who has insurance would need to be seen medically by their primary health care physician, who may or may not have a good handle on Drug Addiction treatment options.For counseling their options are AA/NA or private counseling.A counselor would have to demonstrate that there are other issues which are billable in order to continue care after the allowed period.While usually Drug and Alcohol use are symptoms of bigger issues, a case cannot always be made to the satisfaction of the insurance server that someone continue in therapy, in which case a client would have to pay out of pocket.

Conversely if an individual is on government aided programs like Medical, Medicare, Healthy Families (for children up to 21yrs of age) they will be covered indefinitely for any amount of Drug and Alcohol treatment.Yes, there are few facilities and the wait list may be long but in theory they have access to better and longer treatment than a privately insured individual.

One begins to see how this may make people feel like the mental health system and how we contribute to it is lopsided.

Also for family related issues.Socially subsidized individuals have more access to treatment.If someone is having trouble parenting due to mental health issues there are federal and state mandated programs to pay for that.

If you work and have insurance, you’d better start looking in the back of Sunset Magazine and seeing about getting a second on your mortgage because your insurance doesn’t cover youth treatment facilities.In addition most of the state funded facilities for troubled youth, mentally ill youth and adults do not accept patients with insurance.They are typically medical only funded with a slight possibility of cash payments. There are other private facilities, however they are typically out of the middle class family’s price range beginning at about $5000.00 a month and heading up from there.

I don’t think it is anyone’s intention to leave the mentally ill to the streets with no care.But at some point some people begin to wonder if the system is being worked.At what point is someone unstable enough mentally to warrant Social Security payments?Should someone unable to work due to mental illness qualify for social security payments even if their family is in a position financially to help them?Should families be held financially responsible for their adult offspring if they are of comfortable means? Should someone whose own actions, such as drug abuse led to a resulting mental illness be supported by tax payers?A lot of people say yes to these questions.It is difficult for them to see where a struggling county, state or federal budget should accommodate this while other programs that they see as beneficial are cut.

However, studies show that interventions including financial ones keep the mentally ill at a higher level of social functioning.In addition it helps to keep the mentally ill from falling through the cracks and becoming criminal.

I sat down with one of my county’s Department of Behavioral Health contracts overseer, Paul Bugnacki LCSW, who told me that “For every dollar spent in prevention we save 7 dollars in the long run.Our federal government is tuned into the need for treatment.The Federal Government adjusts how much money they reimburse states to provide mental health services by the unemployment rate.When unemployment goes up in your state so does the dollar rate for reimbursement to the states for providing Mental Health Services.The Federal Government is not the only factor in providing adequate and effective treatment to those who suffer.” He went on to explain that, “Californians passed a measure (Prop 63) that taxes the wealthiest Californians in order to assist in funding treatment of their mentally ill.And it is not only therapy.Prop 63 addresses multiple areas such as housing of the mentally ill, jobs, job training and education.California jails are overcrowded with mentally ill people and the law enforcement staff has been overwhelmed by the necessity to treat these folks while they are in their care.Law enforcement is one of the strongest advocates for effective treatment of the mentally ill in California. A prime example of this is what L.A. County is doing with their prison system.” [Go HERE to see about L.A. County programs]

The prison system has long been recognizing that a large population of its inmates meets one or more qualifiers for mental illness.It is this sort of duel diagnosis that has made the prison system addresses the mental health of its inmates.

Current funding for prison based treatment covers areas from sexuality all the way to family functioning.Families whose members are inmates are also beginning to be included in extensive services from counseling to medical interventions, all through the prison system.Indeed the argument made that we should not as a society pumps so much money into the mental ill and poor is effectively nullified by the prison statistics.We end up paying for it anyways, just at a later date.

The 2006 Bureau of Justice Statistics reported 1.25 million state jail inmates with mental health diagnoses nationwide, that up from 283,000 in 1998.The same BJS report reveals that state prisoners with mental health problems were twice as likely to have been homeless and twice as likely to have lived in a foster home, agency or institution while growing up as those without mental health problems. Prisoners with mental health problems were also significantly more likely to have reported being physically or sexually abused in the past, to have had family members who had substance abuse problems, and to have a family member who had been incarcerated in the past. An estimated 42 percent of state inmates had both a mental health problem and substance dependence or abuse. Women reported in slightly higher at 73% and men at 55%.

People must ask themselves whether they want to be proactive or reactive in their support.Primary intervention in Mental Health treatment is incredibly effective in keeping individuals functioning members of society.Many people with many types of diagnoses are able to finish school hold jobs and have careers and healthy relationships, with early education and intervention.However without funding for early intervention programs a lot of people end up jumping in and out of more and more social service systems.We would be saving money, people and possibly our society by voting to fund mental health and other related social service bills.

