Kennedy's vision for mental health never realized

Last bill JFK signed aimed to provide patients treatment while working and living at home
Associated Press
Oct 20, 2013

The last piece of legislation President John F. Kennedy signed turns 50 this month: the Community Mental Health Act, which helped transform the way people with mental illness are treated and cared for in the United States.

Signed on Oct. 31, 1963, weeks before Kennedy was assassinated, the legislation aimed to build mental health centers accessible to all Americans so that those with mental illnesses could be treated while working and living at home, rather than being kept in neglectful and often abusive state institutions, sometimes for years on end.

Kennedy said when he signed the bill that the legislation to build 1,500 centers would mean the population of those living in state mental hospitals — at that time more than 500,000 people — could be cut in half. In a special message to Congress earlier that year, he said the idea was to successfully and quickly treat patients in their own communities and then return them to "a useful place in society."

Recent deadly mass shootings, including at the Washington Navy Yard and a Colorado movie theater, have been perpetrated by men who were apparently not being adequately treated for serious mental illnesses. Those tragedies have focused public attention on the mental health system and made clear that Kennedy's vision was never fully realized.

The legislation did help to usher in positive life-altering changes for people with serious illnesses such as schizophrenia, many of whom now live normal, productive lives with jobs and families. In 1963, the average stay in a state institution for someone with schizophrenia was 11 years. But only half of the proposed centers were ever built, and those were never fully funded.

Meanwhile, about 90 percent of beds have been cut at state hospitals, according to Paul Appelbaum, a Columbia University psychiatry professor and expert in how the law affects the practice of medicine. In many cases, several mental health experts said, that has left nowhere for the sickest people to turn, so they end up homeless, abusing substances or in prison. The three largest mental health providers in the nation today are jails: Cook County in Illinois, Los Angeles County and Rikers Island in New York.

"The rhetoric was very highfalutin. The reality was a little more complicated, and the funds that were provided were not adequate to the task," said Steven Sharfstein, president and CEO of Sheppard Pratt Health System, a nonprofit behavioral health organization in Baltimore.

"The goals of deinstitutionalization were perverted. People who did need institutional care got thrown out, and there weren't the programs in place to keep them supported," said former U.S. Rep. Patrick Kennedy, the president's nephew. "We don't have an alternate policy to address the needs of the severely mentally ill."

He is gathering advocates in Boston this week for the Kennedy Forum, a meeting to mark the 50th anniversary of his uncle's legislation and an attempt to come up with an agenda for improving mental health care.

The 1963 legislation came amid other changes in treatments for the mentally ill and health care policy in general, Appelbaum said. Chlorpromazine or Thorazine, the first effective antipsychotic medicine, was released in the 1950s. That allowed many people who were mentally ill to leave institutions and live at home.

In 1965, with the adoption of Medicaid, deinstitutionalization accelerated, experts said, because states now had an incentive to move patients out of state hospitals, where they shouldered the entire cost of their care, and into communities where the federal government would pick up part of the tab.

Later, a movement grew to guarantee rights to people with mental illness. Laws were changed in every state to limit involuntary hospitalization so people can't be committed without their consent, unless there is a danger of hurting themselves or others.

Kennedy's legislation provided for $329 million to build mental health centers that were supposed to provide services to people who had formerly been in institutions, as well as to reach into communities to try to prevent the occurrence of new mental disorders. Had the act been fully implemented, there would have been a single place in every community for people to go for mental health services.

But one problem with the legislation was that it didn't provide money to operate the centers long-term.

"Having gotten them off the ground, the federal government left it to states and localities to support," Appelbaum said. "That support by and large never came through."

Later, during the Reagan administration, the remaining funding for the act was converted into a mental health block grant for states, allowing them to spend it however they chose. Appelbaum called it a death knell because it left the community health centers that did exist on their own for funding.

Robert Drake, a professor of psychiatry and community and family medicine at Dartmouth College, said some states have tried to provide good community mental health care.

"But it's been very hard for them to sustain that because when state budget crunches come, it's always easiest to defund mental health programs because the state legislature gets relatively little pushback," he said. "Services are at a very low level right now. It's really kind of a disaster situation in most states."

