Legislators, policy makers and funders must acknowledge the critical role of mainstream institutions in providing mental health services in America’s informal mental health system according to a diverse group of mental health and other policy experts meeting in Washington for the Fundamental Policy: Spotlight on Mental Health conference.

“With more than one in four of Americans dealing with some form of mental illness in the course of a year, and given our shift from a system dominated by mental hospitals to a network of community-based care, public institutions like schools, hospitals and prisons are becoming primary providers of mental health services,” said Jonathan F. Fanton, President of the MacArthur Foundation. “As long as the mental health role of these institutions remains unacknowledged and unsupported, many people with mental illness will go without effective treatment – at great cost to them, their families, and their communities.”

Despite the fact that 30 percent of SSI and SSDI recipients, 18 percent of the persons in prison, 25 percent of juvenile offenders, 25 percent of the homeless, and 10 percent of youth in schools have serious mental health conditions, public agencies in these sectors are not designed, prepared, or equipped to deal with their mental health treatment and service needs.

Public schools, universities, prisons, health care and housing providers, employers and other institutions have increasingly been called to provide front line mental health care. While dealing daily with the needs of individuals with mental illness, they have done so without the tools or evidence base they need to most effectively address complex mental health issues.

“We need to move the conversation about mental health squarely into the mainstream where we discuss housing, education, primary medical care, veteran’s affairs, and other national priorities,” said Howard Goldman, Director, MacArthur Mental Health Policy Research Network. “When we consider mental health and its effects on everyday life, we not only improve conditions for those with mental illness, but we build stronger and more effective public policies and social institutions for everyone.”

A collection of issue briefs released today by the MacArthur Foundation Research Network on Mental Health Policy Research highlight critical priorities for creating the research, resources, and relationships to effectively address mental health issues in public policy.

The prominence of mental health in daily life is increasing. As large numbers of soldiers return from combat with post-traumatic stress disorders, their local communities will also grapple with the effects. After each incidence of campus violence, the pressure for schools and universities to understand and respond to mental illnesses increases. Even the presidential debate over universal health care plays a role in determining how large a priority mental health will become for any new health insurance plan.

Since the treatment of mental illness began to shift from hospitals into community settings beginning in the 1950’s, people dealing with mental health conditions became regular users of a wide range of community institutions and services. When their needs are not well addressed, as in the case of homeless mentally ill people, the results can be tragic. Nearly 30% of homeless individuals suffer from severe and persistent mental illness.

“Housing policy has moved far ahead of research on what works best for people with a severe mental illness,” continues Goldman. “Rigorous research into effective approaches can result in improved access to housing among those individuals with severe and persistent mental illness and, equally importantly, ensure that they remain housed with access to needed support services--which benefits the entire community.”

  • The same can be said for other policy areas covered by the briefs released by the Network which are available at www.fundamentalpolicy.org.
  • The standards-based approach of No Child Left Behind moves the educational focus away from overall development and hurts special needs children while also lowering the performance score of their school.
  • The most effective mental health treatments don’t reach everyone. Unlike some other medical treatments, health care providers have been slow to adopt proven treatments and medications for mental illness.
  • The U.S. criminal justice system has become a major provider of mental health services for youth and adults. We know little of effectiveness of interventions for either the justice system or individuals involved.
  • While the role of competition and changing market environments has been explored in healthcare in general, the effect on mental health care has been largely unexamined.
  • People with mental illness might have been able to work on a factory line but may be less able to interact with the public in a service job. Is the shift to service economy pushing more mentally ill individuals onto public assistance?
  • Minorities have less access to mental health services, but equal or better mental health status compared to whites, despite lower socioeconomic status and greater social problems. Questions remain about possible cultural protective factors and barriers to access.
  • The majority of individuals who experience mental illness receive services from specialized groups who assist with housing, employment or treatment. They are often left to navigate this array of services on their own. Appropriate “public stewards” could help to overcome political, structural and administrative obstacles to providing holistic services.

MacArthur has funded mental health research since its founding 30 years ago. Following the thrust of its research network’s findings, it has begun a more distributed grantmaking strategy that addresses mental health where we are faced with the issue—in schools, communities and the justice system. The Foundation is, for example, supporting New York-based MDRC to evaluate and perform a rigorous cost benefit analysis of a demonstration in 60 Head Start classrooms in Chicago of the impact of a mental health professional in the classroom. It is also working on preservation of affordable rental housing across the country, including stemming the loss of supportive housing.

The Foundation’s own Models for Change national juvenile justice systems reform initiative is investing more than $11 million dollars aimed at developing better strategies to identify and treat youth with mental health needs in the juvenile justice system and to make sure that those strategies are understood and valued across the country.

About the Mental Health Policy Research Network
MacArthur created the Network on Mental Health Policy Research in 1999 to conduct research and analysis to guide health policymakers. Network members come from diverse fields, including psychiatry, psychology, sociology, pediatrics, economics, business, and law. The Network has addressed the major policy challenges of the next decade and examined ways to deliver high quality care both within and beyond the traditional boundaries of the mental health system. More information available at www.fundamentalpolicy.org.

Read the briefs below.

Health, Policy, Research