Saturday, May 7, 2011

Failing in Mental Health Access

According to the National Association for the Mentally Ill (NAMI;, the United States' mental health care system is abysmal, currently receiving a D grade. Mental health care refers to both inpatient and outpatient psychiatric services as well as partial or day programs. For the Grading the States report (2009), the grading of the U.S. and individual states was based on four key categories: Health Promotion and Measurement, Financing and Core Treatment/Recovery Services, Consumer and Family Empowerment, and Community Integration/Social Inclusion. Below is an description of each category:

  • Health Promotion and Measurement: Number of programs delivering evidence based practice, emergency room wait times and quantity of psychiatric beds by setting
  • Financing Core Treatment/Recovery Services: Includes whether Medicaid reimburses providers for all or part of evidence based treatment
  • Consumer & Family Empowerment: Consumer/family access to information from the state, family/peer education & support, promotion of consumer-run programs
  • Community Integration/Social Inclusion: Includes activities that require collaboration among state mental health agencies and other state agencies and systems

Unfortunately as the need for mental health services is increasing nationwide, especially in light of the economic downturn, state budget cuts are actually decreasing access to necessary psychological care. This has no doubt resulted in the poor quality of the U.S. mental health system. Individually, some states are doing better than others; Massachusetts, Maine, Connecticut, New York, Maryland and Oklahoma each received a B grade. Connecticut was the only one of these states to receive an A grade in any category; the state received top marks in the area of Consumer and Family Empowerment. The category that even the top states struggled with was Community Integration and Social Inclusion, a category in which 5 of the 6 states received a C grade. 

On the other end of the spectrum, the states that received failing (F) grades were South Dakota, Wyoming, West Virginia, Kentucky, Arkansas and Mississippi. In terms of individual categories, Mississippi was the only of these states to receive a grade higher than a D which was received in the Consumer and Family Empowerment category (with a C grade). Florida and Texas, two of the most populated states, received D grades overall. Recommendations for states with poor mental health systems included expanding crisis stabilization, services for veterans and the homeless, creating dual diagnosis programs, and establishing alternatives to inpatient hospitalization that do not include jail.

From this report one can surmise that large segments of the population either do not have access to or are not receiving adequate mental health care. This is especially problematic as the World Health Organization reports that major depressive illness will be the leading cause for disability for women and children by the year 2020 ( Additionally, NAMI reports that without treatment, the consequences of mental illness for both the individual and society include unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives. It is estimated that untreated mental illness also costs the United States $100 billion annually.  The impact of mental illness on children in particular has important implications for education reform in terms of its effect on academic achievement and future educational attainment. While some states are attempting to make improvements to mental health access, more needs to be done nationally to ensure that those with mental illness can receive any and all required services.

For more information regarding the Grading the States (2009) report, please see

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