Mental Health In Health Care Reform

Fear. Fear for no reason. The feeling of being chased while standing still; the feeling that there is a train coming at you on the train tracks, and you cannot move - all you can do is breathe and wait for it to go away. Yet, it does not go away; the feeling stays there, and it consumes you, chokes you. For me, most days were like this, resulting in my refusal to leave my room at all and my living with this constant fear. I often thought about ending my suffering. However, after a month of missing school and contemplating suicide, my mother attempted to force me into attending school. I was given an ultimatum: go to school or go to a mental hospital and get help. Inside, I screamed for help, but I was never good at showing weakness. I meekly told my mother I would go to the hospital.

Upon arriving at the hospital, the first thing I saw was a lady who looked like she had had better days. She carried everything she owned with her, and she was waiting for a bed to become vacant. She looked like what I imagine I, myself, looked like - scared. A moment passed, and I was told that a bed would be ready for me in a few hours. Therefore, my mother and I went to breakfast. She called my grandmother and started crying while I sat hiding my emotions of fear and sadness from her, while she told my grandmother where I was going. When we returned to the hospital, they were ready for me. They asked all the standard questions: have you had thoughts of suicide, yes; have you tried to kill yourself, yes; how often do you think about death, all the time; do you plan on killing yourself, yes.

After processing, I was told that I cannot have shoe laces, elastic underwear, or shorts; it did not take more than a few seconds for me to figure out why. For the rest of my stay, I looked for ways that people could kill themselves if they wanted, keeping my options open. I then introduced myself to the group of people who would be my family during my stay. Nervous and scared, I tried to sit down with them while they ate dinner. I was quickly informed by my new family that guys cannot sit with girls. They were a comfort, for they genuinely seemed interested in someone such as myself. I ate dinner with them. The food was edible which was more than I expected.

Soon afterward, it was time for bed. The room had two beds and one bathroom; however, the bed was hard that one might call it hard plastic. The pillow was like a sheet, thin and depressing, like many of my peers that called this place their home. When we were told it was lights out, I could not help but feel the tension in the room, the sense of constant routine they inflicted upon us; this place is prison. I have never been good sleeping in new places; this was no exception. I found it hard to sleep. It did not help that my “cellmate” snored very loudly. To top it all off, in the “infinite wisdom” of the hospital staff, there was a fire drill at three in the morning, which naturally woke up the entire hospital. I was terrified, shaking uncontrollably, hyperventilating, and unable to be comforted. The orderlies ordered everyone to go back to bed. I still could not move, so one of the orderlies told me to breathe, but trying to breathe slower did not help. Then she gave me a newspaper and said, “Read this.” I started to read, and within minutes, I was fine. After making sure I was fine, she sent me back to bed; yet, I could not sleep. I am not sure even the Sandman could have helped me that night. Sleep felt more like a constant state of limbo, never really asleep but not conscious. I was made aware suddenly by a woman checking my blood pressure. After a little while, we were told it is time for group. The walls were blank, like a new canvas awaiting someone’s inspiration. There was a round robin of desks with a myriad of different faces in each of the seats. To my amazement, some were just kids. Others were budding teens, much like myself. Some faces seemed scared to death, and others were apathetic. One might have been able to hear a pin drop, as only the soft voice of a man in a white uniform was audible. I sat there content, quietly listening, while the others were fidgeting, crying, or just off in their own world. Soon, the man in white let the first person start sharing why they were there. One by one, they tell their tales, sharing as little or as much as they want about themselves. Then after going round the circle, it is my turn. Similarly, I did not share much because, like the others, I was still a bit new and, in hindsight, probably scared to share the parts of me that even my family could not accept.

The question is, should mental health facilities be not only better funded, in order to improve conditions and increase the number of people who have access to the facilities, but also expand into prisons, in order to improve the number of mentally ill inmates who can’t live outside of prison.Given my background, I know some of what is required to improve our current mental health system, and the fact that “up to 30% of the population worldwide has some form of mental disorder, and at least two-thirds of those people receive no treatment, even in countries with the most resources” ( Herrman , and Leslie Swartz 1243) is an issue worth talking about and working toward meaningful change.

