The U.S. has only 11 mental health beds in general hospitals per 100,000 people, according to the most recent data available from the World Health Organization.
This is not a shock, since this number has been falling since the 1950s. However, the same study revealed that the U.S. was not keeping up with its peers.
Monaco and Finland topped the list with 148 and 147 beds per 100,000, respectively. Japan and France are the only other G7 (Group of Seven) countries in the study and reported 66 and 22 beds, respectively.
This forces us to ask why the U.S. rate is so low. The answer is linked to the nation’s history of mental health care.
In 1955, the number of acute long-term mental health patients peaked at 559,000 (430 per 100,000).
This led to a rethinking of how to care for these patients during an era in which a growing segment of the U.S. was working toward racial and gender equality, as well as respect and justice for all.
Congressional and public inquiries into abuses at state run hospitals directly precipitated changes.
The most notable investigation began in 1965, looking into Willowbrook State School.
The facility was only meant for 4,000 residents but was housing over 6,000 intellectually disabled children in horrid conditions. Public outcry ultimately forced New York City to begin closing the school in 1974.
Ken Kesey’s book, One Flew Over the Cuckoo’s Nest, also contributed to public awareness about what was happening within the walls of asylums. His work directly turned public opinion against the barbaric practices of lobotomies and electroshock therapy.
Of course, there were also economic considerations. Big asylums were not only places where horrific abuses were taking place, but also were expensive. So, cost containment factored into the push for new approaches.
An effort was launched to move mental health patients out of large institutions and state hospitals to community-based centers (CBCs), which were less restrictive for the patients and provided a more nurturing environment. This allowed for more appropriate and compassionate treatment.
To that end, President John F. Kennedy signed the Community Mental Health Act in 1963, which sought to build community-based preventive care and treatment facilities.
However, with the passage of Medicaid in 1965, states began to move patients from hospitals to nursing homes. This was because Medicaid originally did not cover “institutions for mental diseases.”
By transferring patients to nursing homes, states could continue to get funds for the long-term housing of mental health patients. This bypassed the emerging CBC system.
President Jimmy Carter continued the CBC movement by signing the Mental Health Systems Act in 1980. Unfortunately, one year later President Ronald Reagan signed the Omnibus Budget Reconciliation Act, which eliminated the federal government’s direct role in mental health services by giving direct grants to states.
While this helped the federal government reduce its mental health spending by 30%, by 1984 only 11% of community mental-health agencies’ budgets were covered by federal grants. As a result, the CBC system envisioned by Kennedy and Carter never received the appropriate funding that would have ensured its success.
Therefore, between 1955 and 1994, the country saw 487,000 mentally ill patients discharged from state-run hospitals.
The drastic decline caused most of the psychiatric facilities in the country to close, resulting in a shortage of mental health beds and services that continues to plague the U.S. health system.
During this reduction of inpatient beds, the number of people needing mental health services has increased.
For example, following significant cuts in Rhode Island between 2008 and 2011, the state saw a 65% increase in pediatric mental health admissions to hospital emergency rooms. Other states experienced similar trends.
Crisis and emergency mental health care in an emergency room setting are costly and less effective, which means that state budget cuts do not ultimately save any money.
Rather, it actually costs the public more because the lack of other options causes frequent and expensive admissions that could have been avoided with a CBC.
The lack of mental health beds at general hospitals and psychiatric facilities has given rise to the number of mental health patients who are incarcerated.
The Treatment Advocacy Center estimates there are 10 times the number of individuals with serious mental illness in jails and prisons as in state hospitals.
Inmates who wrestle with mental illness are not provided effective treatment options while behind bars.
Not only is this cruel but it is also not cost effective, as the housing of mentally ill inmates can cost three times more than if they were in a community mental health center. It also creates a vicious cycle as these individuals move in and out of the prison system.
We need to seriously rethink our mental health care system. Our current approach is not compassionate, effective or cost efficient.
We need to learn from the past and consider fully funding the CBC programs, which can provide access to quality, affordable care for those who need it the most.
How Christians respond to people who are hurting physically and mentally says as much about our beliefs as the gospel we preach.
Editor’s note: May is Mental Health Awareness Month. A series of articles published during the week of May 17-21 that focused on mental health is available here.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
