Disintegrating Systems:
The State of States’ Public Mental Health Systems

From the foreword to Disintegrating Systems:

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A Call for Action

The reports and investigations quoted in this 24-page report attest to the unraveling of the nation's public policy for meeting the needs of people with major mental illnesses.

For decades, state mental health systems have been burdened with ineffective service-delivery programs and stagnant bureaucracies. Their operations have become rote, spurred to change only by crises. Combined with ever-increasing fiscal pressures, this situation has precluded innovation and kept most systems from incorporating the new and more effective interventions developed in recent years. As a result, patched-up state mental health systems have all but disintegrated, falling ever farther from the ideal of accessible, effective services that promote meaningful community membership.

Almost everywhere, consumers and families are frustrated, providers are overwhelmed and state mental health administrators are beleaguered. Policymakers and taxpayers alike should be concerned because the result is both unnecessary human suffering and a waste of precious resources.

Although many isolated examples exist of exemplary programs, these are rarely brought to scale and made available to significant numbers of people in need. These successes (often funded with demonstration dollars for limited periods) illustrate the potential for positive change, given adequate resources and political will. Yet they are overshadowed by the failings described in this report-signposts on the road to disintegration. Consider, for example, the following from two states' mental health commissions:

• Specific state initiatives have been effective, but none represents a system-wide strategy to these problems. (Florida)
• The public mental health safety net is stretched too thin and has holes in some places. Statewide, the supply of mental health services does not meet current demand and will not meet increasing demand in the future. (Ohio)

This situation exists not because we lack information about what to do. It exists because, collectively, we have chosen not to do it. The Surgeon General of the United States in his 1999 report on mental health deplored "the gap between what is known from research and what is practiced" and cites "a range of treatments of documented efficacy...for most mental disorders," few of which are widely available in most public mental health systems.

The Bazelon Center’s Report

The Bazelon Center for Mental Health Law collected recent materials from 35 states. The documents come from various state sources, primarily independent commissions or task forces,but also investigative journalists, advocacy organizations and states' own mental health authorities. The excerpts quoted illustrate a wider picture than the image they reflect of a problem in any one state. The same themes were found, variously worded, in documents from all of the states, and are supported by other research and policy literature known to the Bazelon Center.

Reports from some states are quoted more often than others. This should not be taken to mean that some states are in particular crisis or that, conversely, those without cited reports have fully functional systems. Review of the documents revealed that both the facts and the critiques are common-that the state of all states' mental health systems is very similar and the policy recommendations are parallel.

It is past time to elevate public mental health to a position of priority that more truly reflects the impact and the cost of mental illness. Failure to exercise the political will to do this will guarantee the continuing disintegration of state mental health systems, leaving more and more people with nowhere to turn. Accordingly, the Bazelon Center has developed a model law providing an entitlement to recovery-oriented mental health services and supports. We urge advocates and policymakers in the states to examine our new vision of public mental health and consider adapting the model to their state's circumstances.

The 24-page report is available through the Bazelon Center Online Bookstore or the order form on our Publications Page.