So why don’t we?  Part of the reason is the cost, when we see it at voting time looks so high.  We see a big number and we are trying to save money, especially when we feel it doesn’t apply directly to us, we tend to take a Scroogish stance, “Are there no prisons, are there no work houses?”  Conversely when we see bills to fund prisons and jails we are likely to see funding for them as necessary.   We don’t want murderers, rapists and drug dealers on the streets!  What we don’t realize is there is a lot fewer murders and rapists in prisons than we would like to believe.  What the majority of the prison population encompasses is people who did not fit the cube shaped public service model and got bumped.  People have to eat and survive so they sell drugs, prostitute themselves, commit burglary, robbery, and fraud.

Those in opposition to more mental  health support wonder; what about the savvy work dodger who pretends to be mentally ill in order to collect Social Security, dodge child support payments and generally get up to no good on the public dole.  After all with the high amount of advertising drug companies are doing in regards to mental health diagnosis and treatment, and the increasing availability of the average person to read and understand diagnostic tools such as the DSM IV, doesn’t it make sense that people are going to run a scam on the public service system?

This creature, the scam artist, the self made Schizophrenic or Tourretts sufferer or Clinically Depressed individual is probably out there, but is as hard to find as Big Foot.  The idea that someone can pull one over on the public is of course and idea but is extremely hard to do.

In order to qualify for Mentally Ill designated funding a person must be evaluated by a Psychiatrist.  In order to see a psychiatrist at a State or County funded agency someone typically has to complete an assessment and be currently working with a licensed therapist.  After all that they can be referred by their therapist to see the Doctor.  Now it’s not going to be easy to stay in your chosen character long enough to get the diagnosis that would qualify you.  These are licensed and experienced professionals who work with the public.  Add to that, the fact that they don’t work in a vacuum, the very fact that the y work at an agency means more input from more people.  But let’s just say for fun that someone did pull the wool over a whole agency’s eyes.  Then they have to submit their application to the government for approval.  This process takes about 6 months.  So what is this clever scam artist going to do to survive for 6 months?  If it is shown that they did anything they will automatically not qualify.  Very often applicants are denied 2or more times even when they do technically qualify.  So it’s not a slam dunk paycheck…”hi I’m depressed I need public assistance.”

Unfortunately,  because of our fear of supporting what may be considered undeserving individuals, we set into place all these measures which also make it difficult for the seriously mentally ill to get services.  Those individuals who truly cannot function well without help have a hard time navigating those steps as well.  The difference is they don’t get tired and move on to some other plan, they just cause problems in their families and communities until the point where services come to them.

Should people be responsible when they are able for themselves and their families?  Yes, definitely.  The problem comes when we try to legislate this type of morality.  Like legislating any form of morality it is by nature subjective and we can never know the heart of an individual, what their true intent or maybe even their abilities are.  Many have the ideal of handing a shovel to someone and making them dig, ala pre-welfare law style.  The idea is if they can dig, they can work.  While digging is really only an illustration, I tend to agree, if someone can do a job they should.  However perhaps the goal should be in supporting people fully and completely so that they can get to and stay in that place.

Nelson Henderson is quoted as saying “The true meaning of life is to plant trees, under whose shade you do not expect to sit.”  If we treated all of our deeds in this manner, including supporting the Mentally Ill, we would be in a better state with a lot more shade.

10 Comments on ““Stand Up For The Stupid and Crazy”-A case for supporting public funding of Mental Health Care”

  1. You’ve delved into a very strong issue here. Apparently the general public is not aware of the dangers associated with untreated Mental Health patients. Many people waive it off as a non-existent, unproven condition. Testing for Mental Health conditions should be mandated. Everyone would have to undergo some type of testing, either through questionairres, surveys, it should start as early as school and be given every ten years or so. Although I am not sure how viable school testing would be since some children tend to play out their imagination when it has anything to do with school. However the reason for updated testing is that people change; severe depression is known to knock people off a stable balance. Post partum mothers, deaths in family, and things like abuse have also been known to affect people mentally.

    If we remove the blindfold and raise awareness among societal members it would make a difference. It might prevent people from taking drastic measures to be noticed. Treatment wouldn’t be as difficult to attain and overall people would be taught how to identify the telltale signs of a mental disorder. A new compassion and respect for such a neglected issue will develop. Then we can seek out the Bigfoot’s of the world and give them the assistance they need. We should start an internet petition.

  2. Well done. You know, then Governor Ronald Reagan emptied the mental health system in California. He litterally put them out on the streets. The mental health system is broke. The pharmacutical companies are driving a messed up perception of mental illness and its effective treatment. On their end its all about the dollar. To be fair they have developed some effective drugs to help with schizophrenia. There has been some great advances in diagnosis and treatment of mental illness. Especially with brain imaging (see Dr. Amon in Davis and the Geffin school at UCLA). This is where I have to divert from Mayas comments about manditory testing. We need to be very careful to protect all of our civil liberties and rights to privacy and our freedom of choice. Yes even homeless, mentally ill petty thefters and drug addicts have freedoms. Who know…tomorrow they may want to try something different or come across one individual that could shift change. Everyone can change no matter what their history is.

