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.
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.