Fifty years ago, the March on Washington and President John F. Kennedy’s signing of the Community Mental Health Centers Act marked two important milestones for equality and justice in the United States. Unfortunately, just as Martin Luther King Jr.’s dream of racial and economic justice remains a dream unfulfilled, so too is our quest to help those with mental illnesses come out of the shadows and gain equal access to health care, jobs and housing without fear of stigma.
The link is strong between the movement for racial justice and the civil rights of Americans with mental-health conditions. Both groups sought relief from segregated, discriminatory and abusive treatment and the hopelessness seeded in disproportionate rates of poverty, joblessness, homelessness and health disparities. The Community Mental Health Centers Act decried the awful conditions and poor treatment delivered to those confined in psychiatric institutions, calling on Americans to “bestow the full benefits of our society on those who suffer from mental disabilities ...”
And while much has been accomplished in the past 50 years, recent reports underscore that there is not only the unfinished business of racial discrimination, but also much to be addressed — and redressed — in mental health disparities.
Just a year ago, the World Health Organization identified discrimination against persons with mental illnesses and disparities in their access to health care, human services and housing as “a hidden human rights emergency.” The sad truth is that in the United States, and across the globe, people who have mental illnesses are more likely to be in poverty, be unemployed, homeless and incarcerated. They have such poor access to health care that those with serious conditions die as much as 25 years sooner than their peers without mental illnesses — largely because of other chronic health conditions worsened by neglect or under treatment.
Other issues compounding the problem include a lack of new drugs in development for treating mental-health conditions, a decline in public and private spending for behavioral health treatment, and an insufficient supply of front-line medical professionals prepared to identify, diagnose and treat affected children and adults.
A population-based public health approach, in which mental health is a part of all health, is built on investment in health promotion, illness prevention, early identification and effective treatment. The move to integrate mental-health screening, diagnosis and treatment in primary care settings holds promise for promoting wellness, preventing mental illnesses, intervening early with effective treatment, and addressing the multiple health conditions affecting individuals with serious and disabling mental illnesses.
Primary care settings can engage individuals concerned about the stigma associated with specialty behavioral health care, and can serve as a first line of defense to detect problems early in children, adolescents, adults and elders.
Despite gains made on behalf of individuals with mental illnesses in the past 50 years, stigma and discrimination in health care persist, just as they do for African-Americans and other minority groups. We need to take the occasion of Kennedy’s signing of the Community Mental Health Centers Act 50 years ago not only to remember and reflect, but to rededicate ourselves to the unfinished work of those eras.
For so many millions of Americans, equality for people with mental-health issues remains a dream deferred.
Dr. Danna Mauch, a principal associate and senior fellow at Abt Associates, is the former director of the Rhode Island Department of Mental Health, Retardation and Hospitals, and former assistant commissioner of the Massachusetts Department of Mental Health.