Executive Director, New York Association of Psychiatric Rehabilitation Services (NYAPRS)
In the wake of several recent mass shootings, many are calling for an overhaul of the nation’s systems of mental health care. A national debate has been renewed over whether legislation is needed to force local officials and mental health providers to be more responsive to those with more profound mental health needs, and whether those groups should, in turn, force such individuals to accept some form of treatment. In this post, Harvey Rosenthal argues we should reframe the debate and focus on reforms that significantly increase the range and raise the bar for community outreach and supportive services.
Fixing Not Forcing Services
Over the past year, we’ve seen an intensified focus on our nation’s and state mental health systems that has drawn a broad array of advocacy groups to weigh in on the merits of two legislative proposals put forward by House members Rep. Tim Murphy (R-Pennsylvania) and Ron Barber (D-Arizona).
Central to Congressman Murphy’s bill is a provision that would require states to adopt or expand court-mandated outpatient commitment programs like New York’s Kendra’s Law in order to access federal block grant dollars. These and several other provisions have generated much controversy. While it now appears that contentious provisions like these will not be moved by the House GOP leadership this year, it is imperative that we address a number of challenges that the bills present.
Getting mired in a debate over outpatient civil commitment distracts us from what should be our greatest focus—the need for fundamental reform of state mental health service systems.
While both bills call for the greater availability of services that have been or are beginning to show evidence of their effectiveness, this is really the responsibility of state governments. They determine how the vast majority of service dollars are spent. They have the opportunity and the responsibility to ensure that people with the most serious mental health needs get access to state of the art voluntary community outreach and engagement strategies that feature real-time crisis and harm reduction approaches and far greater access to peer support, housing, employment and educational supports.
Forced treatment is not the answer
Expanding coercion is an unacceptable substitute for getting much more out of our mental health systems and practice. We now know so much more about how to help even the most distressed individuals and families, but these approaches are scantly available and represent the exception rather than the rule for the $113 billion dollars we spend each year on mental health services.
Rather than forcing patients to conform to one standard treatment course, we should offer a diversity of paths to stability and recovery, with increased community-based support and outreach for those who have found traditional treatment approaches to be ineffective, impersonal, and too often as spirit breaking.
Outpatient commitment should be considered as system failure not “patient failure.”
But this will require much greater persistence, creativity, flexibility, and a systemic willingness to accept responsibility when our current efforts don’t succeed. When once asked by a director of a large NYC mental health agency what to do when someone consistently rejected the care that they were being offered by their community worker, I replied “send somebody else and offer something better.”
In our next post, Mr. Rosenthal will provide recommended alternatives to coercive commitment into traditional care.
- To what extent should legislators rely on civil commitment or involuntary treatment as the key to fixing the mental health care system?
- What kinds of programs do you think legislators should consider as part of mental health care reform?