  3. Hubbleboy, I felt the same qualms about the use of mandatory testing. There is too strong a tendency among people who climb the social ladders into authoritative positions, to abuse the power of their office in favor of a personal agenda. Forceful obedience to policy has never and will never, improve mental health conditions.

    Grainne, i’m glad you brought up the issue of mental health within the prison system. Although superficially, the social opinion is that it should be a rehabilitation system, in reality it is a punishment system. Even minor offenses that include bench warrants for traffic violations, personal soft drug use, petty shop lifting and public drunk are treated with the same dehumanization process of strip searching, finger printing, and jail time with the more hardened elements of hard drug traffickers, burglars and violent offenders. Their theoretic rehabilitation begins with an introduction to criminality and is supported by the correctional contempt of their peers. Instead of the experience becoming one of willingness to progress beyond petty infractions, it becomes one of resentment for a social organization that apparently has very little interest in their individual well-being.

    There are no undeserving individuals, only confused ones. As Hubbleboy said, anyone can change. Much of the difference lies in the manner in which we care for each other. If we view as unworthy, those who have not been able to comply to the pressure of becoming economically successful, are deviant in their life styles or have been diagnosed with a severe mental disorder such as schizophrenia or depression, we’ve compounded their feelings of low self-esteem and failure as contributing individuals. This judgmental attitude creates a catalyst effect, a clear separation of “them” and “us”, grouping the border line of mental health sympathizers on one side and the advocates of punishment dictations on the other. The funny thing is, the ice cream topping of iconic social responsibility is an illusion. We can’t predict who will fold to destructive behavior simply by the neighborhood status. Extortion, embezzlement, alcoholism, mental disease, even murder is found in the highest social capacities; bankers, attorneys, legislators, administrators, the teaching profession. No one is invulnerable. Only arrogance dictates that the higher your status, the greater the assumption of good mental health. That same assumption is what locks the issue away from a true examination of exactly what constitutes a healthy society.

  4. As with all research there are theories and methods to detecting a psychological instability. The testing wouldn’t necessarily have to be your average standard “alert, it’s a test” type of questionnaire. It could be something as simple as a game for children, such as a strategic puzzle, which route would you take where tasks have to be completed. Choices made would determine if further testing would be needed. It might detect early signs.

    It might lead to hoards of people taking advantage of such a system. Our next topic should include people that abuse the system and throw their normal children into unnecessary special education classifications for the sole-purpose of attaing social security income. I wonder if these people are actually aware of the label that they are creating for their so-called impaired child.

  5. I too have a big problem with any mandated testing. First off no standardized test ever has or even could take into account differences in cultures and individual functioning. Many cultures in our midst from the Native peoples we found here to the new influx of Asian peoples inculuding the Hmong in my community believe absolutely that they walk between worlds, that communication with the dead and with ancestors never known is an ok and even blessed occasion. These people given standardized tests on mental health would not pass several of the measures yet they have no mental illness, just a different understanding of the ‘World we have Agreed upon.’
    Another trouble I see with testing is the change it would make in someone’s life for the negative. While treating mental illness early is good, it has to be individualized. Hearing at a young age that you have certain psychological proclivities may make you act differently and those around you behave differently than if you never had that information. Some people work out their own coping stratgies and to take that power over themselves away would be a very bad thing.
    As with Don Quiote who fell apart when his family forced him to see who he was, he was perfectly happy in his reality until then, who’s to say where his best place was but him?
    Another good fictional character to illustrate this is Lars in the movie “Lars and the Real Girl” Who’s family and friends allowed him his delusions until he didn’t need them anymore.
    Choice is paramount. We must allow for people to decide what works best for them without judgement, and give to them what they need, so they will grow. People work better in their mental illness when allowed control about how to treat it.

  6. You’ve blossomed into quite a journalist. I can’t believe all the work that’s gone into this! I would much prefer our dollars be spent domestically–on mental illness assistance, battered women’s shelters, homeless assistance, hunger assistance–than on aid to Africa and other things that, I am sorry, just don’t seem relevent right now when we are on a shoestring budget in our country. I don’t see our ‘president’ addressing these issues at all, but rather, doing what he thinks will make him look good (as always). The mentally infirm were given excellent benefits until Ronald Regan came into office, and he booted them onto the streets, where they’ve been ever since, harassing passers-by for change and probably committing some amount of crime just to try to stay alive. They need help, and our country needs to refocus on that fact. I am glad my husband is soon to be helping homeless veterans, who have a lot of issues. You are also quite right to point out that just about everybody is affected by the mental health issue.

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