Some of those opposed to this change include tax payers who wrongfully think that it will cause an increase of the taxes they pay to help someone they have never met and will never meet. However, the privatized prison systems in the US are payed by the government to house criminals, and they are paid per prisoner. One study showed sixteen percent of the thirteen million inmates studied in this article had some mental illness that could benefit from some form of treatment (Steadman, Robbin, et al 765). Another study showed people with mental illness in and out of prison getting no help; these are people with documented mental illness. Not only are their doctors not notified, but they also don’t give them any help in finding mental help. Even if they are currently receiving treatment, the doctors and prisons almost always do nothing in helping people with mental illness. Studies also continued on to talk about how often people with mental illnesses are repeat offenders of violent crimes. The highest rating of repeat offenders has a bipolar disorder, which has many different medications and treatments to reduce the symptoms of the disorder. Someone with a bipolar disorder can benefit greatly from receiving treatment for their disorder (Baillargeon, Jacques, et al 103-107). If we could prevent even one murder by giving people the help they need before they are released, isn’t it worth it? The privatized prison system only cares how many bodies they can fit in a building. By actually helping these people, they would lose out on “repeat customers.” Helping these people would not cost more money for the taxpayers; it would just take away from the prisons to help fund it. This is what the privatized prisons do not want.

Another study I found talked about the barriers of prisons leaving jail little health insurance, all but refusing to give health care to former inmates. The American Journal of Public Health said it best “As a result of the deinstitutionalization of the mentally ill and the war on drugs, more mentally ill people can now be found in New York City (and US) jails than in its mental hospitals” (Freudenberg N, Daniels J, et al 1726). They also state that people with unresolved medical issues increase the chances of people turning to drugs and going back to prison. This depicts the necessity of helping these individuals to prevent crime and improve our nation as a whole.

Prisons are not mental health hospitals; we can agree on that, but they should be able to provide the basic needs of someone with a mental illness. A study was done on different mental health conditions in prisons or on the lack thereof.. It also focused on the link between mental illness and repeat offenders. It showed prejudice toward the mentally ill just because they are mentally ill; “behaving no worse than offenders without mental illness, it seems inappropriate to use incarceration to achieve social control over offenders with mental illness, regardless of whether this is motivated by fear or paternalism” (Skeem, Lance, et al 115). They went on to talk about how people with mental illness, who are released from prison, are given little, if any, support to help them adjust to outside life, dooming them to fail their parole and being sent back to prison.

The benefits of actually treating inmates with mental illness are great. A study was done on the differences between prisons that do offer mental health care and prisons that do not. The prisons that do have mental health care assistance see as much as a twenty percent improvement in rehabilitation rates for those with mental illness as compared to the prisons that do not have mental health care assistance. These are people that need to be on medication that need help. They do not need to go round and round in a revolving door of the prison system (Steadman, Robbin, et al 766-769).

Places outside of the United States have shown different statistics. England, for example, has gone through health reforms in their prisons, which began in the year 2000, and they have made some great progress toward bettering mental health care for all. England has positively changed this crisis for the better;however, I think taking it further would only improve the benefit. “In 2000, 5 prisons were classified as red, 45 as amber, and 83 as green; by the end of 2002 (when 4 more prisons had opened) there were 0 red, 28 amber, and 110 green”. The colors indicate whether or not prisoners are receiving satisfactory service, red being not satisfactory, amber being less than satisfactory, and green being satisfactory. According to the prisoners, the reform has made a massive change in a very positive way. While the prison system in England is not perfect, it is leaps and bounds better than our prison system (Hayton, Paul, and John Boyington 1730-1733).

Now, mental health reform is not just for prisons; it is important for the whole system to be reformed. There is an article on the view of primary care physicians’ on the availability of mental health services. Many areas are lacking in mental health services, creating barriers to reaching the services that the people need. According to the journal of Health Affairs “PCPs (primary care physicians) have become the gateway to mental health systems for many patients by screening for mental health problems.” PCPs are being used as a way to get mental health services something that PCPs do not have direct access to. This causes problems for the patients because many PCPs have reported having difficulty obtaining outpatient health services for patients. Only two thirds of PCPs reported they had access to high quality outpatient mental health services (Cunningham, Peter J 490-497). This is an issue for obvious reasons; when one third of the people seeking help cannot find it, that is a problem.

