Tucked away in the gun law President Biden just signed is a provision increasing funding for preventive outpatient treatment for mental illness. This is an important step toward solving America’s mental-health crisis but only part of what’s needed. Happily, help may be on the way if Republicans take back Congress in November.
From homelessness to crime to rising suicide rates, a variety of problems in America today correlate with mental illnesses. But Democrats, journalists and social activists often focus on other potential causes such as racism, economic inequality or police misbehavior. Ask a Democrat about solving homelessness and the standard response is a call for more housing. But housing alone does little to help people who are in psychological distress. It sometimes makes matters worse if people are more isolated.
More outpatient counseling and medication is a much better solution than many that these politicians prescribe. But for severe mental illness—untreated and acute psychosis—it may not be enough. Some people need longer-term residential care with trained physicians.
Unfortunately, the inpatient resources these patients require have been stripped away. “We so overcorrected the problematic state of institutions in the 1960s that we created an enormous deficit in funded psychiatric beds,” Thomas Insel, a former director of the National Institute of Mental Health, has said. The 1965 legislation establishing Medicaid included a provision called the Institutions Mental Disease Exclusion, which prohibits most Medicaid payments to state psychiatric hospitals. America now has only 5% as many psychiatric beds as it had six decades ago.
As hospitals reduce beds, patients are supposed to move to community care facilities, but community care facilities often can’t dispense medication and provide little more than housing. These facilities typically lack professional medical and psychiatric attention, and patients with acute psychosis are asked to leave before they have recovered enough to take responsibility for attending therapy and taking medication.
Instead these patients end up in the streets, hospital emergency rooms and jails. The nonprofit Treatment Advocacy Center estimates that more than three times as many psychotic cases reside in America’s prisons as in state hospitals. Many judges won’t consider mandatory treatment for severely disturbed persons because psychiatric hospital beds are so scarce. Prison care typically provides scant help for the mentally ill and is unlikely to prevent recidivism.
This neglect may be coming to an end. If Republicans take Congress, Rep. Cathy McMorris Rodgers of Washington is likely to head a crucial committee to deal with direct mental-illness legislation. Mrs. Rodgers has been instrumental in calling attention to the IMD exclusion, whose effects she sees in her hometown of Spokane.
Reps. French Hill (R., Ark.) and Andy Barr (R., Ky.) and Sen. Tim Scott (S.C.) are preparing legislation to allow housing funds to be used, in part, for mental-health services and drug-addiction treatment. They intend to push their proposals if the GOP takes Congress in November. Democrats would be wise to join, but so far have been resistant.
As House Republicans refine their commitments, they should emphasize improving mental health. Polls may not show much worry among voters over untreated mental illness, but it lies at the heart of many of their top concerns.