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Commentary: Pandemic Foreshadows Crisis in Mental Health Services

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In 2013, the New York State Office of Mental Health established OnTrackNY, a statewide network of coordinated specialty care treatment programs for adolescents and young adults experiencing first-episode psychosis. The OnTrackNY treatment team consists of four full-time equivalent staff members and serves between 35 and 45 patients. The goal of the program is to provide psychopharmacology, cognitive therapies, substance abuse treatment, suicide prevention, case management, and supported education and employment services as needed to patients at the early stages of their illness.

Skyland Trail is a philanthropically supported facility in Atlanta, Georgia, that offers different levels of care, including residential, day treatment, and outpatient to patients with serious mental illness. In addition to standard evidence-based psychotherapy and pharmacotherapy, Skyland Trail employs a holistic treatment model, offering interfaith spiritual counseling, family education and therapy, vocational services, academic service programs, and integrative medical and mental health treatment.

These initiatives are welcome, innovative, and admirable. But exciting as they are, they are one-offs, the products of visionary individuals and organizations, and are from the ground up (not top down) and are not comprehensive fixes. For broader impact, we need macroenvironmental change, which means in healthcare policy and financing. We also need changes in medical education and postgraduate training curricula that will provide a capable workforce.

Such policy and legislative changes require a political solution that allocates sufficient funding through Medicaid, Medicare, and SAMHSA. This can only be achieved by the federal government, with an administration or Congress that wishes to make mental health care a priority. There have been historical examples of such leadership: President Kennedy and the Community Mental Health Act; President Carter's Commission on Mental Health and Mental Health System Bill; and congressional mental health champions such as Senators Pete Domenici, Ted Kennedy, Paul Wellstone, Arlen Specter, Gordon Smith; as well as Congressmen John Porter, Patrick Kennedy, and Jim Ramstad. But they are all in the past.

Aggressive and grassroots advocacy can make real change in reforming mental healthcare. However, while we have organizations such as the National Alliance on Mental Illness, Mental Health America, and the National Council on Behavioral Health, their views and priorities have yet to be shaped into a compelling message and campaign, as we have seen in other diseases, like HIV, cancer, diabetes, and heart disease.

That the remedy to effectively addressing mental health must come from federal government again likens the issue to the climate crisis. But unlike global warming, the key to solving the mental health care problem is not our knowledge of mental illness and ability to treat it; in these areas we are doing just fine. It is policies and financing that give rise to the deficiencies in our mental health care system. Only the federal government (with the cooperation of state governments) has the ability to orchestrate such changes on a grand scale. The inability of our government to meet this challenge is a failure of our political system.

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