Sharfstein points out that most mentally ill people are at a very low risk of becoming violent. He said it's unthinkable we would go back to the era when people were housed in "nightmare" conditions at overcrowded, understaffed and sometimes dangerous state hospitals.

"The opportunity to recover is much greater now than it was in 1963," he said.

But for those who do not take their medication, don't recover from their first episode of illness and don't seek treatment and support from professionals, they are vulnerable to homelessness, incarceration and death, he said.

Linda Rosenberg, president and CEO of the National Council for Behavioral Health, counts among its 2,100 member organizations many of the original community mental health centers that were built under the 1963 legislation.

"Whenever you pass a piece of legislation, people would like to think that you've solved the problem," she said. "It did some very important things. It laid some ground work. It's up to us now to move forward."

 

Comments

Contango

Re: "those with mental illnesses could be treated while working and living at home,"

Kinda like he had interns available in order to help him with his "mental health".

"Mimi Alford tells of her secret affair with JFK"

http://www.telegraph.co.uk/news/...

Informed

What does that have to do with the topic at hand? Mental illness still carries such a stigma in our society. Or people are still uneducated about things like depression and blame the patient. It's ridiculous. And insurance companies only compound the problem by having different benefits for psychiatric disorders vs. other medical problems.
We have a long way to go. And there are a lot of people out there with mental health problems.

Contango

Re: "And insurance companies only compound the problem by having different benefits for psychiatric disorders vs. other medical problems."

Few authorities can agree on the definition of "cured," some mental health professionals tend to bleed and abuse the benefits - hence the difference.

Informed

There are many medical conditions that cannot be cured. That does not explain the difference. Just like anyone with a chronic medical condition needs ongoing treatment, so do those with chronic mental health issues.

Contango

Re: There are many medical conditions that cannot be cured."

Exactly; likewise the expenses in regards to mental health are sometimes never ending.

Why do you think that the govt. largely emptied the institutions and put many out on the street with medication? Cost.

If money was no object, almost ANYTHING is possible.

Unfortunately, liberals tend to believe that there is an endless supply.

The Big Dog's back

Raygun turned them loose.

The Big Dog's back

That's what happens when CONservatives rule, every man for himself.

Contango

Re: "What does that have to do with the topic at hand?"

"St. John" was a philandering, lying member of a scumbag political crime family, whose affairs were covered up by the media at the time.

He deserves little-to-none of the cult of personality fawning that the lefties bestow upon the him, the Camelot crap and his sanctimonious wealthy Kennedy gang.

AJ Oliver

It's a national disgrace that our communities are full of homeless mentally ill people. 40% of homeless are veterans. Many homeless work, but "earn" poverty level wages and cannot afford shelter.
Contagion's response is a good illustration of the fact that most righties don't care at all about these people.

Contango

Re: "a good illustration of the fact that most righties don't care at all about these people."

And the old tired liberal mantra of: "Let Govt. do it", shows the vacuous nature of their thinking.

"I'm always willing to engage people who post under their own names - the rest, no way."

- AJ Oliver, 10/15/13

How are you not being hypocritical? :)

grumpy

"Contagion's response is a good illustration of the fact that most righties don't care at all about these people."

This is how the Kennedy family handled the mentally ill sibling of John and Robert. They lobotomized her, leaving her permanently incapacitated. I guess this shows how most lefties try to sweep this problem under the rug., at least if you use AJ Oliver's logic. I wonder how many of you even heard about this sister?

Quote from her wiki:
"Because of her condition, Rosemary became largely detached from her family, but was visited regularly by her mother and by her sister Eunice Kennedy Shriver. Joseph P. Kennedy, Sr., did not visit Rosemary at the institution."

http://en.wikipedia.org/wiki/Ros...

Informed

This was the standard treatment of the time.

KnuckleDragger

Yes, and the example you give in your post is exactly why the government should not be involved in mental health treatment. If they do as well with the general population as they do with those who are eligible for treatment by the VA, it would be mediocre at best. Lefties are the only ones I know that would consider the VA's outcomes with mental illness a success.

