In opening the 2013 National Council for Behavioral Health Conference, National Council President and CEO Linda Rosenberg remembered the last piece of legislation signed by President John Kennedy, only weeks before his death: the Community Mental Health Act of 1963. Invoking the spirit of the deceased president, Rosenberg remembered the hope of the time and of the community behavioral healthcare movement, for a “bold new approach in which the cruel mercy of custodial care could be replaced by the open door of community care.”
“JFK was relentlessly optimistic about the potential of science and public policy to improve the lives of people with mental illnesses and developmental disabilities,” said Rosenberg. “He told us that there was a new frontier and asked us to be pioneers in that frontier. You,” she continued, signaling the audience, “are behavioral health’s pioneers, helping to uncover the science of the mind, to undo ignorance and prejudice, to grasp the impact of poverty on health.”
In the beginning, she remembered, those pioneers were relatively few. The National Council, she continued, “began in 1963 with 96 community mental health centers as members.” Today, she continued, after years of vigorous growth, the movement has grown to encompass more than 2,000 such centers, employing more than half a million individuals who care for more than eight million Americans with behavioral health diagnoses each year.
A key source of that growing care population, of course, were the thousands of state psychiatric patients affected by deinstitutionalization in the 1960s and 1970s. At the peak, more than 1.5 million individuals were institutionalized in psychiatric hospitals, places Rosenberg described as “little more than warehouses.” It was in this setting—the fading world of custodial, institutional care—where Rosenberg, then a recent college graduate, got her own career started.
Like so many in the field, Rosenberg continues to find inspiration in Kennedy’s new frontier, even 50 years later. While she celebrated the fact that “today, a higher proportion of people with mental illnesses get treatment than ever before and are more likely to get treatment in their community than in a psychiatric hospital,” she also lamented that “mental illness remains the largest source of morbidity in society.” Among the millions that receive little or no care, she said that many are in jails or housed in nursing homes or adult homes that continue to provide only custodial care.”
“We’ve only begun to move the needle on public mental health problems,” noting the recent spate of public and legislative attention resulting from recent gun-related tragedies linked, in several cases, to mentally ill individuals.
She concluded her talk with a call to the audience for support of what she called “three opportunities” to continue the effort to bring mental illness out of the shadows.” First, she asked for support of the Mental Health First Aid Act, now being considered in Congress, which will train community first responders to recognize and work more effectively to engage those with behavioral health problems in treatment.
Second, she asked for support of policies that adequately fund treatment, notably the Excellence in Mental Health Act, which calls for federally qualified behavioral health centers, which would have the same level of federal safety net support as federally qualified health centers.
And thirdly, she asked the audience to support policies that “help us to explain the outcomes that we are achieving using information technology” through passage of the Behavioral Health Information technology act—an act that would dramatically expand the availability of federal incentives for behavioral health organizations, not just individual providers.
Harking back to the 60s, Rosenberg concluded by stating “there will never be a better time to reclaim the new frontier” in behavioral healthcare. Ultimately, she said, “we shall prevail.”