The history of mental health legislation in the United States demonstrates the difficulty of dealing with the issue as a matter of politics. With the stress of modern life being compounded by the COVID-19 pandemic, it is more important than ever for lawmakers at the state and federal levels to bolster mental health care throughout the country.
Providing help for those in need and determining the proper course of action while respecting individual rights is a balancing act without a clear answer. There is a difference between somebody who does not always adhere to societal norms and somebody who could pose a danger to themselves or others. For those facing mental health crises, governments have spent the past six decades weighing the roles of the federal government vs. state governments, and the effectiveness of imprisonment vs. a mental health facility.
In Washington, people can be held involuntarily for three reasons: If they pose a danger to themselves, pose a danger to others, or are deemed “gravely disabled” — meaning they are unable to provide basic care for themselves.
As The Seattle Times recently reported while taking a look at the role of courts in those resolutions: “There are no easy decisions when judges are determining whether someone experiencing a mental health crisis should be held at a hospital against their wishes. ‘It’s always hard,’ said Judge John McHale, one of three judicial officers devoted to presiding over cases in King County’s Involuntary Treatment Act court.”
That difficulty is not limited to Washington. A federal judge this week ruled that the Oregon State Hospital must place strict limits on how long it holds people who are accused of crimes and require mental health treatment.
Nor is there anything new about such issues. In 1963, President John F. Kennedy signed the Community Mental Health Act, designed to create community facilities and give the federal government more sway on the issue. One month after he signed the bill, Kennedy was assassinated; it was never fully funded by Congress.
In 1980, President Jimmy Carter signed the Mental Health Systems Act to create grants and fund Kennedy’s vision. Within a year, new President Ronald Reagan led Congress in repealing much of the law while slashing funding for mental health. Reagan’s legislation created block grants for states, again pushing the issue away from the federal government.
Beginning in the 1960s and continuing to this day, changing philosophies and shrinking funding led to a sharp decline in the number of people in mental health institutions. There are benefits to this, with more weight given to individual freedom; there also are drawbacks, with mental illness contributing to homelessness and drug use.
The Centers for Disease Control and Prevention estimates that one in 25 Americans lives with serious mental health conditions such as schizophrenia, bipolar disorder or major depression. Many more live with occasional issues such as depression that can intermittently impede their ability to function.
Gov. Jay Inslee is pursuing a five-year plan to shift care away from large state hospitals to decentralized community facilities. And many local organizations provide assistance and outreach. According to Mental Health America, Washington ranks 11th among states in terms of access to care.
While simple solutions to a complex issue are nonexistent, one thing is clear: It is not going away. Lawmakers must make strident, immediate efforts to bolster mental health care in the United States.