The last piece of legislation President John F. Kennedy signed turned 50 today: the Community Mental Health Act, which helped transform the way people with mental illnesses are treated and cared for in the United States.
As part of Kennedy’s New Frontier initiative, the 35th President signed the legislation on Oct. 31, 1963, only 22 days before Kennedy was assassinated. The CMHA aimed to build mental health centers accessible to all Americans.
According to National Public Radio, the legislation was instrumental in creating many life-altering changes for people who suffered from serious illnesses, such as schizophrenia, many of whom now live normal, productive lives with jobs and families. When the bill was signed, the goal was to build 1,500 centers, which would have moved at least half of the 500,000 institutionalized patients at the time to state-run clinics.
In a message to Congress earlier that year, Kennedy said that his idea was to successfully and efficiently treat patients in their own communities and then return them to “a useful place in society.”
In 1963, the average stay in a state institution for someone with schizophrenia was 11 years. However, only half of the 1,500 proposed centers were ever built, and none of those received the funding for long-term care.
Dr. Paul Appelbaum, a psychiatry professor at Columbia University, told NPR that in many cases those who are unable to get help end up homeless, in prison or suffering from substance abuse.
This claim is evidenced by the fact that the three largest mental health providers in the nation today are not mental health institutions or hospitals, but rather jails: Cook County in Illinois, Los Angeles County in California and Rikers Island in New York.
Some states saw the legislation as a way to close down expensive state hospitals without spending those savings on community-based care. Deinstitutionalization accelerated after the adoption of Medicaid in 1967, according to the Washington Post.
Since the CHMA was enacted, 90 percent of beds have been cut at state hospitals nationwide.
“The goals of deinstitutionalization were perverted,” former U.S. Rep. Patrick Kennedy, the president’s nephew, told the Associated Press. “People who did need institutional care got thrown out, and there weren’t the programs in place to keep them supported. We don’t have an alternate policy to address the needs of the severely mentally ill.”
Here in North Carolina, recent years have seen our own mental health budget dwindle. As the General Assembly has not only stepped back from funding institutional hospitals, the state senate actually voted to close down three state-run addiction clinics as well as the Wright School, a school that serves special needs children in Durham. Thankfully, the budget, which Gov. Pat McCrory signed, kept these intact thanks to bipartisan work done in the State House.
As those who are not able to help themselves continue to see the care they deserve taken from them, we as citizens, as human beings cannot afford to stand back and watch.
In North Carolina, as in many states, there aren’t enough hospital beds to accommodate mentally ill individuals. For mental healthcare providers in North Carolina, 2013 marked yet another year of cuts to Medicaid reimbursement rates, which have declined steadily since 2008.
According to the National Association of State Mental Health Program Directors, more than $4.3 billion has been slashed from state mental health budgets nationwide since 2009.
If we are to be considered a nation that truly serves all of its citizens, we cannot allow those most vulnerable to fall through the cracks. While the stigma that once existed against the mentally ill is no longer prevalent, the inability for our state to act to protect is just as harmful.
To fail to do so would not only mean denying Kennedy’s vision, but denying the humanity of those who are most unable to help themselves.
One of the major telling signs of the time that our mental healthcare has simply fallen through the cracks are the recent gun violence crimes.
The gun crimes in Sandy Hook, last year in Colorado, last month in the Washington Navy Yard, were all perpetrated by men who had not received the mental health treatment that they clearly needed.
But gun crimes are only but the tip of the iceberg, as here in North Carolina, many of the “community-based health initiatives” advocated by Kennedy have not received substantial funding due to the state government’s increasing reliance on private solutions for public problems.
We can continue to make small talk at both the state and federal level about the lack of mental health care, or the condition that many of our most vulnerable citizens face, but until we as a nation truly to decide to put action behind those words, the vision set by Kennedy 50 years ago will remain just that, a vision.