In response to the recent Oregon shooting, for example, previous presidential candidate Ben Carson cited mental illness as an underlying issue rather than inadequate firearm regulations. It seems that there is nothing like a mass shooting to suddenly spark political interest in mental health. However, the aftermath of a mass shooting, might be the worst time to actually talk about mental health. In 2014, the Annals of Epidemiology found that a large majority of people with mental disorders do not partake in violent activities. The American Journal of Public Health also published that “fewer than 5% of the 120,000 gun-related killings… were perpetrated by people diagnosed with mental illness.” In fact, “…adults with mental illnesses were more likely to be victims than perpetrators of community violence.” The fact that we talk about mental health in a gun related context is deeply misleading. But if now is the only time for society to actually have a conversation about mental health, then perhaps we should do it.
Our approaches to managing mentally ill citizens have been neither appropriate nor beneficial. Last year, the Associated Press found that nearly 125,000 young and middle aged adults with serious mental illnesses lived in U.S. nursing homes. Worse yet, over 2 million people with mental illness end up in prison each year, which is ten times the amount found in state-funded psychiatric treatment facilities. Jails house the most mentally ill, but using the criminal justice system to treat the mentally ill is not just ineffective; it is dangerous and costly. For example, police response to mental health crises sometimes end in tragedy. Of the people shot at and killed by police this year, at least half endured mental health problems. Fortunately, some police forces are creating units dedicated to addressing this issue. Crisis intervention trainings (CIT), which are programs designed to divert the mentally ill out of jails and into adequate treatment centers, have been implemented into law enforcement trainings. However, only 15% of law enforcement agencies, excluding special units, use the training program, and even so, they regard the modules as voluntary. Fortunately, The New York City Police Department has begun to incorporate this intervention in its training models. However, mental health advocates have found that only 4,000 NYPD officers have received the training and when there are mental health cases, The Emergency Service Unit is called in instead of the CIT officers.
New York City Mayor Bill de Blasio has already begun to introduce the city to new methods and mindsets when it comes to addressing the unmet needs of New York residents who are struggling with mental illness. ThriveNYC, a 2015 public initiative, will provide $850 million in funding for mental health programs over the next four years. A crucial investment will be providing mental health first aid training to 25,000 people, starting with police officers and firefighters. While there has been skepticism surrounding ThriveNYC and its programs focusing more on the “worried well” rather than the mentally ill homeless, I believe that this is a step in the right direction.
There is no need to reinvent the wheel when New York City has already begun to acknowledge and implement social welfare policies for mental health. There is always room for improvement and I do believe that additional measures need to be implemented to address the mental health epidemic. Not only should more NYPD officers be receiving crisis intervention trainings and not only should initiatives like ThriveNYC be set in motion, but there also needs to be an overall intensive and highly integrated approach for community mental health service delivery in New York City. Designed to let those with serious mental illnesses live in the community, I propose that New York should offer services that provide regular in-home visits and help coordinate assistance with housing and employment. Mental health therapy is not just centered around visiting a psychiatrist, it is also about having entitlements in place or having rent paid on time. Instead of meeting with the client talking about how they are doing and how they feel once or twice a month, I propose that New York programs do everything it takes for people to live independently. There needs to be a major increase in funding for rehabilitation efforts. A major portion of this funding would be in the form of grants to build new rehabilitation centers and programming grants to current centers that are particularly effective or innovative.
There should also be funding for academic research to see which methods are working, and why they are working. It would be required for the organizations accepting grant money to treat patients from an interdisciplinary perspective, focusing on the whole person. Programs would also include improved education and job-training resources for patients. The guiding principles behind the policy proposal are simple: more education and rehabilitation, less stigmatization and incarceration. It is imperative to engage communities in the policymaking process for policies that directly affect them, so before finalizing this policy, one must consider input from the users themselves, their families, and the professionals that would be implementing it. As a society, we need to figure out how to fund them, not just because it makes fiscal sense, but because it would save lives. If we constantly use mental illness to dodge conversations about gun control, then the very least we could do is create a plan.