Editor in Chief
Every American psychiatrist alive today has lived through working in what the 1999 Surgeon General’s report called a fragmented and sorely underfunded system of mental health care in the US. Unfortunately, this report came during the midst of some of the worst managed-care abuses of reimbursement for psychiatric services. And 9/11 came 2 years later, which refocused national attention to external threats rather than internal needs.
Then came the financial crisis, followed by increasing numbers of mass murders of civilians in the US and around the world, and the rise of ISIS. So, for the past decade, in spite of the passage of federal legislation guaranteeing parity for mental health treatment, the crying need for funding adequate access and treatment of those with psychiatric disorders has gone unattended. Oh, except, that is, for the regular pontification about how everyone who is a mass murderer is psychiatrically ill, and the most important thing we need to do is get them diagnosed so that they won’t be able to buy a gun. How politicians can say that with a straight face is beyond me.
On the other hand, though, the focus on mass murderers all being psychiatrically ill did seem to have some positive impact on Congress (though I hesitate to say there is anything good about such harmful distortions of reality), when legislators were finally driven to enact some important mental health legislation in the waning days of the Obama administration.
Thankfully, the 21st Century Cures Act, a hopeful name if ever I’ve heard one, was passed in December 2016. This legislation incorporated many provisions of bills that had been proposed to improve access and reimbursement for needed psychiatric treatment, and to improve federal coordination of government supported mental health programs.
The need for better coordination and focus has been known for years. The commentary by Ellie McCance-Katz1 in our April 2016 issue highlighted some of the concerns in this regard about the function and focus of SAMHSA (Substance Abuse and Mental Health Services Administration), a component of the Department of Health and Human Services. Her article stimulated many responses, highlighting some of the concerns and various perspectives about current federal policies. In spite of the differing points of view, none of the comments dismissed the core concerns about the need to substantially increase access to care, support more training opportunities, and incorporate state-of-the-art knowledge in designing federal programs.
Soon after the 21st Century law’s passage, the American Psychiatric Association (APA) sent an email blast highlighting some of the important provisions of the law. I want to single out several of the many important components of the new legislation that were discussed in the APA email.
1. McCance-Katz EF. The federal government ignores the treatment needs of Americans with serious mental illness. Psychiatric Times. 2016; 33(4):12,16. goo.gl/h1Mrm3.
2. Tasman A. Frankly, my dear, they don't give a damn. Psychiatric Times. 2016;33(10):4-5.