The Substance Abuse and Mental Health Services Administration (SAMHSA) announced last month, $24.6 million in planning grants for states to help implement Certified Community Behavioral Health Clinics.
CCBHC is a nationwide demonstration program to improve community mental health services, resulting from the passage of the 2014 Protecting Access to Medicare Act.
CCBHCs will serve individuals with serious mental illnesses and substance use disorders and provide intensive, person-centered, multidisciplinary, evidence-based screening, assessment, diagnostics, treatment, prevention, and wellness services.
Even with this funding more needs to be done.
The problem is seriously mentally ill persons have been swept into our nation’s jails and prisons along with those without mental illness, disregarding their mental illness and discounting their need for mental health treatment.
Twenty percent of inmates in jails and 15 percent of inmates in state prisons are estimated to have a serious mental illness. Based on the total number of inmates, approximately 356,000 with serious mental illness are in jails and state prisons - 10 times more than the nearly 35,000 individuals with serious mental illness remaining in state hospitals.
Of the millions who cycle through courts, jails, and prisons every year, their rates of chronic health problems, substance use, and mental illness are significantly higher than the general population.
Purportedly designed for prevention of mental illness and treatment of persons with serious mental illness, our mental health system is in shambles. We live within an epidemic of mass incarceration, and this is a primary public health challenge.
And, those of us working in the mental health system knew that the state hospital and community-based treatment systems were broken. We knew that successful treatment outcomes were minimal at best and, once discharged, the turn-style called mental health treatment would continue.
We’ve seen a person with a serious mental illness, picked up by law enforcement and placed in the county jail. It was either placement in the state hospital or court-ordered community-based treatment.
This problem has been decades in the making.
In 1963, President John F. Kennedy signed the Community Mental Health Act, beginning the wave of deinstitutionalizing mentally ill patients from state hospitals and the goal of community-based mental health treatment centers.
A decade later, President Nixon’s “tough-on- crime” laws led to the passage of the War on Drugs Act, just as the public policy deinstitutionalizing mentally ill patients from hospitals was underway. The policies collided and the War on Drugs derailed the goals of deinstitutionalization with thousands of persons released from state hospitals ending up in state correctional facilities.
President Jimmy Carter established a Presidential Commission on Mental Health that led to the Mental Health Systems Act of 1980, making grants directly available to community mental health centers.
Yet, in his first months, President Ronald Reagan repealed the Mental Health Systems Act, cut one-third of federal mental health spending, and redirected funding from community health centers to block grants for the states. There was no policy mechanism to pick up the slack left by Reagan’s decisions.
In the 1960s, states unrolled massive budget cuts, reducing the number of state hospitals, and deinstitutionalizing thousands of patients with mental illness.
Forty-six years later, the last decade’s Great Recession exceeded the ‘60s budget cuts: the combined states’ approximately $4.35 billion budget cuts plus the U.S. government’s $4 billion cut in the mental health budget, led to a nationwide cut of nearly $9 billion.
As a result, critical decisions fostered the incarceration of hundreds of thousands of seriously mentally ill persons.
Communities and jails, states and prisons must work together to integrate a public health-justice-incarceration framework.
What can we do?
• Shift the paradigm of mental illness in jails and prisons from incarceration and punishment to one that views mental illness in jail and prison environments as a public safety and health issue.
• Call on public health practitioners to make the case for reallocating public funds to programs that have proven not only to provide access to treatment but reduction in recidivism.
• Integrate families and communities as part of the response to the mental health epidemic.
• Use Medicaid waivers and innovation funding to extend coverage to new groups, and advance health information technology that encourages mental health literacy.
• Call for swift action to establish Certified Community Behavioral Health Clinics throughout our nation and improve Medicaid reimbursement for these services.
Unless and until policies struck by states and the federal government are reformed, inhumane treatment of mentally ill persons will continue.
Parker, PhD, is a former professor and life-long disability justice advocate who founded The Aurora Foundation, Inc, serving women with disabilities for more than a decade. She lives in Tucson, Arizona, and is a public voices fellow with The OpEd Project. Andrade, PhD is an associate researcher professor at The University of Arizona's Southwest Institute for Research on Women and a Tucson public voices fellow with The OpEd Project. Her research in "Frontiers: A Journal of Women Studies," has been included in the Kennedy Institute of Ethics collection at Georgetown University.