May 17, 2019
Actress Glenn Close still remembers vividly the dramatic and troubling scene when her nephew, Calen, had a psychotic break as a 17-year-old living in Montana.
“He had to be put in a straitjacket and driven two hours to the closest place where he could get help,” Close said at a Washington Post Live event yesterday.
The lack of accessible help for Calen -- and that he had to go to the emergency room instead of getting treatment prior -- is part of the reason she’s asking Congress to expand and extend funding for mental health care through a pilot program scheduled to expire on July 1.
Close became a mental health advocate after encountering serious illness within her own family — not just Calen, who has schizophrenia, but also her sister Jessie, diagnosed with bipolar disorder with psychotic tendencies.
She’s backing a program approved five years ago under a bill from Sens. Roy Blunt (R-Mo.) and Debbie Stabenow (D-Mich.), which the senators are now trying to expand from eight states to 19 states for another two years. The bill gives extra Medicaid dollars to community clinics in return for providing a wide range of mental health services. Its aim is to correct a shortcoming in the country’s health-care system, which often prioritizes care for physical ailments but not for mental conditions such as depression, anxiety or bipolar disorder.
Under the pilot, more than 350 health clinics serving a quarter-million Medicaid patients have been able to get fully reimbursed by the federal government for the full range of mental health care. If funding isn’t extended, the centers may have to lay off 3,000 newly hired staff, cut off medication-assisted treatment to 9,000 patients and reestablish wait lists for mental health services, according to estimates provided by the senators’ offices.
“We have seen psychiatric crisis services, 24-hour services, start up in the community,” Stabenow said. “So, someone's not going to the jail, someone's not sitting in emergency room for hours or maybe days trying to get help, and it's transforming those communities.”
Diagnoses of mental illness are on the rise in the United States, particularly among youth. Substance abuse, which often goes hand in hand with mental illness, has also spiked. Yet a large share of people don’t get the help they need, due to a variety of reasons including stigma, insufficient insurance coverage and the unique nature of mental illness, which can discourage patients from seeking care independently.
That was the case for Close’s sister and her nephew. She described her shock when Jessie confided in her that she couldn’t stop thinking about killing herself.
“Our family had absolutely no vocabulary for mental health,” Close said. “We just — we didn’t really get it…I had no clue. She was very good at keeping what she was going through from all of us.”
The Substance Abuse and Mental Health Services Administration estimates that half of adults and teens with any mental illness and one-third of adults with serious mental illness don’t get any kind of treatment. Blunt and Stabenow’s bill tries to get at the problem by expanding mental health services covered via Medicaid, the government program for the low income which is also the single-largest payer of mental health services in the United States.
To be eligible for the increased Medicaid payments, a clinic must be certified as a Community Behavioral Health Clinic. That involves showing it provides a comprehensive set of services including 24-hour crisis counseling, substance abuse treatment and mental illness screenings. Part of the idea is to make treatment more readily available to patients before they end up in emergency rooms or in the criminal justice system.
“For the better part of 50 years the emergency room and law enforcement have been the de facto mental health delivery system in the country,” Blunt said. “And nobody is well served by that or satisfied by that.”
Stabenow said she’ll never forget when the sheriff in Cook County, Ill., told her he had just hired a psychiatrist as a jail director.
“He said, ‘Well, it’s real simple. Over half the people in my jail have mental health problems,’ ” Stabenow recalled.
Then there’s the issue of stigma, a major reason people don’t seek out help before their illnesses make it hard to function. Both Jessie and Calen found the stigma around their illnesses was “just as painful” as dealing with the illnesses themselves, Close said.
“Calen lost all his friends,” Close said. “Jessie felt that she was frightened to tell parents about her bipolar disorder because she was afraid they wouldn’t allow their children to come and play with her young daughter at the time.”
There are signs that the stigma is starting to thin, as more public figures share their own experiences. Sen. Tina Smith (D-Minn.), took to the Senate floor on Wednesday to share her struggle with depression that started in college and returned in her 30s. She described the experience as a “spiral” and called herself “one of the lucky ones” because she had insurance that allowed her to see a therapist.
“Down and down I went, until I could no longer see hope on the horizon,” Smith said. “Now, I was never suicidal, but I was struggling to function. I definitely wasn’t living my best life; I really wasn’t living at all. And that’s the reality for mental illness for millions of Americans.”
But talking more about mental illness has raised another concern among advocates: that it’s possible to address the topic in unhelpful ways, ways that could even trigger people to act upon suicidal thoughts. The Netflix series “13 Reasons Why” recently came under scrutiny when a study purported to find a spike in youth suicides in the month after the show was released.
Close called the series “irresponsible.”
“My sister went through suicide ideation,” Close said. “She tried to end her life twice. And I think you have to take responsibility because there’s so much potential for impact with our social media. You really have to take responsibility for the stories that you tell.”
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