Let’s Get Serious About Caring for People With Serious Mental Illness

I have been writing over the past several months in this column about the barriers to accessing mental health care in our country. We all know that members of minorities and low-income families have a particularly hard time getting the treatment they need, but well-insured, middle-income families are often unable to get timely and affordable care as well.

The access problem is rooted in discrimination against mental illness, which has led to the underinvestment in research and treatment resources. We know that patients don’t go away unless, tragically and needlessly, they die by suicide. Many people end up in our jails and prisons or are homeless on the streets or in shelters. The loss of human potential is staggering. Mental illness is the leading cause of disability from the second to the seventh decade of life in the United States. Making the problem even worse is that the current shortage of psychiatrists is expected to increase over the next several years.

Overcoming this complex and multifactorial access problem requires concerted dedication by APA and the psychiatric community. But let’s be realistic—that’s not enough: The entire mental health provider community—including psychologists, social workers, nurse practitioners, mental health counselors, advocates, and peer counselors—are needed to succeed at convincing our politicians, insurance companies, health care executives, and the public that the costs are worth the benefits to our society and culture.

To this end, as an outcome of the presidential retreat that I led last summer, I appointed a task force to produce joint principles of effective collaboration to promote access to high-quality treatment for people with serious mental illness (SMI). Your APA secretary, Dr. Sandra DeJong, has agreed to serve as chair. Invitations to join the task force were accepted by the National Association of Social Workers, Association of Psychiatric Nurse Practitioners, American Association of Nurse Practitioners, American Mental Health Counselors Association, American Academy of Physician Assistants, Association for Behavioral and Cognitive Therapies, NAMI, American Psychological Association, College of Psychiatric and Neurologic Pharmacists, and International Association of Peer Supporters.

It is time for APA to demonstrate leadership in bringing together other mental health organizations to identify ways we can collaborate effectively to care for people with SMI. It will not be easy to put aside some of our guild concerns, but I believe everyone who chooses to become a mental health professional is motivated to help people with mental illness lead healthy, functional, and fulfilling lives.

Some of our skills are different and some overlap, but all of our skills are needed in the care of SMI patients. A colleague I have known for many years and highly respect responded to one of my earlier columns regarding the problems of treating SMI patients in a private office. As he correctly noted, most psychiatrists do not have the required resources in their offices to care for this challenging population. Perhaps this task force will help identify clinicians throughout the country who want to collaborate with psychiatrists in providing the range of services that SMI patients need.

This is my vision: There is strength in numbers. As we join our voices and organizational efforts to break through the institutionalized discrimination that prevents people from getting the care they need and deserve, we will not only be able to help more people, but also bring an end to the view that mental illness is less of a priority than other medical illnesses and not worthy of the research funding accorded just about every other category of major illness. ■