How the Mental Health System is Failing People with Severe Mental Illness.
Updated: Jun 29, 2020
As a mental health professional, I often critique myself and the kind of service I provide to my clients. I always wonder if I’m actually helping my clients achieve their goals, and I am constantly looking for new ways to help them. I'm passionate about helping others which is what motivated me to become a therapist. I also like being a part of the mental health community; working with people can be a very rewarding and fulfilling experience but it can also be frustrating. Specifically, when I’m not able to help clients move past certain barriers, when the services they need just aren’t accessible, and when there is little to no support available to them. Evidently, there are flaws and cracks in the mental health system; statistically few people actually recover or enter into remission, and I would like explore why that is.
We can all agree that mental health awareness has gained more attention in the past couple of years. Society realizes that helping professionals have a vital role in preventing and addressing trauma, substance abuse, and serious mental illnesses. There has been a push for people to seek professional help with a variety of services available. Here’s the catch. These services are sometimes not accessible to certain populations, some of them are time-limited, and most services are expensive even with insurance coverage. In many cases, the quality and how much help a person is able to receive depends on how much they can afford to spend. A person with severe mental illness can easily get lost in this system, especially if they don’t have the means to access long term mental health treatment.
During the mid- late 20th century large psychiatric facilities started to close; this is widely known as deinstitutionalization- “A process of replacing long-stay psychiatric hospitals with less isolated community health services” (Wikipedia.org). Programs proposed to help with recovery following the closure of these facilities never followed through, and as a result people with severe mental illnesses are comprised of 25% of the homeless population, and an estimated 1.2 million of the prison population (APA.org). Deinstitutionalization was also made possible by the discovery of psychiatric drugs in the mid-20th century; there were financial imperatives with the government viewing it as a way to save costs (Kales, Pierce, & Greenblatt, 2012). Maintaining mental illness with medication is a benefit for pharmaceutical companies, and It’s not unheard of for hospitals to release a patient before they are completely stabilized in the community with little support in order to free a bed for an incoming patient. Many facilities within the system aren’t designed for long term care, and many insurance companies only cover time limited services. A major barrier to improving this flaw is advocacy. People with severe mental illness are not able to advocate for themselves, and people who are put in place to advocate for these patients are faced with the ethical barrier of self-determination.
If there is a price tag on the quality and longevity of mental health services then it shouldn’t be surprising that there are cracks in the system, and unfortunately some of the clients and patients we serve are falling through them. Disadvantaged and poor communities where services are needed the most often have limited resources, and the resources that are available don’t have the capacity to service all the individuals that need the support. This causes agencies, organizations, and facilities to enforce limitations on who are eligible for services and those who don’t meet the criteria are excluded. Again, services in these communities are time limited in order for the agencies to service a larger portion of the population. Because long term care is not accessible, providers are managing symptoms with medications instead of focusing on symptom relief, which contributes to the problem of the “revolving door”.
In many facilities, rehabs, and hospitals bureaucracy has become a barrier to quality and effectiveness of services. In these organizations, the board of directors and administrators make most decision on how services are delivered to the patients. Customer service is a primary concern and customer care is secondary. Another limitation is the lack of autonomy and flexibility to provide individualized treatment to each patient which causes a “one size fits all” approach. The problem with this approach is mental illness is complex and diverse; many underlying behaviors can easily be overlooked and left unresolved. The programs in these organizations are not designed to address deep rooted issues that contribute to the disorder. The idea is to stabilize and then connect the client to other resources. Even if a person can afford long term treatment, they are in and out of multiple facilities. Each facility is designed differently causing inconsistencies in treatment. Inconsistency is another barrier to effective recovery leading clients to regress or drop out of services.
Ways to Improve
I have spent some time talking to people and researching what can be done to resolve the issues discussed. Let me just say that any system will always have flaws, and it’s impossible to satisfy everyone involved. However, the system can improve in the sense that mental health practitioners move from the idea of symptom management to symptom relief. Here are some ways we can work to accomplish this:
1. Make mental health services more affordable and accessible to people who need it. This means outreach in communities that have a need which include education and advocacy services. More investment in mental health in these communities from the local and state level. Better matches for people who aren’t using private insurances to ensure they are receiving services suited for their specific need; and reducing the costs of some co-pays and deductibles for those with private insurance.
2. Provide long term support for people with severe mental illness in which they can continue to have access to services once they leave the facility. This includes in home support and access to other community resources. This type of support is already in place in some areas, however at times the responsibility falls on the client to follow up with the services. Client with severe mental illness may have low motivation or poor follow through; in this case advocates can be put in place to ensure the client is enrolled in services.
3. Increase the client’s confidence in their ability to manage their mental health. Many client’s feel that they don’t have much say in their treatment. Services can focus on giving clients the tools they need to advocate for themselves, allowing them to feel they have the freedom to choose the right treatment for themselves.
4. Using peer support by matching clients with people who have similar experiences with mental illness and addiction. These people can relate to the client and help them learn coping skills effective for recovery.