I recently read an article in the New York Times that talked about the status of mental health care in Texas. This article talked about the problems that have arisen over the last few years and how it seems to only be getting worse. Unfortunately, the mental health care funding is already extremely low in the state and is continuing to be drastically cut.
This article specifically talks about the transformation of prisons into a type of mental institution. This is because so many mentally ill patients are sent there as the only option. There is an insufficient amount of legitimate mental institutions in the state, and those that do exist do not have nearly enough space for all of the help-seeking people. One prison, the Harris County Jail, has seen the number of inmates explode and now has 108 beds for the mentally ill and more than 15 full-time psychiatrists. Some mentally ill inmates claim that this is now the best mental health care available to them in Houston.
The rest of the article goes on to explain why these prisons are having to be transformed into a primary source of mental health care and explains the implications that go along with doing so. Lawmakers who are desperately trying to deal with budget shortfalls accumulating to 15-27 billion dollars often turn to deeper cuts in community-based mental health treatment. With more cuts expected in the near future, totaling to 20% reduction in financing, the problem of mentally ill in prisons, on the streets, and in hospitals is bound to increase.
This article was interesting because it showed the importance of the economical barrier of public health. So often, lack of finances play a role in the problems with public health around the world. This can be easily seen in the lives of those living in low income countries, but this article also expresses the difficulty with distribution of finances. In part of the article, it mentions that in order to not raise taxes, there was little other option for cutting health care expenditures and closing the budget gap. This raises the question, how do we decide what is worth putting money toward and what is okay to take money from? Like in all public health issues, the money used for change must come from somewhere. But is drawing from mental health instead of raising taxes really the right way to obtain that money in this situation?
Finally, this article deals a lot with the idea of prevention versus treatment in terms of cost benefit. The article mentions that it is much more expensive to treat mental health problems by providing care in an emergency room, jail or crisis center, than it is to finance community-based health care in the first place. So who is right: those that want to cut costs and bridge that budget gap, or those that want to focus on prevention and save money in the long run?
This article brings up a lot of the issues facing public health, even within our own country. Mental health has always been an area that has suffered from lack of funding and resources. The reason for this may be because it is harder to see tangible results immediately unlike other forms of health care, and because it is more expensive than primary care in hospitals. Maybe the money going into treatment for mental health should also focus on finding better methods of prevention. We focus on the prevention of many other communicable diseases, why not on the prevention of mental health problems.
ReplyDeleteIf a society does not address its public health problems, they can permeate it at every level.
ReplyDeleteMental illness accounts for at least 10 percent of incarcerations and approximately one-third of homelessness (Torrey, 2008).* This raises an interesting question: If criminality and mental illness are co-morbid with each other, where should the government concentrate its funds for the most cost-effective way to deal with crime related to psychiatric illness?
The deinstitutionalization of mentally ill individuals in the 1960s was largely a response to civil rights violations in "insane asylums." Yet, we now see many people suffering from psychiatric disorders cycling between homelessness and incarceration.
Anyone can agree that the cost of primary prevention--both to the economy and to communal well-being--is much lower than the cost of remedying already bad situations. But, how exactly are we to prevent mental illness?
Even if an unlimited budget were provided to the most skilled epidemiologists, environmental health workers, bio-statisticians and health policymakers and administrators to develop and implement an initiative to prevent mental illness, we would still expect the high rate of major depressive disorders and schizophrenia to persist for some time.
With mental health problems, primary prevention cannot replace treatment. We must face several questions. What are society's responsibilities toward mentally ill individuals? Where should public health administrators allocate resources in order to serve people suffering from psychiatric illness effectively, fairly, and with dignity? How relevant and feasible is global collaboration on mental health initiatives? How can we address the socioeconomic factors that are woven into every aspect of psychopathology?
*http://www.jaapl.org/cgi/content/full/37/2/275
This article presents the reality that when budget cuts come to the fore of health policy, mental health is usually the first to get cut. In my home state of California, the budget deficit has forced the government to enforce cuts on Medicaid and Medicare. The health sector that is most adversely effected by these cuts is mental health. Part of this mentality may have something to do with a generalized stigmatism towards mental health, while Zach's point about the lack of tangible results is itself probably a factor. However, with mental health on the rise, and estimated to be one of the main barriers to health in the US within the next 20 years, the focus on disease prevention needs to switch towards mental health. It would be much better to place the groundwork for tackling this future mental health endemic now, rather than playing catch up later.
ReplyDeleteAfter reading this article, I immediately asked myself this question: "How in the world would society even go about preventing mental disorders?" After a quick google search, I stumbled across a powerpoint presentation that was focused entirely on prevantative measures regarding mental health that was presented at the World Health Organization.
ReplyDeleteLink: http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf
After a quick skim, I found that the WHO attributes many mental health problems to issues of human rights. Therefore, preventative measures would include programs that help protect these rights within families and within societies. The WHO also considers mental health disorders to be an extremely high priority.
Therefore, I think that society should not cut mental disorder prevention funding; rather, legislation should direct more cashflow towards this area, as mental health disorders are becoming one of the leading killers in the world today.