4shizzle

Unfortunately , lobotomy was ignorantly accepted at that time.

Now today , people ignorantly vote for Republicans who have had their total brains removed ( if they ever had any ) .

KnuckleDragger

Ahh yes, this coming from a man who has obviously had the entire left hemisphere removed. This combined with an overstimulated Amygdala gives you what is commonly referred to as the liberal mind, completely devoid of logic, easily angered, with a propensity to indiscriminately breed with anything that moves ;)

4shizzle

Ahh yes, this coming from a man who was born with his head in his arse.
You should get that removed ,Dr.KnuckleDragger -bawh ha ha ha.

grumpy

At one time rum and whiskey running was accepted... well it always was against the law... but some grew rich doing so and bought respectability, lobotomies, silences, Presidencies...

4shizzle

quote mR bUMPY/Clonetango:
"I assume you stand behind the research you bring forth?"

You spew arrogance and ignorance. ( eh , attention grammar master - it's " spew", not "spue")
Lobotomies WERE legal at THAT time .

http://www.ask.com/question/when...
http://psychcentral.com/blog/arc...

grumpy

http://dictionary.reference.com/...

"Lobotomies WERE legal at THAT time ."

Please show where I said they weren't legal. All you have to do is scroll up and copy and paste where I said/wrote it... but since I didn't say/write it... it won't be possible for you to do so. I simply showed where the Kennedy family did so, to at least one of their children... and how they treated her afterwards. Still having trouble with that comprehension thing I see.

I do agree with your observation that the Kennedy family was ignorant though.

"Unfortunately , lobotomy was ignorantly accepted at that time."

4shizzle

grumpy
Mon, 10/21/2013 - 11:04am
"Contagion's response is a good illustration of the fact that most righties don't care at all about these people."
This is how the Kennedy family handled the mentally ill sibling of John and Robert. They lobotomized her, leaving her permanently incapacitated. I guess this shows how most lefties try to sweep this problem under the rug., at least if you use AJ Oliver's logic. I wonder how many of you even heard about this sister?
Quote from her wiki:
"Because of her condition, Rosemary became largely detached from her family, but was visited regularly by her mother and by her sister Eunice Kennedy Shriver. Joseph P. Kennedy, Sr., did not visit Rosemary at the institution."
http://en.wikipedia.org/wiki/Ros...

+

grumpy
Mon, 10/21/2013 - 11:36am
At one time rum and whiskey running was accepted... well it always was against the law... but some grew rich doing so and bought respectability, lobotomies, silences, Presidencies...

+

grumpy
Mon, 10/21/2013 - 1:09pm
http://dictionary.reference.com/...

"Lobotomies WERE legal at THAT time ."

Please show where I said they weren't legal. All you have to do is scroll up and copy and paste where I said/wrote it... but since I didn't say/write it... it won't be possible for you to do so. I simply showed where the Kennedy family did so, to at least one of their children... and how they treated her afterwards. Still having trouble with that comprehension thing I see.

I do agree with your observation that the Kennedy family was ignorant though.

"Unfortunately , lobotomy was ignorantly accepted at that time."

=

doesn't make sense >squirming> FAILURE

Later Clonetango

grumpy

As I stated and you just proved I never said/wrote that lobotomies were illegal then or now. The only thing I wrote that was illegal was rum and whiskey running. Are you now claiming that lobotomies, and rum and whiskey running are the same thing?

I guess you are still having trouble with that comprehension thing yet. Good luck with that.

4shizzle

You are a waste of time.

rottnrog

I think contango should move to North Korea. Virtually no govt. help for the poor, low taxes and govt spending and the whole govt is republican !!!

4shizzle

He would make an excellent communist dictator or propagandist.

KnuckleDragger

That post shows that you know little to nothing about the DPRK.

4shizzle

I know what I'm saying.
He still would make an excellent communist dictator or propagandist.

2Timothy1-7

Does any other reader find the nature of most comments highly ironic in view of the topic of the article?