Since 1985, there have been notable changes in the legislation surrounding mental health. There have also been sweeping changes in the way individuals view mental health and mental illness in the United States. This long and winding journey is actually very rich with history. By understanding the history of mental health management in the United States, we can better understand how and why treatment works the way it does today.
A Brief History of Mental Health Law Since 1980
In 1980, U.S. President Jimmy Carter signed in the Mental Health Systems Act, which worked to restructure the community mental health system and improve treatment for patients who had severe and persistent mental illnesses that required long-term treatment.
However in 1981, President Ronald Reagan repealed Carter’s new Mental Health Systems act and blocked a number of grants for individual states. As a result, the federal government no longer provided direct services to the mentally ill. This did decrease federal spending on mental health and mental illness by 30 percent, but there were some unfortunate circumstances as a result. Mental health treatment became much more difficult for many people to obtain.
By 1985, many studies were finding that up to 30 percent of the homeless population in the United States also suffered from severe mental health issues. Schizophrenia and its treatment became a top priority for many mental health professionals and citizens. Soon after these findings became known, the National Alliance for Research on Schizophrenia and Depression (now known as the Brain and Behavior Research Foundation) began. This group worked to build greater education and awareness of severe and persistent mental illness.
By 1992, however, mental health laws had not changed much, and researchers found that 7.2 percent of all incarcerated prisoners in the United States suffered from severe mental illness. Many of those inmates were simply in prisons to wait for sentencing, or even just to wait for a bed in a psychiatric hospital. The cost to keep each prisoner in jail for such matters finally became a concern for both businesses and lawmakers.
During the 1980s and 1990s, mental health patients were supposed to have the right to determine their own treatment. Patients were, by law, able to determine if they would like to go into inpatient treatment (with the exception of those patients who were in imminent danger of harming themselves or others). However, this was not often the reality. Many patients filed lawsuits in these years, claiming that they signed admission papers under duress or that they signed themselves up for treatment while they were not in a satisfactory state to make informed decisions about treatment.
The famous Olmstead case became a well-known ruling that addressed patient rights and the freedom of each individual to choose whether to use community mental health programs that allow the individual to return home in the evening (outpatient or appointment-only treatment), or to choose inpatient treatment. The ruling stated that each patient may make a decision to stay in inpatient care only if he or she is well enough to make a clear decision, that the treatment program cannot hold anyone against their will and that patients must be given an outpatient option of treatment. This does not apply if the patient is in danger of harming himself or others. If a patient is ruled by a judge to be harmful to himself or others, that person may only be held for up to 48 hours in an inpatient facility. During that stay, the patient must be well cared for and respected.
In 2008, the Mental Health Parity and Addiction Equity Act called for group insurance plans to offer coverage for both mental health issues and substance use disorders just as they offer coverage for all other health conditions. Unfortunately since the law was passed, there have been many cases in which legislators and insurance companies disagree on how to truly define “parity” and what constitutes true equality.
Mental health law and treatment has come a long way across the world, but there is still a very big battle ahead. For instance, 55 percent of males and 73 percent of females in jails across the U.S. struggle with mental illness but do not necessarily get the mental health treatment they need. It will take more effort and time to correct these problems and make mental health treatment accessible to everyone.
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