Mental health facilities are also a great place for children to learn and get help with their mental illnesses. However, children take more time to diagnose and treat. A study was done between 1990 and 2000 on the median length of stay. The result was that the median length of stay ranged from up to 14.6 days in 1990 to as low as 2.9 days in 2000. While spending as little time at a hospital is normally a good thing, most treatments for mental illnesses involve medicine, and these medicines take time to work, which then takes time for one to stabilize. One can not receive the quality treatment he or she needs in 3 days; it would take at least a week for one’s body to adjust to the new drugs in his or her system (Case, Brady G 66-67). It is claimed that inpatient facilities are doing more with less but that just is not true. They are simply underfunded and unable to meet the demand for their services, so diagnoses are rushed and drugs are quickly prescribed in order to make a bed available for the next child in need.

We have already taken some steps toward reform in the form of the Affordable Care Act or ACA. The number of people reliant on publicly funded health care has grown steadily over the past few years. This is not necessarily a bad thing; it means that the change is helping people get the help they need. The reason we need this is that “adults with severe mental disorders were more than twice as likely as their counterparts without severe mental disorders to have incomes under 133% of the federal poverty level” (Garfield, Rachel L 86). This reason alone is enough to justify the need for funding for these programs. Someone with a severe mental disorder who is over 100% under the poverty level shows how much need there is for these reforms. There is no way someone that far under the poverty line could pay for the care he or she needs.

This is all why we need this kind of reform, not to just help the few but to help the whole, and by doing so improving the quality of life for all. This lack of support for such a large group of people is appalling.We need to band together and make this change happen.

Works Cited

1. Baillargeon, Jacques, et al. “Psychiatric Disorders and Repeat Incarcerations: The Revolving Prison Door.” The American Journal of Psychiatry 166.1 (2009): 103-110. Web. 27 Oct. 2015.
2. Case, Brady G. “Trends in the Inpatient Mental Health Treatment of Children and Adolescents in US Community Hospitals between 1990 and 2000.” American Medical Association 6.4 (2007): 66-75 Web. 29 Oct. 2015.
3. Cunningham, Peter J. “Beyond Parity: Primary Care Physicians' Perspectives on Access to Mental Health Care.” Health Affairs 28.3 (2009): 490-501. Web. 29 Oct.2015.
4. Freudenberg N, Daniels J, et al. “Coming Home from Jail: The Social and Health Consequences of Community Reentry for Women, Male Adolescents, and Their Families and Communities.” American Journal of Public Health 5.4 (2005): 1725-1736. Web. 27 October. 2015.
5. Garfield, Rachel L. “The American Journal of Psychiatry: The Impact of National Health Care Reform on Adults with Severe Mental Disorders.” American Psychiatric Publishing, Inc. 168 (2011): 85-96. Web. 29 Oct. 2015.
6. Hayton, Paul, and John Boyington. “Prisons and Health Reforms in England and Wales.” American Journal of Public Health 96.10 (2006): 1730–1739. Web. 27 Oct. 2015.
7. Herrman, and Leslie Swartz. “Scale up services for mental disorders: a call for action.” The Lancet 94.6 (2007): 1241–1252. Web. 27 Oct. 2015.
8. Oberlander, Jonathan J. “Health Reform Interrupted: The Unraveling of the Oregon Health Plan.” Health Affairs 26 (2007): 84-98 Web. 29 Oct. 2015.
9. Skeem, Lance, et al. “Correctional Policy for Offenders with Mental Illness: Creating a New Paradigm for Recidivism Reduction.” Law and Human Behavior 35.2 (2011): 110-126. Web. 27 Oct. 2015.
10. Steadman, Robbin, et al. “Prevalence of Serious Mental Illness among Jail Inmates.” Psychiatric Services 60.6 (2009): 761-769. Web. 27 Oct. 2015.