June 10, 2002
The Jewish Council for Public Affairs has consistently supported comprehensive, accessible, affordable, quality health care coverage for individuals and families regardless of income. This includes mental as well as physical health care, consistent with our understanding that Judaism concerns itself with the health of the mind and soul as well as the body. According to the teachings of Maimonides: “When someone is overpowered by imagination, prolonged meditation and avoidance of social contact, which he never exhibited before, or when he avoids pleasant experiences which were in him before, the physician should do nothing before he improves the soul by removing the extreme emotions.”
Mental illness can shatter lives, bringing suffering not only to individuals but also to family and friends. Its impact is felt in every sector of life, making access to effective, quality treatment an important social issue with far-reaching economic and human welfare implications. One in every five adults and as many as three million children of every race, gender, and ethnicity, experience some type of diagnosable mental disorder each year. Among those 55 and older, nearly 20 percent experience specific mental illnesses not associated with normal aging. Yet, while those with physical illness are generally treated with solicitude and concern, those with mental illness are more often marginalized, viewed with contempt, fear, or ridicule. Although many mental illnesses can now be treated effectively, less than one third of adults and half the children with a diagnosable mental disorder receive treatment in any year, largely the result of stigmatization, limited access, and inadequate funding.
Despite research suggesting that mental health insurance parity would increase premiums only slightly and provide care that would save money over the long term, most health insurance policies set more restrictive annual and lifetime limits for mental health than for other health care benefits. In the public sphere, Medicare coverage is lower for outpatient mental health treatment than for other outpatient services, and there is a lifetime limit of 190 days on coverage for care in a psychiatric hospital. Moreover, mental health spending for Medicaid, Medicare, and other federal programs has grown more slowly than overall program spending, while over the last decade state level spending on mental health systems has declined.
The inability of many with serious mental illness to access comprehensive and timely mental health services has caused unnecessary institutionalization, homelessness, dependence and incarceration, all of which carry significant economic and social costs. As illness prevents people from carrying out the essential functions of daily life, it can push them out of jobs and ultimately out of homes. Homelessness itself impedes recovery and may worsen illness, pushing many into the criminal justice system. While some individuals with mental illness are incarcerated for minor crimes and status offenses, others may be driven by their illness to commit violent crimes. All are in need of appropriate mental health care and treatment while they are incarcerated.
Finally, among the more tragic outcomes of inadequate mental health care is the high rate of emotional and mental disorder within the juvenile justice population. The problems these children face are often exacerbated by detention facility staff who are not trained to recognize and deal effectively with mental health disorders. At the same time, many youngsters who are mentally ill commit minor, nonviolent or status offenses and would be better served by a system of closely supervised community-based services.
While millions of dollars are spent dealing with the consequences of untreated mental illness, investment to improve access and treatment options, and to more effectively coordinate service delivery remains seriously inadequate. The nation must act to close the gap between what research has revealed about effective mental health care and what is currently available, to expand access to a comprehensive system of care for people with mental illness. The JCPA will therefore support:
- Federal and state legislation to require parity between physical and mental health coverage by health insurance carriers, both private and public;
- Increased funding for mental health services, as well as for mental health research and the development and testing of innovative mental health programs;
- Greater government and community support for assistance to family caregivers who struggle to coordinate services from numerous public and private sources;
- State legislation to provide funding to fully implement the Olmstead Supreme Court decision to provide community based treatment for those with mental illness when placement in a less restrictive setting is appropriate;
- Government integration and coordination of quality housing and mental health systems to provide comprehensive assistance (including access to a variety of affordable housing options from independent living arrangements to supported or supervised arrangements);
- An end to unlawful workplace discrimination against those with mental illness, in fact as well as in law; government development of additional programs to aid qualified workers with mental illness in returning to the workplace, and to assist employers in working with them;
- Mechanisms to ensure that those who are incarcerated and suffer from mental illness receive appropriate and humane treatment; placement of nonviolent, mentally ill criminal offenders in community-based mental health programs;
- Law enforcement agency policies, practices, and specialized training to help police and corrections officers deal appropriately with individuals with mental illnesses;
- Greater government attention to the youth within the justice system, and the need for increased funding for community-based treatment programs for this population;
- Greater resources devoted to “problem-solving courts”, whose charge will be to holistically address the needs of mentally ill defendants.
- A coordinated system of care for children and teenagers with mental health problems emphasizing early recognition, prevention, and intervention;
- In those states and federal jurisdictions that retain the death penalty, exclusion of people with mental illness from consideration for a death penalty sentence.
Further, the JCPA calls on Jewish communal organizations and agencies to:
- Provide health coverage for employees that guarantees parity in mental health coverage;
- Participate in communal efforts to de-stigmatize mental illness, to provide accurate information about mental health problems, improve public awareness of effective treatment, and encourage individuals to seek help.