If Senator Debbie Stabenow has her way the next time Iron Man gets whacked by a panic attack he’ll be able to go to the nearest community mental health center and get immediate help. The Excellence in Mental Health Act (S. 264, H.R. 1263) revives a policy idea from the 1960s that was never fully implemented. The Community Mental Health Centers Act of 1963 (P.L. 88-164) was passed and signed into law October 31, 1963 after a major effort by the John F. Kennedy Administration but foundered when Congress failed to fully appropriate the legislation. Now two bills have been introduced—S. 264 by Sen. Stabenow of Michigan in the Senate and H.R. 1263 by Rep. Doris Matsui (D-CA6) in the House—that would revive the idea of community mental health centers with a focus on the broader concept of behavioral health that adds a substance abuse component.
Stabenow’s bi-partisan bill (14 Democrats and 4 Republicans including Florida Sen. Marco Rubio) has been referred to the Health, Education, Labor and Pensions Committee chaired by Iowa Sen. Tom Harkin. Matsui’s bill, also bi-partisan (8 Democrats and 3 Republicans) was referred to the Energy and Commerce Committee’s Health Subcommittee chaired by Rep. Joe Pitts (R-PA16). Obviously, the Senate bill has a better chance of making it out of its Democratic-controlled committee if Harkin can be convinced to give it a hearing. Both bills will need more co-sponsors to get serious consideration. On the House side, members of the Social Work Caucus and the Mental Health Caucus represent potential co-sponsors.
The Community Mental Health Act of 1963 was supposed to bring the mental health field out of the dark ages. Despite the noble crusade of social worker Dorothea Dix in the mid-19th century, the field of mental health treatment still relied heavily on institutionalization in the first half of the 20thcentury. The population of state psychiatric hospitals peaked at 600,000 in the mid-1950s, but began a steady decline with the discovery of psychotropic drugs that allowed many mentally ill people to function outside hospital wards. The period of deinstitutionalization would continue over the next several decades as states reaped the economic benefits of reducing psychiatric hospital beds.
In order to meet the challenge of caring for the newly-released mentally ill, the Kennedy Administration pushed hard for passage of the Community Mental Health Centers Act of 1963 to bring about more humane treatment for people suffering with mental illnesses by creating a system of community mental health centers that would care for the mentally challenged in non-institutional settings. These centers were designed to provide a broad range of comprehensive services including inpatient and outpatient care, educational programs and crisis intervention. They were to be guided by boards consisting of people representing the socioeconomic and ethnic makeup of the communities they served.
The bill was passed and signed into law in October, 1963 despite much opposition from conservatives who resisted what they believed was further expansion of the welfare state. They feared the federal government would create community mental health centers and that states would be ultimately be left to bear the cost of their operation. As a result, the law was never fully appropriated. Funding was provided for facility construction, but funds for staffing were not appropriated. Therefore, resources were not available to provide proposed services.
President Gerald Ford vetoed attempts to reauthorize the legislation in 1974 and 1975 on the grounds that the law was too expensive. Congress overrode his 1975 veto by a large margin but many states were reluctant to participate in the program because they believed the federal government would eventually bow out which it did in 1981 when the Reagan Administration ended the program.
A network of community mental health centers is policy that makes sense. Because the original plan was not fully funded, thousands of mentally ill people were deinstitutionalized into communities and families that were ill-prepared to meet their needs. Many of these people wound up homeless or locked in jails and prisons that became de facto psychiatric wards. Our society still does not provide adequate resources for people with mental challenges.
We all in some period of our lives experience mental health challenges that range from mild depression to more severe illnesses. Our brains and psyches—while miraculous apparatuses—are not perfect. They require some fine tuning with prescribed drugs or psychotherapy. To think otherwise would suggest that, unlike our bodies, our brains can function well unattended.
Social workers provide more mental health services than any profession or discipline. We need to be outspoken on this issue. We need to advocate in full force. Only then will people take us seriously as a profession that is committed to the most vulnerable in our society.
For a thorough understanding of the Community Mental Health Center Act of 1963, read: Cutler, D. L., Bevilacqua, J., & McFarland, B. H. (2003). Four decades of community health: A symphony in four movements. Community Mental Health Journal, 39(5), 381-398.
Written by Dr. Charles E. Lewis Jr.
President of The Congressional Research Institute for Social Work and Policy
Dr. Charles E. Lewis, Jr. is President of The Congressional Research Institute for Social Work and Policy. He has served as deputy chief of staff and communications director for former Congressman Edolphus “Ed” Towns and was the staff coordinator for the Congressional Social Work Caucus. He was a full-time faculty member at Howard University School of Social Work prior to joining Rep. Towns’ staff and now is an adjunct associate professor. As staff coordinator for the Social Work Caucus, Dr. Lewis helped to plan and to coordinate numerous briefings and events on the Hill and in the 10th Congressional District in Brooklyn, New York.
Originally Posted at http://crispinc.org/?p=668
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