So, even if President Reagan was a great man, it was during his presidency that treatment for our nations most vulnerable went from bad to worse.  The following article is a reprint because I found it expresses my concerns adequately and one month after the horrible shootings in Tucson, people seem to be more receptive to learning about this issue.

Ronald Reagan, Mental Health, and Spin . . .

Man Behind the Myth

By Phyllis Vine

For the next twelve months, the Ronald Reagan image machine will be turning out countless vignettes of the nation’s 40th president, the man neighbors called “Dutch.” He will be described as no-nonsense yet kindly, remote but avuncular, a movies-star-turned-politician, and remembered as a local lifeguard rescuing people in troubled waters. With dashing good looks, a sonorous tone that became the voice of General Electric, and an affable smile, even those who disagreed with his policies will say he was genuinely kind-hearted.

So what did this mean practically for policies about mental health? Here we need to  ask how the image departs from the reality.

Contrary to the spin about trimming government, which he called “the problem,” we all know he oversaw increases in federal spending that exploded the national debt, and grew the size of the government he impugned. Another part of the reality, rarely the image, is how he attempted to savage the  entitlement system and roll back supports for people with a mental illness.

When Ronald Reagan arrived in Washington, he inherited the Mental Health Systems Act of 1980. One of the last achievements of Pres. Jimmy Carter, this was passed by the House 277 to 15, in the Senate, 93 to 3. With as many critics as there were special interests, it was far from perfect. Yet it expanded the federal government’s commitment to services, to research, to training professionals, and to patient rights. It identified stigma as an impediment to seeking and receiving services.  It established parity in Medicaid and Medicare. It recognized the link between physical health and mental health. And it dedicated $800 million over 4 years to redress the gross neglect of the commitment to mental health in earlier administrations.  In short, it moved an agenda that minimized homelessness, the reliance on expensive nursing homes, jails and prisons, and one that to more hopeful choices for those who needed help.

The Mental Health Systems Act was a milestone. It came on the heels of four years of hearings and a presidential task force benefiting from First Lady Rosalynn Carter’s active involvement.  Philosophically it affirmed Pres. John F. Kennedy’s Community Mental Health Centers, an attempt to thwart hospitalizations. It fit into the safety-net values championed by Pres. Lyndon B. Johnson with the passage of Medicaid and Medicare.

Still, by 1980 the nation needed more for those with a chronic illness. Many failures accompanied the attempts to close the miserable hospitals, often little more than warehouses, to help patients succeed in the community. The neglect of government support conspired to form a patchwork system with notable gaping holes. A 1977 GAO report said, “Government needs to do more.”  Congressional hearings in 1979 re-affirmed the need to strengthen impoverished services and the failed policies.

Although not perfect, the Mental Health Systems Act responded to these problems. For the first time since the National Institute of Mental Health became part of NIH in 1949, mental health was front and center in federal policy.

Then came Ronald Reagan. Within a month, the Office of Management Budget announced it would curtail the budget of the National Institute of Mental Health (NIMH), phase out training of clinicians, interrupt research, and eliminate services.  Cutbacks to staff followed; chaos ensued. Experienced people left, others remained in government service but were forced into menial jobs. Trained professionals were reassigned to labs to dissect dead rats; science writers were reassigned to typing pools. The Mental Health Systems Act would disappear. Instead, the Omnibus Budget Reconciliation Act (1982) would merge money for mental health programs into block grants, and with fewer dollars going to the states.  They had the discretion to use them however they saw fit, often to perpetuate programs already deemed problematic. The pretense for all this was the president’s concept of a “new federalism.”

“Many of our dreams were gone,” wrote Rosalynn Carter in Helping Someone with Mental Illness. “It was a bitter loss.”

This could have been enough, but it was not. Pres. Reagan attempted to restrict criteria for determining eligibility for SSI, thought to be a safety-net. Nearly 2.6 million people were receiving insurance because their disability prevented them from working. New evaluations for eligibility led to widespread terminations. Of those who were terminated, about half appealed, and in two-thirds of the cases, administrative law judges reversed the decision. The process took nearly a year, during which time they, and their families, were deprived of promised help.

