A 2014 federal survey estimated that 43.6 million (18.1%) Americans ages 18 and up experienced some form of mental illness; 20.2 million adults (8.4%) had a substance use disorder; and of these, 7.9 million people had both a mental disorder and substance use disorder. An earlier report stated that 38% of homeless people were dependent on alcohol and 26% abused other drugs, and that substance abuse is much more common among homeless people than in the general population. The failure to provide appropriate behavioral health services to this huge population often results in consigning these individuals to a lifetime of poverty, chronic disability, and lost opportunities for a meaningful life. It also results in inappropriate allocation of resources from government and the private sector to often warehousing severely mentally disordered in prisons and jails, rather than allowing such individuals to remain in their communities and families. This failure is inconsistent with a society that promises life, liberty and the pursuit of happiness, and diminishes us all.
To our collective shame, local and state prisons are now where most people with mental and substance disorders are being housed. A 2014 study by the Treatment Advocacy Center and National Sheriff’s Association concluded there are ten times as many people with serious mental illness in our jails and prisons than in mental hospitals. The largest psychiatric institutions in the United States are the Los Angeles County jails, the Cook County Jail in Chicago and Rikers Island in New York.
Research shows that community based treatment is frequently more effective and significantly less expensive than in-prison treatment at preventing crime and reducing incarceration rates for people with mental disorders. Our state can and should provide funding for a community-based continuum of care to help those who are victims of these disorders. This continuum must include permanent supportive housing, job training and subsidized employment, educational opportunities, highly skilled professional treatment specialists who will provide services in the natural environment of the consumers of such services, and integrated dual disorders treatment of mental illness and substance abuse simultaneously.
We must begin to recognize, as the World Health Organization has, that mental disorders and substance abuse arise out of a complex set of determinants. They state, “Determinants of mental health and mental disorders include not only individual attributes such as the ability to manage one’s thoughts, emotions, behaviours and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies, social protection, living standards, working conditions, and community social supports among others. Exposure to adversity at a young age is an established preventable risk factor for mental disorders.
“Depending on the local context, certain individuals and groups in society may be placed at a significantly higher risk of experiencing mental health problems. These vulnerable groups may (but not necessarily) include members of households living in poverty, people with chronic health conditions, infants and children exposed to maltreatment and neglect, adolescents first exposed to substance use, minority groups, indigenous populations, older people, people experiencing discrimination and human rights violations, lesbian, gay, bisexual, and transgender persons, prisoners, and people exposed to conflict, natural disasters or other humanitarian emergencies.”
Therefore an emphasis on early prevention requires a systemic approach to identifying vulnerable populations and providing resources to address them. People entering the field of behavioral health must be trained to understand these social determinants as well as learning culturally appropriate interventions and strategies. Furthermore, there must be an ongoing public health campaign to educate the population at large that ultimately we are all at risk of experiencing a mental disorder at some point in our lives, which requires all of us to treat those who are already suffering with dignity and respect.
It is high time to acknowledge that those who suffer from chronic mental illness or substance abuse are human beings just like us, deserving of dignity and respect and provided with the resources necessary to survive in our increasingly unequal society. Removing the criminal justice system as a primary treatment locale for severely disordered individuals would go a long way toward destigmatizing mental illness and substance abuse.
Both the state of California and the private sector should engage in an ongoing educational effort to sensitize all of our population to the needs of the mentally disordered. This should include skillfully crafted public service ads portraying the realities of mental illness, as well as encouraging the entertainment industry to sensitively portray this population in both films, television, Radio and social media. Funds should be provided to encourage local communities to have ongoing conversations with both those at risk and the provider community. Such sensitive “listening” on the part of all is vital for true community mental health. Taking mental illness out of the shadows is long overdue and vital for helping the victims heal and for our communities to thrive.
I have worked as a county mental health treatment specialist for almost 20 years with children and families. I have seen firsthand the devastation caused in my community by the previously mentioned social determinants of mental disorder and have advocated on behalf of the mentally disordered population. I am all too aware of the lack of resources devoted to both primary prevention and early intervention in this area. As a consequence, I have advocated on behalf of this community as a public official in Richmond California for the past eight years, and will continue to do so for the foreseeable future. In that regard, I believe that a Medicare for all Insurance system in California will begin to provide the equity that behavioral health services deserves. I also intend to promote the WHO model of” addressing income generation and education opportunities, housing and social services, and other social determinants of mental health.” I will keep emphasizing the community multisectoral approach model espoused by the World Health Organization as follows. “A comprehensive and coordinated response for mental health requires partnership with multiple public sectors such as health, education, employment, judicial, housing, social and other relevant sectors as well as the private sector.” As a wrap around team facilitator for two decades, I have extensive background in coordinating multiple needs of individuals with multi disciplinary teens. This experience will serve me well in forwarding this work at the state level where policies are created.