Skip to main content

How to make mental health care work

By Debbie F. Plotnick
updated 9:32 AM EST, Mon November 25, 2013
STORY HIGHLIGHTS
  • Debbie Plotnick: Much not known about Deeds incident, but mental health implicated
  • She says mental health care inadequate in U.S., particularly with painful funding cuts
  • She says Obamacare, Mental Health Parity Act will help, but community effort needed
  • Plotnick: Restored funding, along with peer support, coordinated services essential

Editor's note: Debbie F. Plotnick is the Senior Director of State Policy for Mental Health America, , a community-based network that advocates for changes in mental health and wellness policy, and delivers mental health and wellness programs and services.

(CNN) -- In the days and weeks ahead, we hope to learn more that will help us understand the tragedy that befell Virginia State Sen. R. Creigh Deeds and his family last week. On Friday, Deeds was released from the hospital four days after his son Austin "Gus" Deeds stabbed him repeatedly before shooting himself to death.

Mental health officials initially said that after a psychological evaluation for the younger Deeds, they had been unsuccessful in finding a bed at a psychiatric hospital for him. But nearby hospitals later said that they had available space but were never contacted. The state of Virginia is investigating the matter and also conducting a review of state and local mental health services to determine if changes are needed.

Much is still not known about that sad incident. But what we do know is that mental health care is an area that remains underserved; many who need care do not get it. For years, the mental health system has suffered from shortages of funding and political attention. Of the estimated one in five people who experience a mental health challenge each year, about 60% receive treatment.

Debbie Plotnick
Debbie Plotnick

While the one-in-five number includes depression, anxiety, insomnia, eating disorders and substance use, it is important to note that those are the issues that people report to their doctors when they do seek help. Sometimes these symptoms indicate that there is a more serious problem that, if treated early, it can be key to preventing a disorder from reaching a crisis or leading to disability.

The mental health system in the United States is fragmented, and reductions in public mental spending have resulted in severe shortages of services, including housing and community-based services. Since 2008, more than $4.5 billion has been cut from state budgets nationwide, and there are unmeasured challenges brought about by sequestration. These include reductions in block grants to the states for mental health and justice initiatives and cuts to Indian Health Services, which have resulted in fewer mental health counselors being hired.

These cuts have placed even greater demands on programs that provide community treatment and crisis services. And while we don't know whether these difficulties played any role in the Deeds incident, we do know that years of discrimination toward people with mental health conditions has contributed to confusion about how to access care and often resulted in denied care.

Fortunately, there has been significant progress in removing barriers and expanding and equalizing insurance coverage. The Affordable Care Act includes mental health care and substance use treatment as one of its 10 essential health benefits. That sends a strong message about the importance of mental health to overall health and wellness. Coupled with the just-released final regulations for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, these changes will greatly improve access to care.

We know that acute mental health inpatient services are very expensive, just as they are for the medical/surgical side of the health care equation. In recent years, there have been reductions in the number of community hospitals providing psychiatric care, as well as shortened stays. Treatment is increasingly being delivered in alternative/outpatient settings, as is the case for health care in general. This is not necessarily a bad thing, as long as coordinated community-based treatments are available.

Community-based care, particularly when coupled with coordinated and supportive services similar to what is provided for other health conditions, produces better outcomes, helps people recover and reduces overall societal and medical costs.

Mental healthcare at fault in stabbing?
Questions over son's mental health care

As part of their Medicaid plans, states such as Pennsylvania and Georgia are offering programs that provide alternatives to traditional services. They not only work well, they also cost less than not providing mental health services.

For example, rather than having people experience long waits in overcrowded emergency rooms or forcing them to travel long distances, mobile crisis services are coming to adults and children (and their families) in their own homes in places as diverse as rural North Carolina, Minnesota and Tennessee, as well as in some of the nation's largest urban centers, including Los Angeles and Philadelphia.

We know that community alternatives to traditional hospitalization are proving effective.

In Lincoln, Nebraska, with its Keya House; at Rose House serving people in the counties north of New York city; and in multiple sites across Georgia, peer support and respite centers provide hospital diversion, a safe place for people in crisis and ongoing support to those at risk for a mental health crisis. Even New York City has recently added crisis alternative services.

Legislators must make the commitment to restore the cuts to state mental health budgets. More state Medicaid plans and private insurance must add certified peer specialists to their plans to let people with state-provided nonclinical training help others stay on their medications and build social supports.

Municipalities must better coordinate their mental health services and increase the number of mobile and alternative crisis services, and all community members need to understand that mental health is essential to overall wellness.

