| |
ESTABLISHING
A COMPREHENSIVE SYSTEM OF CARE
FOR PERSONS WITH MENTAL ILLNESSES
Submitted
by: The Commission on Social Action of Reform Judaism
The Department of Jewish Family Concerns
BACKGROUND
While
the definitions and terms are varied, we here refer to
both persons defined as having diagnosable mental disorder
and those with a serious mental illness, as well as those
with co-occurring substance-abuse disorders, when using
the term "persons with mental illnesses."
Mental
illness can shatter lives. It is a condition often lacking
explicit physical manifestations, and thus is both easily
hidden and easily denied. Like physical illnesses, and
perhaps even more so, mental illnesses and their ramifications
are experienced in every sector of life. Treatment - or
the lack thereof - of persons with mental illnesses is
therefore best considered not only as a medical issue,
but also as an important social one with far-reaching
economic and human welfare implications.
Judaism
concerns itself with the health and well-being of the
mind and the soul as well as of the body. Maimonides wrote:
When
someone is overpowered by imagination, prolonged meditation
and avoidance of social contact, which he never exhibited
before, or when he avoids pleasant experiences which
were in him before, the physician should do nothing
before he improves the soul by removing the extreme
emotions.
The
reality is that mental illness continues to be stigmatized
in our society. While people with physical illness are
usually treated with solicitude and concern, persons with
mental illness are frequently the objects of ridicule,
contempt, or fear. While we often go to great lengths
to accommodate and include people with physical illness,
the mentally ill are frequently marginalized and excluded.
In
this context, we examine the issue of mental illness,
and its multiple and far-reaching manifestations for individuals
from all walks of life.
Adults
Mental illness strikes often, affecting millions of men,
women, and children across America, in both our communities
and in our synagogues. Approximately 23% of American and
Canadian adults (ages 18 and older) suffer from a diagnosable
mental disorder at some point during their lives, but
only half of those report impairment of their daily functioning
due to the mental disorder. Of this number, approximately
5% are diagnosed as having a serious mental illness, such
as schizophrenia, major depression, or bipolar disorder.
In addition, between 25% and 50% of all people with mental
illnesses are believed to have a substance-abuse disorder.
Almost
20% of the U.S. population age 55 and older experiences
specific mental illnesses that are not part of the normal
aging process. This population is also the U.S. demographic
group most likely to commit suicide.
Children
Mental illness is also prevalent among children and teenagers
within North America. Approximately 20% of children and
adolescents, 11 million in all, are believed to have mental
health problems that can be identified and treated. At
least 1 in 20 children - 3 million in all - may have a
serious emotional disturbance, defined as a mental health
problem that severely disrupts a juvenile's ability to
function socially, academically, and emotionally. Each
year, almost 5,000 young people aged 15 to 24 commit suicide
in this country.
Parity
An important issue facing North America today is the lack
of availability and access for individuals to mental health
treatment, exacerbated by the need for mental health insurance
parity, defined as the requirement that health plans provide
the same annual and lifetime limits for mental health
benefits as they do for other health care benefits. The
UAHC has consistently supported health care for all, declaring
in 1975, for example: "In the United States there
should be made available national comprehensive prepaid
single-benefit standard health insurance with no deductible
to cover prevention, treatment, and rehabilitation in
all fields of health care." Currently, however, great
disparities exist between coverage of mental health care
and physical health care.
Employment
and Mental Illness
According to a report by the Association for Health Services
Research and the National Alliance for the Mentally Ill,
employers bear significant costs due to mental disorders
of their employees, probably more than they realize, because
many costs are difficult to measure or are not easily
recognizable as being caused by mental illness. Depression,
for example, results in $30 billion a year in direct and
indirect costs to employers. Depressed employees use 1.5
to 3.2 more sick days per month than other employees -
lost time that costs employers $182 to $395 per worker
per month, according to a study by the U.S. Centers for
Disease Control and Prevention (CDC). Mental illness also
takes many potential workers out of the labor force. Of
disabled workers, more than 22% of those who receive Social
Security Disability Insurance (SSDI) benefits and 30%
of those who receive Social Security Insurance (SSI) qualify
because of mental illness. Yet research has shown that
people with mental illness have high productivity potential
and that they can work and remain in the labor market
for significant periods of time. It is thus vital to advocate
for increased attention to ways in which persons with
mental illnesses can continue to serve as productive members
of the work force and to advocate for protections of these
persons once in the workplace.
Homelessness
and Mental Illness
According to the National Coalition for the Homeless,
approximately 20-25% of the single adult homeless population
in the United States suffers from some form of severe
and persistent mental illness. In Canada, it is estimated
that approximately one third of the homeless in major
Canadian cities suffer from a mental illness. The problems
of homelessness and mental illness exacerbate each other.
