o Ensure Delivery of State-of-the-Art Treatments: A wide variety of
effective, community-based services--carefully refined through years of
research--exist for even the most severe mental illnesses, but they are
not yet widely available in community settings. We need to ensure that
mental health services are as universally accessible as other health
services in the continuously changing health care delivery system. We
must speed the transfer of new information from the research setting into
the service delivery setting.
o Tailor Treatment to Individuals, Acknowledging Age, Gender, Race
and Culture: To be optimally effective, diagnosis and treatment of mental
illness must be attentive to these factors. Patients often prefer to be
treated by mental health professionals who are of the same racial and
ethnic background, a fact that underscores the need to wain more
minorities in the mental health professions.
o Facilitate Entry into Treatment: Access to mental health services
can be improved immediately if we enhance the abilities of primary care
providers, public schools, the child welfare system and others to help
people with mental health problems seek treatment. In addition, ensuring
ready access to appropriate services for people with severe mental
disorders promises to significantly reduce the need for involuntary care,
which is sometimes required in order to prevent behavior that could be
harmful to oneself or others.
o Reduce Financial Barriers to Treatment: Equality or parity
between mental health coverage and other health coverage is an affordable
and effective way to decrease the number of ill people who are not
receiving proper treatment.
The U.S. system is extremely complex; it is a hybrid system that
serves many people well, but often seems fragmented and inaccessible to
those with the most extensive problems and fewest financial resources.
Critical gaps exist between those who need services and those who receive
them; only about 40% of those with severe disorders use any services at
all.
Although research shows little direct evidence of problems with
quality in mental health service programs, there are signs that programs
could be better implemented, especially ones that serve children and
people with serious impairment. While an array of quality monitoring and
improvement methods have been developed, incentives to improve conditions
lag behind incentives to reduce costs.
These inequities in insurance coverage for mental and physical
health care have prompted 27 states to adopt legislation requiring
parity, and compelled President Clinton to order the Federal Employees
Health Benefits Program to provide parity for federal employees by the
year 2001. Some localized attempts at creating parity so far have
resulted in better mental health service access at negligible cost
increases for managed care organizations.
Issues relating to mental health and mental illness have been
overlooked or ignored in this country too often and for too long. While
we cannot change the past, I am convinced that we can shape a better
future.
IMAGES FROM WITHIN
Truth be told, we tend to consider mental illness in the abstract,
as the misfortune of strangers. In these compelling portraits, however,
photographer Marc Hauser reveals the individuality and humanity of
sufferers of mental illness. They are cat owners and car lovers, uncles
and neighbors. They are all clients of the Lockport Center for Behavioral
Health in Will County, Illinois. A complete collection of their
portraits, with text by Alisa Hauser, appears in Images From Within:
Portraits of People Confronting Mental Illness (High Tide Press,
1999).
GREG GIANNINI
I'd describe myself as a regular person .... Most of the time I
like taking walks around my house. Before I was living in a group home
out in the country and there weren't that many stores or streets to walk
on. I like walking to 7-Eleven and Mr. D's fast food.
ROSE CLARK
Sometimes I wake up so sick, but then I go to work and feel better.
Being with animals makes me feel 100% better. Does that sound
funny?
I love my boss. He's crazy. When he does surgery he dances, does
the jitterbug. Sometimes I go into surgery with him to make sure all the
animals are lying down straight and not awake. Mostly my responsibilities
are taking care of the cages and general cleaning.
I've been with this program for four years. Since then I've gone
back to school and gotten a job. I live in my own apartment, got two
cats, and have a checking and savings account.
TONY RIVERA
When I first came to the Pastimes Cafe & Antiques I told them
that it reminds me of the coffee shops in Baltimore and Maryland. They
laughed and we've been friends for two yearn. They know my name when I
walk in. I used to know all their names but I only come every few weeks
now and I can't remember. They make me feel comfortable, like I'm not
bothering anybody.
KATHY MOLYNEAUX
I didn't know I was depressed until after college. I just thought
everyone felt the same way I did. I had problems sleeping, feeling down,
overwhelmed, worried and not happy. My graduation from DePaul University
in 1983 was a good day. After college, I worked successfully as a nurse
for 13 years. I felt like I could relate to the patients because I had
been there myself.
SHERYL CAUDLE
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