The Overall Crisis in America’s Mental Health Treatment System

This initial post to this blog will introduce the reader to what this blog will be mostly addressing: the ongoing crisis in the United State’s mental health treatment system. I as a psychiatrist started tracking this slow motion crisis in the 1980’s when the state of Massachusetts uinderwent a number of changes under the then new and catchy codephrase of the future” mental health reform. It began with statewide changes in mental health funding; while lauded, it resulted in such disastrous funding for mental health services that one of the then medical school psychiatric departments, Tufts Medical School, had to sell off its child psychiatry service to Harvard to survive and continue to operate. Then the state of Michigan under the then Governor, Republican John Engler, whose approach foreshadowed the cut mental health funding approaches of the future in his multi-term tenure as governor slashed the state’s mental health system, closed state hospitals and reduced state hospital psychiatric beds by over 50%, and privatized the system in short order, throwing the system into chaos. Then the mental health reform revolution moved from Michigan to North Carolina in 1999-2000, fashioned by the same group of privatizing, slash and burn group. NC is where I have long practiced over 2/3 of my career since training at Duke in the 1970’s. The same spreadsheet based system from Michigan and in part from Massachusetts was sold, in my view, as a bill of goods to the “Oversight Committee” of the General Assembly of NC, given a two month comment period and instituted in short order over the statewide protest os hundreds of psychiatrists, psychologists, social workers, mental health advocates and all the state level professional organizations such as the NC Psychology Association, the NC Association of Social Workers and the NC Psychiatric Society. since then other states have gone down this path in eerily similar plans with the results that resources have been lost such as state psychiatric hospital beds, statewide systems such as the previously well functioning county based mental health centers, and, the promised mega-menu of outpatient mental health systems and providers of care ranging from developmental evaluation centers, mental health crisis stabilization units, new regional smaller “state hospitals,” mental health group homes and services for substance abuse and the intellectually disabled did not appear for over 12 years on average3, throwing the patient populations and their families into chaos and tragedies repeated all over the country.

Many series of inestimable value have been documented in the American public media, one of the earliest being a long series in the late 1990’s in the Detroit Free Press, which is no longer available online due to it appears, the cutbacks in that long revered newspaper’s slide into a much reduced state of publishing akin to the economic debacle in the city of Detroit. Other award winning series have documented the issues since, but I will refer the reader to the most recent at the time of this writing in The Guardian as of this past month and prior, at This series will give the reader as good and as timely an introduction to all these issues as well as any previous similar series. This entire topic will be the main focus of the commentary of this blog.

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