Mental illnesses, without proper treatment, prevent people
from carrying out essential functions of daily life, thus
pushing individuals out of mainstream society, out of
jobs, and ultimately out of homes. Mental illness and
lack of medical treatment also lead to the use of drugs
and alcohol as forms of self-medication, increasing the
inability of individuals to function within society. At
the same time, homelessness prevents recovery or worsens
mental illness; a mentally ill individual will often slip
through the cracks of conventional programs and treatments,
never obtaining the treatment and medication necessary
to regain wellness. Many of these homeless, mentally ill
individuals then end up in the criminal justice system,
as discussed in the next section. According to the U.S.
Department of Justice, mentally ill state-prison inmates
in the United States were more than twice as likely as
other inmates to report living on the street or in a shelter
in the 12 months prior to arrest (20% compared to 9%).
A
shortage of affordable housing also exists, compounding
the problem. Between 1973 and 1993, 2.2 million low-rent
units disappeared from the market. These units were either
abandoned, converted into condominiums or expensive apartments,
or became unaffordable because of cost increases. Between
1991 and 1995, median rental costs paid by low-income
renters rose 21%; at the same time, the number of low-income
renters increased. In the past, Single Room Occupancy
(SRO) housing served to house many poor individuals, especially
poor persons suffering from mental illness or substance
abuse. From 1970 to the mid-1980s, an estimated one million
SRO units were demolished.
Mental
Illness and the Criminal Justice System
An additional area of concern is the intersection between
mental illness and the criminal and civil justice systems.
In 1998, some 283,800 people with mental illnesses were
incarcerated in American prisons and jails. This is four
times the number of people in state mental hospitals throughout
the country. Sixteen percent (179,200) of state-prison
inmates, 7% (7,900) of federal inmates, 16% (96,700) of
people in local jails, and 16% (547,800) of probationers
have reported a mental illness. According to a 1999 U.S.
Department of Justice study, approximately 53% of mentally
ill inmates were in prison for a violent offense, compared
to 46% of other inmates. While many believe that these
mentally ill offenders must be held in jail because of
the serious, violent nature of their offenses, it is vital
that they receive treatment while incarcerated.
We
must be concerned as well with the civil-liberties consequences
of some forms of treatment for mental illness within the
criminal justice system, especially the use of physical
restraints and the imposition of mandatory treatments.
It is equally important that nonviolent offenders receive
proper medical treatment and that noncustodial treatment
programs be explored and made accessible to offenders
with mental illnesses, who are often turned away from
community treatment programs because of reluctance to
treat them.
Notwithstanding
our existing policy of opposition to the death penalty
in all circumstances, we take special note of the number
of persons with mental illness who have been executed
in the United States.
The
prevalence of youth with mental illnesses within the juvenile
justice system is astounding. Approximately 50-75% of
those in juvenile detention facilities suffer from mental
illnesses, and approximately half of these suffer from
co-occurring substance-abuse disorders. Each year approximately
11,000 boys and 17,000 girls attempt suicide while living
within juvenile facilities. According to the Department
of Justice's Office of Juvenile Justice and Delinquency
Prevention, however, 75% of juvenile facilities do not
meet basic suicide-prevention guidelines, and many detention
facility staff are never trained to recognize and respond
appropriately to the symptoms of mental health disorders.
Coordinated
Systems of Care
The absence of a coordinated system of care for individuals
with mental illnesses has resulted in dangerous dispersal
of responsibility for their care and treatment. This is
especially true for individuals with co-occurring substance-abuse
disorders, who are often turned away from mental illness
treatment facilities. The U.S. government has begun to
draw attention to the situation of the mentally ill in
America today. In 1999, President Clinton hosted the first
White House Conference on Mental Health, calling for a
national campaign against stigmatizing the mentally ill.
The Surgeon General issued a Call to Action on Suicide
Prevention in 1999, and the Surgeon General's first Report
on Mental Health was also issued in 1999. For decades,
private and nonprofit organizations have worked tirelessly
to establish access to services, to protect the rights
of persons with mental illness, and to call for a comprehensive
system of care for those who are in need.
Caregivers
Currently, federal funding for 22 statewide family organizations
is provided through the Child and Family Branch, Center
for Mental Health Services, Substance Abuse and Mental
Health Services Administration. Support and technical
assistance are also provided by government agencies as
well as by consumer groups via family support groups and
respite-care services. An emphasis on the development
of a coordinated system of care has also drawn attention
to the needs of caregivers of individuals with mental
illnesses. Over the past several decades, there has been
a growing awareness of the difficulties families face
because services are provided by so many different public
and private sources. In addition to problems with coordination,
parents and caregivers encounter conflicting requirements,
different atmospheres and expectations, and contradictory
messages from system to system, office to office, and
provider to provider.
