Steps To Reform Our Broken Mental Health System

1. Centralize mental health administration

Transferring final administrative responsibility for the community mental health care system to the state Department of Human Services, like the state hospital system, rather than individual counties.

This would reduce administrative duplication between counties and make it easier to allocate community-based services to regions of the state that need them the most.

2. Suspend, don’t terminate, Medicaid benefits

Change administrative rules to suspend Medicaid benefits for pre-trial detainees rather than terminate them.

When a Pennsylvania resident is covered by Medicaid, a federally funded, state administered health insurance program for low-income people, they lose that coverage when they’re jailed – regardless of whether they’re found innocent or guilty of the charges facing them.

This is a problem for people with mentally illnesses because, upon their release from county prisons, they are forced to sign up again for Medicaid. This process can take weeks and, for a person who isn’t thinking clearly, can be particularly arduous.

In order to fix this, Pennsylvania’s Department of Human Services should work with the federal government to apply for a waiver to allow the state to suspend Medicaid benefits for all pre-trial detainees rather than terminating those benefits. That would make it easier to turn those benefits ‘back on’ for a person with a serious mental illness when they’re released from jail.

3. Fund public awareness campaigns

Increase public awareness campaigns about mental illness.

4. Expand assisted outpatient treatment

Some mental health advocates say one of the major reasons that so many seriously mentally ill people end up in prison or living on the streets is that they eventually stop taking their prescribed medication or refuse therapy because they don’t think they need help.

This is particularly acute among people with bipolar disorder and schizophrenia, roughly half of who don’t believe they have a mental illness. This condition is known as “anosognosia” within the field. 

5. Restore cuts to community mental health programs

Restore funding for community mental health services to pre-2012 levels.

County mental health departments, which provide the bulk of community mental health services (services like group homes and caseworkers) have historically been underfunded, according to mental health advocates and mental health workers.

6. Expand mental health courts

Provide incentives for counties to establish mental health courts.

Mental health care advocates argue that there’s often little point in punishing a seriously mentally ill person who committed a minor offense when that person was in a psychotic or delusional state at the time of the offense. 

7. Increase state hospital beds

Expand Pennsylvania’s psychiatric inpatient hospital beds.

Experts and academics typically point to the dramatic closure of state psychiatric hospitals since the 1950s, coupled with underinvestment in community mental health services, as the major reason that U.S prisons have become so filled with seriously mentally ill people.

Many mental health care advocates maintain that Pennsylvania and other states have cut too many state hospital beds for people who genuinely need a short-term or long-term stay in an intensive hospital setting.

In 1955, Pennsylvania had about 41,000 beds. Today, with a state population that is 15 percent larger, it now has only 1,500 beds.

Dominic Sisti, an assistant professor of medical ethics and health Policy for the University of Pennsylvania, says research shows that nationally there are too few psychiatric hospital beds to meet demand.

“For episodic, acute situations, for short stays of one to two weeks, and extended stays for the very severe cases, those beds are very few and far between,” Sisti says.

He adds that in order to create a comprehensive mental health care system, states need to expand inpatient beds in conjunction with expanded community mental health services and better methods of diverting seriously mentally ill people who enter the criminal justice system.

8. Promote informed consent:

Informed consent is a crucial aspect of mental health care that respects individual autonomy and decision-making. Mental health providers should be required to fully inform patients of the risks and benefits of treatment options, including any potential side effects, and obtain consent from patients before administering any treatment.

9. Reduce reliance on involuntary hospitalization:

Involuntary hospitalization is a coercive measure that restricts an individual’s liberty without their consent. Mental health reform should aim to reduce reliance on involuntary hospitalization and promote alternative interventions, such as crisis intervention and community-based services.