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Changes To Mental Health System Lessen Stigma
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Once hidden away, mental illness has become a very public health issue. Health insurance now routinely covers mental illness treatment, TV ads promote medications. Officials often link violent crime to mental illness.
This week, 89.7 NPR News will examine the evolution of mental health treatment in a special three part series. In part one, WOSU looks at the changes to the system which has helped de-stigmatize the issue.
Treatment for those suffering with mental illness has come a long way since Ohio opened its first so-called “lunatic asylum” nearly 200 years ago.
We openly discuss mental illness. Insurance covers visits to therapists. And then there are the meds.
As a result, the stigma attached to mental illness has lessened.
But two centuries ago, people who suffered with mental illness were considered insane. Many were basically imprisoned, in lunatic asylums.
Ohio opened its first state institution in 1824 in Cincinnati.
Long-term hospitalization remained the option for the mentally ill all the way until the 1960s, when thinking started to change.
The novel turned movie, One Flew Over the Cuckoo’s Nest, offered one man’s viewpoint of mental institutions. Highlighted on the big screen were the coercive and what some would say inhumane treatments in mental health hospitals. One Flew Over the Cuckoo’s Nest came during the push for more outpatient care.
“Do I know that that movie was the particular the driver of that, I’m not sure,” said Ohio State University Harding Hospital executive director Amanda Lucas.
Lucas said, there was a lot of momentum for human rights coming out of the 60s.
“You had a lot of action just around human rights. And part of human rights is how you address people’s mental health,” she said. “And then that sort of led into this whole study, if you go back just google mental health therapies in the 1970s you’ll see that there is just a flurry of activity.”
Rapid change came in the 70’s and 80’s. In 1975, the Supreme Court ruled it was unconstitutional to involuntarily hold people because they have a mental illness. The ruling forced states to assess commitment criteria which, in Ohio, include being a danger to oneself.
Franklin County Probate Magistrate Robert Morris hears mental health cases from more than a dozen area counties. He began working with the court during the mid-70s.
“It was relatively easy [then] to deprive someone of their liberty and put them in the hospital…They aren’t prisoners; they’re people suffering from a mental illness,” Morris said.
As better drugs appeared to suppress symptoms of mental illness, lawmakers made another push to deinstitutionalize. In 1988, the Ohio Legislature passed the Mental Health Act.
“And with that, the population of our state psychiatric hospitals started to drop substantially and more people were treated in the community,” noted Dr. Mark Hurst, Ohio Department of Mental Health medical director.
Hearst said deinstitutionalization is the biggest transition he has seen in the system. In 1988, there were 17 state mental health hospitals. Today there are six.
“Many people who had been hospitalized for a number of years were able to go into the community, be successful in the community and actually become productive members of our society…that of course would be impossible if they were hospitalized.”
But now some wonder if Ohio has enough mental hospitals. Ohio has fewer than 1100 beds. Most days they are full.
That leads people like 46-year-old Traci Parks searching for a place to go. Parks has suffered with depression for 20 years, hospitalized three times. The last time, she was treated in the emergency room. But finding care thereafter was difficult.
“There’s not a program that has room for me. There’s not a psych unit that had a bed available. There’s not a day treatment that has a spot for me.”
And once she finds a facility, insurance caps and stipulations can kick in. During one of Parks’ hospitalizations she was discharged after eight days. She wasn’t considered “actively suicidal” anymore.
“It was so scary because I thought, it took all this courage to check myself in and admit I needed help and then eight days later they go, ‘OK, bye!,’” she recalled. “And I thought there’s no way I’m ready to go back to work. They’re no way I’m ready to go back to regular life.”
Insurance has improved. Before the 90s, most people paid for treatment out of pocket. Harding Hospital’s Amanda Lucas credits The Mental Health Parity Act.
“We had a huge gain in that parity and recognition of mental health as a true health care/public health matter,” she said. “But the employer still can choose whether to put that in as a covered benefit in the plan or not. So it only gets us part of the way to the solution.”
The stigma of mental illness has lessened. But hospitalization remains taboo.
Traci Parks said while people easily admit they see a therapist or take anti-depressants – hospitalization is a different story.
“If you are experiencing a severe episode and you’re hospitalized, I’ve been hospitalized three times, and not a single day, not a single time did any of my friends and family visit me in the hospital.”
Parks said friends don’t know what to say. Still, her family doesn’t understand why she can’t just “get over” her deep sadness.
Department of Mental Health’s Mark Hurst said the stigma won’t completely disappear until people see mental illness as other medical diseases.
“We do not yet treat individuals with mental illness the same way we do individuals who have any other biological illness, like hypertension, like diabetes or a cardiac diseases,” he said. “So, although there’s been progress, we haven’t gotten where we need to be just yet.”
Tuesday, part two of this three part series will examine the money behind mental health…from community resources to big pharmacy.