About 340,000 people would lose their insurance before public outcry and courts halted the process. Sen. John Heinz, a liberal Republican from Pennsylvania, told the New York Times the policy was a “meat grinder.” Sen. Carl Levin, Michigan Democrat, said the reviews caused “unconscionable suffering.” In June 1983 HHS Secretary Margaret Heckler announced she would halt suspending about 135,000 people until the government could improve standards for “functional psychotic disorders.”

By then, however, the nation was doubting the president’s kindness. A1982 Louis Harris survey found nearly three-quarters of the respondents said the president was hard-hearted toward the poor.

These are the facts. And they add up to a roll-back of opportunities for people already struggling with a psychiatric illness.  Whatever spin accompanies the birthday celebrations for Ronald Reagan, we should not create yet another mythic figure, larger than life, more pure than Ivory soap, or with qualities he did not have.  He may have portrayed himself as everybody’s lifeguard, but he seemed willing to let people with a psychiatric illness sink.

Originally appeared in MIWatch.org

Contact: Steve Vetzner, (703) 797-2588 or svetzner@mentalhealthamerica.net

ALEXANDRIA, Va. (January 10, 2011)—Mental Health America joins Americans in mourning the loss of those killed in Saturday’s tragic and senseless attack and expressing our wishes for the full recovery of Congresswoman Gabrielle Giffords and fellow citizens who were injured. Our thoughts and prayers are with the families and loved ones of those who lost their lives and everyone who is affected by these horrific events. And we join in applauding the brave actions of individuals who prevented greater harm.

It will likely take many days to understand the reasons and motivations behind this national tragedy. Many have pointed to mental health as an issue.

It must first be emphasized that people with mental health conditions are no more likely to be violent than the rest of the population. And we have science-based methods to successfully treat persons with even the most severe mental illnesses. A very small group of individuals with a specific type of mental health symptoms are at greater risk for violence if their symptoms are untreated.

At the same time, we must recognize that the nation’s mental health system is drastically under-funded and fails to provide Americans living with mental health conditions with the effective community-based mental health services they need. Sadly, in the current environment of strained state budgets, mental health services have been cut drastically just as demand for these critical services has risen dramatically.

It is also important that, as a community, we assist persons with signs and symptoms of mental illnesses to seek treatment. Although rare, when a person becomes so ill that he/she is a danger to themselves or others state laws provide a way to get them help even if they don’t believe that they need it. The best strategy, however, is to have an accessible system of care that is easy to use.

Science has not developed tools to predict reliably individuals at risk for violence. But we can reduce the small risk of violence in those with certain mental health conditions by investing in proven intensive, coordinated community-based mental health services and making certain that they can access these services.

We do not know if the mental health system failed in this situation or if there were missed opportunities or if effective treatment might have averted this tragedy.

We do hope that we can find answers and create solutions that prevent this from ever happening again.

Mental Health America (www.mentalhealthamerica.net) is the country’s leading nonprofit dedicated to helping all people live mentally healthier lives. With our century of service to America and our more than 300 affiliates nationwide, we represent a national movement that promotes mental wellness for the health and well-being of the nation— everyday and in times of crisis.

As a mental health advocate and person who is currently educating high school kids about depression and suicide prevention my initial thoughts (after my shock and sadness) about the gunman was that he must be mentally ill, and as most of you know I am passionate about people receiving proper care for mental illness and reducing the stigma surrounding these issues.  So, initially I was going to write this blog about just that, the inequalities of the treatment of people with mental illness and the shortcomings of the system, but as the weekend progressed I have been struck more by the calls for compassion and the need to temper the on-going bitterness and hate filled rhetoric that seems to be all too prevalent in our society.

Some blame it on the media, some blame it on the Internet and some blame it on dysfunctional family environments.  All I know is that I don’t think this is the time nor place to start placing blame and focusing anger on anyone or any one entity.  If  anything, now is the time for us to focus on restoring Peace, Love and Harmony to society.

