Nation’s mental health system more maze than help, says commission

By The National Psychologist Editor
March 1, 2003



A $30 million-a-year program designed to keep troubled young people at risk in their homes instead of institutions won high praise from the President’s New Freedom Commission on Mental Health.

But, beside pointing out Wraparound Milwaukee as an example of a mental health treatment system that works, the commission’s interim report paints a bleak landscape in which ineptitude and ineffective treatments present more barriers than help for those suffering mental disorders.

”The system is not oriented to the single most important goal of the people it services–the hope of recovery,” the report charged.

Michael Hogan, head of the Ohio Department of Mental Health, said that “many more individuals could recover from even the most serious mental illness if they had access to treatment tailored to the needs, to support, and to services in each of their communities.

“State-of-the-art treatments, based on decades of research, are not being transferred from research to community settings,” the report said.

However, there are programs that appear to be working, including the Milwaukee program as well as ones in California that provide integrated services to homeless adults with serious mental illnesses, and in Dallas, where a school-based mental health treatment program includes partnership with parents and family members, treatment and follow-up.

Despite the few bright spots in an otherwise dismal system, the commission reported that there are few, if any, mechanisms for transferring locally successful model programs into broad, national initiatives.

”Federal programs should be structured to support proven effective models as the standard approach, not the alternative, which requires local ingenuity,” according to the report.

Wraparound Milwaukee, which is now in its eighth year and was started with a $15 million federal grant, was also mentioned in former Surgeon General David Satcher’s landmark 1999 study that called for increased mental health services, particularly to minority communities.

The president’s commission, which will deliver its final report in the Spring, had its genesis in the Satcher report.

Bruce Kamradt, director of Wraparound Milwaukee, said the program has grown dramatically and, despite its $30-million-a-year budget and a staff of 120, is saving the community money and keeping at-risk children out of institutions.

The program, he added, gets $10 million a year each from Medicaid, child welfare and juvenile justice programs in the county. A mobile crisis team of 10 people employs psychologists for assessment and treatment, Kamradt said. In all, 230 agencies are involved in providing services to the 530 children in the program on any given day.

Cost savings result when children are allowed to remain at home and in their local schools instead of being institutionalized, he said.

Kamradt agrees with the commission’s report that it would not be a simple thing to duplicate Wraparound Milwaukee, given turf problems and lack of funding.

Indeed, the report noted that part of the problem is that “each funding source has its own complex, contradictory set of rules” that result in wasting at least $80 billion a year for treatment of mental illnesses.

The mental health system looks more like a maze than a coordinated system of care, the report said.

But mental health of Americans is not the only trouble spot in the system. The number of uninsured Americans jumped to 41.2 million last year and health insurance premiums increased in double digits.

The latest idea for jump-starting healthcare reform is coming from Sen. Ron Wyden, D-Ore., and Sen. Orrin Hatch, R-Utah, who say they want to make improvements to the healthcare system that can be accepted at all levels from communities to the federal government.

The commission’s report can be found at www.mentalhealthcommission.gov/reports/interim_toc.htm.

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