The lack of appropriate mental health services in the United States has led patients to increasingly seek care in hospital emergency rooms—a practice known as “psychiatric boarding.” Others only receive mental healthcare within the confines of jails and prisons, often incarcerated for crimes associated with their mental illness.
The bleak situation faced by millions of Americans with mental health problems was highlighted in a recent article by Dr. Anne Zink, published by STAT, an online health publication produced by Boston Globe Media. Dr. Zink is the medical director for emergency medicine at Mat-Su Regional Medical Center in Palmer, Alaska.
According to the article, nearly 1 in 5 adults, some 44 million people, experience mental illness every year, a figure that is projected to increase in the coming years. Every year approximately 1 in 25 adults, 9.8 million people, experience a serious mental illness that severely interferes with their major life activities.
Homeless people make up one of the largest populations suffering serious mental health problems. According to the National Alliance on Mental Health, an estimated 26 percent of homeless adults who stay in shelters have a serious mental illness. Forty-six percent of the homeless live with severe mental illness and/or drug use disorders.
The United States’ homeless population expanded in the aftermath of the 2008 financial crisis, with the population increasing in 2016 for the first time since 2010. Rent prices soared beyond what the average worker could pay, while mental health services became less affordable and accessible. There is no doubt that the growth of underemployment and unemployment has contributed significantly to the psychological distress among workers and youth.
Another manifestation of the mental health crisis is the perpetual shortage of trained psychiatrists. The annual rise in mental illness has created an atmosphere where, according to Zink, “the demand for mental health professionals is outstripping supply.” A 2017 report from the National Council for Behavioral Health estimated that the psychiatric deficit will be between 6,100 and 15,600 by 2025.
The shortage of psychiatric professionals is particularly acute in Alaska. The only psychiatric hospital in the state is the Alaska Psychiatric Institute. In 1990, the hospital maintained 160 beds. That number has since decreased to 80, with only 50 beds available for patients experiencing severe mental breakdowns.
The article acknowledges that the final result of the grossly inadequate funding for mental health treatment, exacerbated by corporate downsizing among the large hospital chains, is that patients swing indiscriminately from poorly-equipped group home facilities to emergency rooms—and, ultimately, jails and prisons.
As Zink points out, “jails and prisons are now among the largest settings for mental health services, a final destination for individuals failed by the medical system.” Indeed, the largest mental health hospital in America is Cook County Department of Corrections in Illinois. A third of those incarcerated in the jail suffer from psychological disorders.
The source of the crisis of mental health as well as healthcare in general lies not simply in the incompetence or negligence of this or that psychiatric institution, but in the very nature of the capitalist system, which subordinates all aspects of social need to the profit interests of the ruling class.
The explosion of psychiatric disorders has coincided with the proliferation of “deaths of despair” from opioid overdoses and suicides. Pharmaceutical conglomerates have made a fortune in recent years by pushing doctors to overprescribe highly addictive painkillers, flooding communities and the black market with opioids and then dramatically hiking the price of the drug used to treat overdoses, naloxone. According to the Centers for Disease and Control Prevention (CDC), more than 72,000 people died from drug overdoses in 2017 alone.
According to the latest annual mortality report by the CDC, the suicide rate in 2017 rose to its highest level in 50 years, with suicide being the second leading cause of death for those ages 10 to 34.
These disturbing trends are the predictable outcome of the austerity agenda pursued by both Republicans and Democrats, including reactionary tax cuts for the rich, attacks on social programs, the neglect of infrastructure, and healthcare policies designed to cut costs and increase profits for corporations by rationing care for working people.
The Trump administration’s 2018 budget cuts are a sign of an accelerating attack on mental health programs and support. The 2019 fiscal year budget for the Department of Health and Human Services saw a 21 percent cut in its funding from 2017. Trump’s budget reduced funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) and its affiliated programs by $600 million. It also eliminates $451 million in other health professional and training programs.