Yes, some will think I’m an idealist with no grasp of reality, but it is reality that motivates me to wish and pray for more compassion and tolerance in our world.  There is darkness, but just the light of one small match can illuminate a room.  I think we all have the potential, no the responsibility as humans to be a positive force. I don’t know of any situation where more violence and hate can solve a problem.

Hopefully this senseless tragedy that happened in my home town yesterday will be a catalyst to help us to find our way back to the loving and kind humans were are meant to be.  As mental health advocates teach in Crisis Intervention Training, rather than escalating the situation, let’s try and de-escalate and bring reason and calmness to the situation.

Congresswoman Giffords has the skill to do just that.  I witnessed her ability to reason and respectfully disagree with irate, inflamed constituents at town hall meetings over the last year.  Gabe Zimmerman, her now deceased aid, was a master at conveying how important the well being of our community was to him.  When Congresswom Giffords was unable to attend some of the mental health community events she was invited to, Gabe provided the same kind of support and understanding that she would  have.

In memory of Gabe and the others that died yesterday and out of respect for Congresswoman Giffords, I think it could be a new day for our country if we focus on the healing rather than the negativity.

The law included a six month extension of higher Medicaid federal matching funds for states – a major contribution towards some of the drastic slashes in mental health coverage in Arizona.

Recent budget slashes (I prefer that term over cuts as I feel it’s much more descriptive) in the state’s healthcare system for the poor have forced many people to search for alternatives to afford their medications. Some are going to Canada, while some have been fortunate to be able to get discounts directly from the pharmaceutical companies. I applaud the efforts of some of the drug companies to help and I wish they would all step up.

While illegal immigration and calls to enforce the border by sending in troops occupies the headlines, our state’s most vulnerable citizens are doing the best they can just to survive.  In my world they take priority over someone who has illegally crossed our borders to look for a better way of life.  Helping disabled and seriously mentally ill people is not only money well spent, it’s the “right” thing to do!

How Did Your Member Vote?

View the House roll call vote on final passage of HR 1586

Both McCain and Kyle voted no when the bill went through the senate.

Read further details on the provisions in HR 1586 designed to support state Medicaid programs into 2011.

Beginning July 1, 2010, deep budget cuts at the state level will affect publicly funded behavioral health services. Over 300,000 adults and over 7000 children  statewide could loose their coverage.  (things are complicated with the new federal health care legislation)  Because timely information sharing is critical, Arizona’s Department of Behavioral Health Services (DBHS) has set up a CLICK HERE: Web site to communicate with members, families and stakeholders – both to provide information and to obtain your input.

DBHS will post the latest information as it becomes available on topics including:

• Changes to covered benefits for adults with serious mental illness (SMI) who do not qualify for Medicaid (also called AHCCCS or Title XIX).
• Efforts to ensure there is a comprehensive and effective statewide crisis system for anyone experiencing a behavioral health crisis.
• Clarification of benefits related to supported housing for adults with serious mental illness (SMI).

Submit your CLICK HERE: questions and concerns to DBHS.   CLICK HERE: FAQs are updated each Tuesday by DBHS.

A New York times article today says that the homeless population in New York City has escalated 34% recently. There are many theories why, but my concern is that most likely it will happen in Tucson as well.
State budget cuts have slashed over 300,000 people from the states Medicaid (ACCCHS) system. Many of those are mentally ill. If those people, who are already living in poverty get sick – whether they can’t afford their medication or can’t afford to go to the doctor, many of them will most likely loose their jobs (if they are lucky enough to have one). Once they loose their jobs, their shelter seems to be the next basic necessity to go as what little money they have most likely will need to be spent on food.
So…….where does this put this person? You’re right, possibly on the streets, unless they are hospitalized or in an emergency room for a short period of time. Sometimes entire families end up being homeless.
All because this is how our state has decided to save money.
The only light at the end of the tunnel, and it is only a small light, is for voters to pass the 1 cent sales tax in May. It’s not going to solve all our problems, but not passing it will make things much worse.
I hope you’ll consider it.

I don’t consider myself a “tax and spend” liberal, but if I had to choose one side I would definitely fall on the side of being a liberal because I believe we need to take care of our most vulnerable.  In this case, those vulnerable 310,000 people that fall below the national poverty level, but aren’t destitute enough to qualify.

