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12. To combat poor mental health care in America...

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12. To combat poor mental health care in America...

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there needs to be strong public health surveillance, improved access to treatment services, and cutting-edge research.

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Is Obamacare Working? The Affordable Care Act Five Years Later

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Mass shootings have increased from 6.4 per year between the years of 2000 and 2006 to 16.4 per year between years of 2007 and 2013 (Carol, 2018). According to the Treatment Advocacy Center, approximately one-third of individuals who carried out a mass killing had an untreated mental illness (Carol, 2018). According to a report on Mass Attacks in Public Spaces–2017 released by the U.S. National Service Threat Assessment Center in 2018, “18 (64%) of the attackers experienced mental health symptoms prior to their attack; 9 (32%) were psychotic and 7 (25%) had been hospitalized for treatment or prescribed psychiatric medication prior to their attacks” (Carol, 2018).

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According to MHA, “between 300,000 to 400,000 people with mental illnesses are incarcerated in jails and prisons across the United States” (2018). In prison, individuals are exposed to cruel conditions, which exacerbates mental illness. In addition, individuals receive inadequate mental health care in prison, which is intensified with overcrowding (MHA, 2018).

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According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 11.8 million people have misused opioids in 2016, 2.1 million Americans have an opioid use disorder in 2018, and out of the 64,070 drug overdoses, 75% are from opioids (2018). However, only 1 in 5 individuals with an opioid use disorder receive treatment (SAMHSA, 2018).

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11. History of Mental Health in the United States

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11. History of Mental Health in the United States

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1896-

Connecticut “prohibited marriage for epileptics, imbeciles, and the feeble-minded” (Larson, 2018)

Early 19th century-

Institutionalization refers to the state of being placed into a residential institution, such as an asylum.

Physicians treated patients with “moral treatment” by exposing them to normal daily habits, such as farming work (Larson, 2018).

1907-

Connecticut and thirty-three states mandated “sterilization of an individual after a board expert recommended it”, resulting in more than 65,000 sterilizations of the mentally ill (Larson, 2018).

1907 to 1930-

A doctor named Henry Cotton “removed patients’ teeth, tonsils, spleens, and ovaries to try and ameliorate their symptoms”, resulting in a 30 to 45 percent mortality rate for these procedures (Larson, 2018).

Antonio Moniz, a neurologist, developed an extreme physical treatment of mental illness called lobotomization, which involved drilling a hole through the skull (Larson, 2018).

ECT, or electroconvulsive therapy, was also used to induce seizures in patients with a series of electrical shocks to treat illnesses such as schizophrenia and manic depression (Larson, 2018).

1946-

President Harry Truman passed the National Mental Health Act, which provided funds to the National Institute of Mental Health (NIMH) in 1949.

1954-

The Community Mental Health Act was enacted in the state of New York, which supplied funding to outpatient clinics for mental illness therapy and medications (Larson, 2018), resulting in the beginning of deinstitutionalization.

Thorazine, known as chlorpromazine, was approved by the Food and Drug Administration to treat psychotic episodes (Larson, 2018).

1955-

The number of mental health patients increased to 558,000, which was 3% of the U.S. population.

1963-

The Kennedy Administration proposed a program which would allow the mentally ill to live within their communities successfully.

This program would allow the effective treatment of mentally ill individuals acquiring new knowledge and drugs, making it possible for these individuals to return to their communities and society.

President Kennedy’s bill provided $150 million in grants to community mental health centers (CMHCs), which would require the centers to offer inpatient services, outpatient services, hospitalization, 24-hour emergency services, and educational work, and entailed that 2,000 CMHCs be built by 1980.

1972-

Federal programs served to empty state institutions by providing funds for the elderly to be treated in nursing homes through Medicare.

Social security encouraged people to live independently by allowing payments to be made to individuals not living in a hospital.

Medicaid encouraged people to move out of hospitals into smaller facilities (Larson, 2018).

In California, under Governor Ronald Reagan, the Lanterman-Petris-Short Act diverted funds for patient care at the county level into the state’s general fund (Larson, 2018).

Under Governor Michael Dukakis in Massachusetts, budget cuts were made resulting in the decline in quality care in hospitals and hospital closures (Larson, 2018).

1981-

President Reagan’s Omnibus Budget Reconciliation Act repealed funding for CMHCs (Larson, 2018).

20th century-

Rates of uninsured adults with a mental illness has decreased by 5% (MHA, 2018).

States that increased Medicaid expansion saw a greater improvement in youth coverage and had fewer uninsured adults with mental illness (MHA, 2018).

States that do not participate in Medicaid expansion under the ACA, low-income individuals will not be required to purchase insurance (Rowan, 2013)

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5. Economic Cost of Mental Health on the United States Economy

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5. Economic Cost of Mental Health on the United States Economy

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According to Davlasheridze, “5-6 million United States workers cannot find work due to mental health problems and among those employed, poor mental health may reduce annual income by as much as $3,500-$6,000 per worker, totaling approximately $100-$170 billion in annual losses” (2018). According to the NAMI, serious mental illness costs America $193.2 billion in lost earnings per year.

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According to Kamal, “13% of those reporting foregoing mental health care said they could not afford the cost, with 12% of individuals reporting that their insurance would not cover it, 10% of individuals reporting fear or embarrassment kept them from seeking care, and 8% reporting that they did not know where to get care” (2017).

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According to Mental Health America (MHA), 56% of American adults with a mental illness did not receive treatment (2018). If a patient with mental illness does receive treatment, 1 in 5 patients report an unmet need (MHA, 2018).

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“A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” (World Health Organization, 2014).

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"Health conditions involving changes in emotion, thinking or behavior” (American Psychiatric Association, 2018).

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"The number of American adults with a mental health condition is more than the populations of New York and Florida combined" (Beacon Health Options).

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In the United States, 19% of Americans have some form of mental illness, 4.1% have a serious mental illness, and 8.5% have a substance abuse disorder (American Psychiatric Association, 2018).

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Public stigma occurs due to a lack of engagement in mental health care and worse treatment outcomes, which results in discrimination, segregation and reduced self-efficacy of the mentally ill (Parcesepe, 2013).

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“A pervasive barrier that prevents many individuals in the United States from engaging in mental health care” (Parcesepe, 2013)

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Approximately 26% of homeless adults in shelters live with a serious mental illness and 24% of prisoners have a recent history of a mental health condition (NAMI).

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"Between 300,000 to 400,000 people with mental illnesses are incarcerated in jails and prisons across the United States, and more than 500,000 people with mental illnesses are under correctional control in the community” (Mental Health America, 2018).

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Startling number of mental patients behind bars in US

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In America there are thought to be three times more psychiatric patients in prison than in hospital.

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Individuals with a mental illness are 10 times more likely to be victims of a violent crime compared to the general public, where a fifth of all prisoners in the United States have a mental illness of some kind (Larson, 2018).

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8c. Lack of Access: Mental Health Professional Shortage

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8c. Lack of Access: Mental Health Professional Shortage

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In Alabama, there is only one mental health care professional per 1,260 people (MHA, 2018).

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According to NAMI, suicide is the 10th leading cause of death in the United States, the 3rd leading cause of death for people aged 10-14 years, and the 2nd leading cause of death for people aged 15-24 years. MHA reports 7.7% of youth had no access to mental health services through their private insurance and over 1.7 million youth with major depressive episodes did not receive treatment (2018).