THEREFORE,
the Union of American Hebrew Congregations resolves to:
- Prepare
materials to be used for training synagogue, religious
school, camp, and youth-program personnel to recognize
and deal appropriately with members and participants
with mental illnesses;
- Call
upon all member congregations to:
- Participate
in communal efforts aimed at destigmatizing mental
illness, and work with the entire Jewish community
to develop resources and programming aimed at addressing
stigmatization of mental illness;
- Work
with persons with mental illness and their families
so that they may feel welcome within our synagogues;
- Make
use of the materials prepared by the UAHC to train
personnel to recognize and deal appropriately with
members and participants with mental illness; and
- Work
with other groups performing mental health outreach
within the Jewish community toward persons with
mental illness;
- Call
for increased governmental and community support and
development of programming for caregivers of persons
with mental illnesses;
- Call
on the U.S. and Canadian governments to maintain and
increase funding for federal programs aimed at treating
persons with mental illness and assisting them to live
healthy and independent lives;
- Call
on the U.S. and Canadian governments to increase funding
for mental health research and the development and testing
of innovative mental health programs, including those
focusing on the co-occurrence of mental health disorders
and substance-abuse disorders;
- Encourage
governmental integration and coordination of quality
housing and mental health systems to provide comprehensive
assistance, with special attention paid to persons with
mental illness who live on our streets and in our shelters;
- Call
for federal and state legislation in the United States
to require parity between physical and mental health
coverage by health insurance carriers, both private
and public, similar to the system of universal comprehensive
mental health coverage in Canada;
- Call
on member congregations and the UAHC to provide health
coverage for employees that guarantees parity in mental
health coverage;
- Call
for increased attention to the many inmates in our nations'
prisons with mental illnesses, focusing on the need
to:
- Place
nonviolent, mentally ill criminal offenders into
community-based mental health programs, and also
work to ensure that persons with mental illness
sentenced to prison receive appropriate and humane
treatment, including access to appropriate medication;
- Limit
the use of involuntary physical restraints and the
imposition of mandatory treatment solely to instances
that are not otherwise manageable.
- Limit
civil commitment and mandatory treatment to circumstances
where it is used as a last resort, and only with
due-process protections;
- Call
upon law-enforcement agencies to develop policies,
practices, and specialized training for police officers
and corrections officers to recognize and deal appropriately
with persons with mental illnesses;
- Call
for increased governmental attention to the youth
within the justice system, and the need for increased
funding for community-based treatment programs for
mentally ill juvenile offenders;
- Call
on state and federal jurisdictions within the United
States that retain the death penalty to exclude
from consideration for the death penalty persons
with mental illness; and
- Work
to find common ground with all groups-including
those who otherwise support the death penalty-who
oppose the execution of persons with mental illnesses;
- Encourage
an end to workplace discrimination against persons with
mental illness, in fact as well as in law, and also
encourage governmental development of further programs
to assist persons with mental illness in returning to
the workplace, and to assist employers in working with
them;
- Call
for an increased focus on the mental-health needs of
children, including teenagers, by advocating for:
- A
coordinated system of care for children and teenagers
with mental health problems;
- An
emphasis on early recognition, prevention, and intervention,
especially focusing on the prevention of suicide;
- Increased
research on the mental health problems of juveniles;
and
- Increased
attention toward mental-health needs within the
schools and among professionals dealing with children
in child-care facilities and schools, as well as
toward the development and implementation of training
programs for these individuals; and
- Call
for increased focus on the recognition, prevention,
intervention, and treatment of depression and other
mental illnesses in the adult population.
- Judge
David L. Bazelon Center for Mental Health Law, Policy
Maker's Fact Sheet, http://www.bazelon.org/policyreview.html
- Mental
Health: A Report of the Surgeon General, 1999.
- The
National GAINS Center, "What We Know About Co-Occuring
Disorders and the Criminal Justice System, http://www.prainc.com/gains/publications/treatment.htm
- Mental
Health: A Report of the Surgeon General, 1999.
- Judge
David L. Bazelon Center for Mental Health Law, http://www.bazelon.org/sct99ada.html
#limitations on activities
- National
Alliance for the Mentally Ill, "Employment, Work,
and Income Supports for People with Brain Disorders,"
http://www.nami.org/update/unitedemploym.html
- National
Coalition for the Homeless, "Mental Illness and
Homelessness," http://www.nationalhomeless.org/mental.html
- Canadian
Psychiatric Association, "CPA Says Politicians
Need to Deal with Homelessness," September 1999,
http://www.cpa-apc.org/Press_Releases/PR_Sep15_99.asp
- Center
on Budget and Policy Priorities, "In Search of
Shelter: The Growing Shortage of Affordable Housing,"
June 1998, http://www.cbpp.org/615hous.pdf
- National
Alliance for the Mentally Ill, "Fact and Figures
About Mental Illness," 1999, http://www.nami.org/fact.htm
- Coalition
for Juvenile Justice, "CJJ 2000 Annual Report -
Handle with Care: Serving the Mental Health Needs of
Young Offenders," 2000, http://www.juvjustice.org/publications/annualreport/2000/report.pdf
- Coalition
for Juvenile Justice, "CJJ 2000 Annual Report -
Handle With Care: Serving the Mental Health Needs of
Young Offenders," 2000, http://www.juvjustice.org/publications/annualreport/2000/report.pdf
|
|