Talk about insanity……as I have said before, these people will be forced to go to emergency rooms when they need care, or in the case of a person with a serious mental illness that can’t pay for their treatment something even worse could happen. Also, according to the article, with proposed cuts the state could be loosing 42,000 jobs!

Most of us are struggling in today’s economy, that’s a fact, but we are all in this together.  At least, I thought we were.  Yesterday two out of three local school districts lost their appeal to voters to approve budget over-rides.  If voters won’t approve a a very slight increase in property tax ($50 – $100 per year) to keep their school district’s head above water I’m not optimistic that they’ll vote to increase a “sin” tax for people that can’t afford health care.  Now, that’s a sin.

With yesterday’s accused “Pentagon Attacker,” Joseph Bedell, the link seems more clear cut. His family had struggled for years to get him into treatment.  But, as so often is the case unless he displayed an obvious threat to himself or others, they were limited in what they could do to help.  Even the law officer that stopped him for a moving violation in Texas could tell he needed to be in a hospital, but he wasn’t able to get him admitted. Mr Bedell was a threat to himself and others and no one paid attention.

There were so many red flags.  Like so many people in our country he was agitated with our government.  Like so many of us that are tired of the activities or in-activities of our legislature, he was frustrated and angry.  But, unlike most of us, he wasn’t able to contain his anger and acted out in the most savage way he could. 

As an advocate for people with mental illness, his tragic story reminds me once again how far we need to go when it comes to treating our fellow human beings that are suffering from brain disorders.  Inflammatory rhetoric and inexcusable callousness does not further growth as a species and can have a devastating effect on some of our most vulnerable.   Compassion and understanding have positive effects. Pushing those living with mental illness aside and pretending they don’t exist, that they are “terrorists,”   or that they are someone else’s problem has consquences.

Below is an excerpt from the most recent “E-News” from the National Alliance on Mental Illness.

For many group health plans, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act went into effect on January 1, 2010. The new law requires most group health plans to cover treatment for mental illness and substance use disorders on the same terms and conditions as medical conditions such as diabetes, heart disease, cancer and asthma. Specifically the new law bars health plans from imposing durational treatment limits (caps on inpatient days or outpatient visits) or financial limitations (higher cost sharing, deductibles or out of pocket limits) that do not also apply to medical-surgical coverage.

The effective date of the new law is actually the beginning of the first new plan year after October 3, 2009. The new law applies to all group health plans sponsored by employers with 50 or more workers.

• View NAMI’s factsheet on the new law
• View a Powerpoint presentation on the new law

Is Your Health Plan in Compliance With Parity?

NAMI is seeking information from individuals and families on how the new law is working. This information is critical to informing policymakers in the U.S. Congress and the Obama Administration on additional steps that may need to be taken to strengthen the law and ensure adequate enforcement. In addition, it is critical for NAMI to demonstrate to the larger public that parity is making a real difference in improving coverage of mental illness treatment and expanding access to critical medical services for children and adults living with mental illness.

The Diagnostic and Statistical Manual (DSM) is used by psychiatrists and other mental health professionals to classify and diagnose mental disorders in children and adults. The DSM has historically had a very significant impact on the treatment of mental illness and on the payment of mental health treatment and related services. A committee created by the American Psychiatric Association (APA) has been working on revising the DSM to reflect current scientific understanding about mental disorders. Earlier this week, the APA posted the draft of the revised DSM, known as the DSM-5. The draft DSM-5 can be found at the website: http://www.dsm5.org/Pages/Default.aspx

For the next two months, the APA is seeking input from individuals, family members, clinicians and others about the proposed changes contained in the DSM-5. The deadline for submitting these comments is April 20, 2010. I will be providing you with more information, including NAMI’s reactions to the proposed changes, in the coming days and weeks. Meanwhile, I encourage you to visit the DSM-5 Web site, familiarize yourself and your members with the proposed changes and submit comments as appropriate. NAMI also wants to hear your reactions and comments. Post your feedback on the National Alliance on Mental Illness website at www.nami.org

NAMI wants to hear from you.