News & Events

Guest Column: Time to act now to restore ravaged mental health care system

From the Massachusetts Nurse Newsletter
November/December 2012/January 2013 Edition

This call for national action to restore our crumbling mental health care system reverberates in Massachusetts. Here in the commonwealth, years of budget cuts for mental health services, the closing of state facilities, an underfunded and poorly run community-based care system, and lack of appropriate social services have left our mentally ill residents languishing without proper care and services. It is nothing short of a travesty. Every day our emergency departments are overcrowded with mentally ill patients who can’t access any services. The time to act is now, the time for further budget cuts is over.

By Deborah Burger, RN
Co-president, National Nurses United

Registered nurses across the country mourn the loss of life marked by the shooting of innocents in Connecticut last month. This should be a clear wake up call for the White House, Congress, and state and local legislators to take action to address causes of such violence, including restoring the devastating cuts that have occurred to mental health services across the U.S.

Every day a massive tragedy is being played out on a smaller scale in emergency rooms, in mental health facilities, and on the streets across our country, where, with sometimes devastating consequences, mental health is underfunded to a shocking and deadly degree.

Members of National Nurses United, the nation’s largest organization of nurses, say it is time to act with both short term and long term responses. It is incumbent on all of us to:

  • Demand private health care systems reverse the pervasive cuts to mental health services, especially by profit-focused institutions that view mental health as an easy target for cuts because it is less profitable and has fewer public advocates.
  • Increase federal, state and local funding of public mental health programs and public health clinics, which play a crucial role in identifying people with potentially violent mental health problems.
  • Require health insurance companies to provide full coverage for mental health services, and require parity in mental health coverage with other health services.
  • Restore school nurses and counselors who are frequently a first target of school budget cuts.
  • Challenge the stigma of mental health that undermines mental health programs and harms people who need mental health care, the overwhelming majority of whom are not violent.
  • Guarantee health care for everyone, including mental health services that are based on a patient’s need, not their ability to pay, as in improving and expanding Medicare to cover everyone.

Sadly, this growing emergency comes as no surprise to America’s nurses who are on the front line of our nation’s mental health crisis. Why must it take such a catastrophe to convene a serious dialogue about the state of our nation’s mental health system? In communities from Maine to California, nurses deal with the fallout that comes from hospitals, schools and clinics, who have cut their mental health services to the bone.

Evidence is in on the crisis
Budget cuts to safety net programs and fundamental care services—from schools to health facilities—have a crucial impact on communities. In 2011, the National Alliance on Mental Illness documented deep cuts to mental health services that led to significant reductions in both hospital and community services for vulnerable individuals with serious mental illness.

Across the country, as noted in this Alter- Net commentary, states cut $4.35 billion in public mental health spending from 2009 to 2012—the most massive cut in funding since de-institutionalization in the 60s and ‘70s. More than $840 million of that occurred in 31 states in 2012 alone.

A 2010 National Institute for Mental Health study asserted that one in every three to four children suffers from a mental disorder and that about one in 10 has a serious emotional disturbance, with few affected youth receiving adequate mental health care. It emphasized that common mental disorders among adults first emerge in childhood and adolescence further stressing the need for early intervention and prevention.

The National Health Council for Community Behavioral Healthcare reports that 60 percent of juvenile detention inmates have at least one mental disorder. Although home and community-based services are more cost effective than warehousing youth in the juvenile justice system while they await treatment, the council notes that these home and community services are “inadequately supported.”

According to the National Survey on Drug Use and Health, Think Progress reported after the Connecticut shooting just 7.1 percent of U.S. adults receive mental health services. Out-of- pocket costs for inpatient and outpatient mental health services are staggeringly high.

While there is a national focus, rightly so, on the tragedy in Newtown, today millions of people and their families in our country continue to suffer from mental illness and post traumatic stress from domestic and sexual violence who do not receive support or counseling.

These millions are the hidden face of mental trauma in the U.S., and the disgrace of a health care industry in particular that is focused on short term profit rather than therapeutic healing. Nurses will continue to advocate for the support and early intervention patients and all Americans deserve.

NNU nurses have been speaking out about the mental health crisis for a long time.

“My first reaction when I heard the news was that he sounded like someone with an untreated mental illness,” said Adelena Marshall, RN who has worked in the mental health unit of the Chicago Veteran Affairs Hospital for the last 20 years.

Last May, Chicago VA RNs with the support NNU had to threaten to hold an informational picket with the Iraq Veterans against the War to decry the appalling staffing conditions on the mental health unit. A couple of weeks later, 20 positions were posted.

“Nurses are on the front line of this issue and need to be part of the policy conversation,” said Michigan RN Jeanette Hokett who works in a 14-bed child and adolescent psychiatric inpatient unit. “They spend the most time at the bedside with the patients and families, and offer a perspective others, such as doctors, don’t have.

”Earlier this year, nurses’ concerns about access to mental health prompted NNU to convene a roundtable on mental health. “Often, the emergency room is where desperate people end up,” said one participant, Diane Fagan, a Kaiser Permanente ER RN in Oakland, Calif. “In the eight years I have worked there, I have seen more and more untreated mental health patients coming into the emergency department and spending long hours waiting to see a psychiatrist because so many of our outpatient services have closed.”

Says Hocket, “The reality is there are not enough treatment options and they are not always available for families because of financial constraints. If there was better access to mental health care, we would be able to improve the outcome for these patients and improve their lives.”

Ultimately, effectively challenging the mental health crisis is an integral part of solving our overall, ongoing healthcare emergency in the U.S.