We know what we need to do to head off tragedies and improve the quality of life for people with mental health conditions, and their loved ones. We need to find the political will to ensure that we address mental health with the same degree of attention as other health conditions, and provide the means and mechanisms to pay for it.

Follow us on Twitter @CNNOpinion.

Join us on Facebook/CNNOpinion.

The opinions expressed in this commentary are solely those of Debbie F. Plotnick.

ADVERTISEMENT
Part of complete coverage on
updated 8:59 AM EDT, Mon September 22, 2014
You could be forgiven for thinking no one cares -- or even should care, right now -- about climate change, writes CNN's John Sutter. But you'd be mistaken.
updated 5:32 PM EDT, Sun September 21, 2014
David Gergen says the White House's war against ISIS is getting off to a rough start and needs to be set right
updated 9:00 AM EDT, Mon September 22, 2014
John Sutter boarded a leaky oyster boat in Connecticut with a captain who can't swim as he set off to get world leaders to act on climate change
updated 3:17 PM EDT, Mon September 22, 2014
Ruben Navarrette says making rude use of the Mexican flag on Mexican independence day in a concert in Mexico was extremely tasteless, but not an international incident.
updated 9:59 AM EDT, Mon September 22, 2014
Michael Dunn is going to stand trial again after a jury was unable to reach a verdict; Mark O'Mara hopes for a fair trial.
updated 7:15 PM EDT, Mon September 22, 2014
Is ballet dying? CNN spoke with Isabella Boylston, a principal dancer at the American Ballet Theatre, about the future of the art form.
updated 5:47 PM EDT, Fri September 19, 2014
Sally Kohn says it's time we take climate change as seriously as we do warfare in the Middle East
updated 3:27 PM EDT, Mon September 22, 2014
Laurence Steinberg says the high obesity rate among young children is worrisome for a host of reasons
updated 9:02 AM EDT, Fri September 19, 2014
Dean Obeidallah says an Oklahoma state representative's hateful remarks were rightfully condemned by religious leaders..
updated 3:22 PM EDT, Fri September 19, 2014
No matter how much planning has gone into U.S. military plans to counter the Islamic State in Iraq and Syria, the Arab public isn't convinced that anything will change, says Geneive Abdo
updated 11:44 AM EDT, Fri September 19, 2014
President Obama's strategy for destroying ISIS seems to depend on a volley of air strikes. That won't be enough, says Haider Mullick.
updated 9:03 AM EDT, Fri September 19, 2014
Paul Begala says Hillary Clinton has plenty of good reasons not to jump into the 2016 race now
updated 11:01 AM EDT, Fri September 19, 2014
Scotland decided to trust its 16-year-olds to vote in the biggest question in its history. Americans, in contrast, don't even trust theirs to help pick the county sheriff. Who's right?
updated 9:57 PM EDT, Thu September 18, 2014
Ruben Navarrette says spanking is an acceptable form of disciplining a child, as long as you follow the rules.
updated 11:47 AM EDT, Fri September 19, 2014
Frida Ghitis says the foiled Australian plot shows ISIS is working diligently to taunt the U.S. and its allies.
updated 3:58 PM EDT, Fri September 19, 2014
Young U.S. voters by and large just do not see the midterm elections offering legitimate choices because, in their eyes, Congress has proven to be largely ineffectual, and worse uncaring, argues John Della Volpe
updated 9:58 PM EDT, Thu September 18, 2014
Steven Holmes says spanking, a practice that is ingrained in our culture, accomplishes nothing positive and causes harm.
updated 2:31 PM EDT, Thu September 18, 2014
Sally Kohn says America tried "Cowboy Adventurism" as a foreign policy strategy; it failed. So why try it again?
updated 10:27 AM EDT, Thu September 18, 2014
Van Jones says the video of John Crawford III, who was shot by a police officer in Walmart, should be released.
updated 10:48 AM EDT, Thu September 18, 2014
NASA will need to embrace new entrants and promote a lot more competition in future, argues Newt Gingrich.
updated 7:15 PM EDT, Tue September 16, 2014
If U.S. wants to see real change in Iraq and Syria, it will have to empower moderate forces, says Fouad Siniora.
updated 8:34 PM EDT, Wed September 17, 2014
Mark O'Mara says there are basic rules to follow when interacting with law enforcement: respect their authority.
updated 9:05 AM EDT, Tue September 16, 2014
LZ Granderson says Congress has rebuked the NFL on domestic violence issue, but why not a federal judge?
updated 7:49 AM EDT, Tue September 16, 2014
Mel Robbins says the only person you can legally hit in the United States is a child. That's wrong.
updated 1:23 PM EDT, Mon September 15, 2014
Eric Liu says seeing many friends fight so hard for same-sex marriage rights made him appreciate marriage.
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT