Underlying many of these barriers is the issue of public attitudes. "The stigma of mental illness is also a major barrier to treatment," the report stated. "Many people are reluctant to seek care because of the shame our society attaches to mental illness. Societal stigma leads to ridicule, ostracism, and inexcusable discrimination in housing and employment. Stigma is often internalized by individuals with mental illness, leading to hopelessness, lower self-esteem, and isolation. Even more tragically, stigma deprives them of the social support they need to recover."
The report claimed that fragmentation in the mental health care system leads to waste and squandering of at least $80 billion in annual expenditures for treatment of mental illness. This is in part because of the large number of separate public agencies and private insurance programs that aim to provide care. "Each funding source has its own complex, sometimes contradictory, set of rules. Taken as a whole, the system is supposed to function in a coordinated manner; it is supposed to deliver the best possible treatments, services, and supports--but it often falls short."
For the estimated 3 million adults with both mental illness and a substance use disorder, the barriers to care are even more daunting. "Mental illness is often treated in one setting... while substance abuse treatment is often given in another... The rules governing eligibility for care often vary across those settings. And the rules governing payment vary, too, depending on which funding sources apply." Adolescents face even another challenge because their benefits may be lost as they enter adulthood.
Federal health programs, such as Medicare and Medicaid, pay for much of the care for the mentally ill, but these mainstream programs "are not tailored to the requirements of good mental health care."
"The reality is that the mental health system looks more like a maze than a coordinated system of care," the report said.
The report also pointed to unemployment as a major problem for individuals with mental illness. "Many of them want to work and report they could work with modest assistance. Instead, our Nation's largest 'program' for people with mental illness is disability payments å Our mental health, rehabilitation, and disability programs unintentionally trap millions of individuals--who want to work--into expensive, long-term dependency."
While much of the report criticized the existing system, it also highlighted model programs in a number of areas that show positive outcomes for the populations they serve. However, there are few, if any, mechanisms for translating locally successful model programs into broad, national initiatives. "Federal programs should be structured to support proven effective models as the standard approach, not as the alternative, which requires local ingenuity."
Among the programs the report cited: