Appelbaum Calls on Members To Fix Crumbling MH System

Appelbaum cited numerous examples of the crumbling system of care in his home state of Massachusetts, noting that the examples are common, “no matter where you’re from.”

It is common, he said, to see patients waiting six months for a new-patient visit, for patients to travel halfway across a state—if not to a neighboring state—for an available inpatient bed, for patients to pile up in emergency rooms because there are no appointments or beds available. Fewer than half of all people with severe mental illness receive treatment for their condition, he said, and in any given year, less than 20 percent of all those with any mental illness receive any treatment.

“I submit to you that we can no longer be quiet about the impending disintegration of America’s mental health system—such as it is,” he said. “And what is the major problem facing our system today?. . . It’s the money—it simply isn’t there.”

He continued, “Unless our society is willing to pay the reasonable costs of care, outpatient clinics across this country will continue to close, and inpatient units will continue to fold,” he predicted. “Middle-class persons—not just the poor or uninsured—will face problems they haven’t seen in half a century of accessing care.”

Appelbaum outlined a five-step agenda that he said should be a vital part of every APA member’s day.

First, he said, members should work through their district branches and follow the example of the Minnesota Psychiatric Society in gathering data about the specific problems confronting their state (see story on page 2), noting that the situation will be slightly different from one state to the next. He urged members to use data from state departments of mental health, state hospital associations, and state medical societies to document the ways in which reimbursements have fallen significantly below actual costs of care, document the closure of inpatient beds in each state, and document the resulting “skyrocketing of emergency room visits for people with mental illness.”

“With the numbers in hand,” Appelbaum said, “it is incumbent upon all of us to sound the alarm.”

The second step in the action plan, Appelbaum explained, is to meet with the local media, particularly reporters for community newspapers. “These weekly publications are read by millions as the newspaper lands on their doorsteps each week. These are the [newspapers] that count—that shape opinions, that alert people to problems in their own communities.”

He urged members to meet as well with local editorial boards, showing them the numbers and making the argument that mental illness could easily become the leading cause of disability and that mental health is a good investment.

“For better or worse,” Appelbaum said, “the media, and legislators as well, are more likely persuaded by [numbers about lack of] access than any other argument.”

Third, members must prioritize a list of targets, specific to the states they live in—whether it be to target declining inpatient beds or barriers to access to outpatient care. “Decide what you want to go after as your priority,” he said, “and do it.”

The fourth step in the action plan is to “make sure you don’t go it alone,” Appelbaum urged. “We must have allies in this fight.” He noted that the National Alliance for the Mentally Ill and the National Mental Health Association are strong allies. State professional groups and national disease-specific associations such as the Depressive and Bipolar Support Alliance are APA’s allies as well, he said. “They all multiply our strength,” he emphasized.

Finally, meet directly with state legislators and local business leaders. Make sure that they understand that “the people they are paying to provide care are pocketing the profits while their employees cannot find anyone to treat them,” he said. “If they realize this, they will begin to demand change.” This, he noted, is precisely the focus of APA’s Business Initiative.

“It’s up to you, it’s up to all of us to do this job,” he charged the members.

Appelbaum noted that while all APA members are very busy, they do not have to tackle these tasks alone, he emphasized. “APA can and will help you with this. We have developed a ‘Take Action Kit,’ the core of which is available in the members-only area of APA’s Web site.”

He added, “If you truly can’t find time, then there’s at least one thing that you can do: You can write a letter.”

Write your governor, Appelbaum told his audience, and send copies to members of state legislatures. “As constituents, as voters, you need to let them know that you demand adequate funding of mental health care.”

Appelbaum concluded, “The current situation is intolerable. It will not be easy to achieve change. But if we work together, we can effect change. I hope you will join me and join the American Psychiatric Association in this endeavor.”