The time is right to change the way mental health is treated in America.
That's how Kathryn Berger sees it. And as someone who has worked in county policy for decades, first as a policy advocate and now as a supervisor in Los Angeles County, California, she has seen people's perceptions shift in that direction. .
“We've seen a shift in the last few years in the fact that people are starting to realize that the status quo isn't working,” she said. “Twenty years ago, there would have been little momentum in California to change the law, let alone the basic definition of 'severely disabled.'” We are beginning to realize that we need to seriously rethink health and services. [as well as] how we provide them. ”
Berger and Dow Constantine of King County, Washington, co-chair the NACo Committee on Mental Health and Human Services. Constantine said changes in public perception won't happen quickly.
“We recognize that what we see in our prisons and on our streets is only the tip of the iceberg, that serious suffering is occurring in every community, and that we have a duty to do everything in our power to help people. “You have to understand that there's a challenge. Keep up the challenge,” he said.
What we heard from constituents helped shape our understanding of how mental health issues impact our communities. Constantine said she has seen mental illness plague families despite ample resources.
“If someone who has all this support and is surrounded by family and a network of high-functioning people can’t take advantage of the help that’s available to them, what chance does someone who doesn’t have those benefits have? ” he asked.
Berger hears what at first glance seems like a counterintuitive response from voters.
“I've talked to families who are relieved that their loved one has been arrested because at least they know where their loved one is at night and they won't get a phone call from the coroner,” she said.
Both Berger and Constantine said they recognize that co-occurring substance use disorders complicate the issue.
“Fentanyl is a really big challenge,” Constantine said. “We do a lot of interdiction work, but it's difficult because fentanyl is so compact.”
Berger sees an increase in complications when people self-medicate.
“The drugs that are on the streets are so powerful that they cause psychosis and take mental illness to a whole new level. Whether it's methamphetamine use in Los Angeles, drugs are becoming more violent and more agitated. It could be a condition, or it could be the use of oxycodone. That makes them much calmer, but either way it creates new challenges in dealing with people facing mental illness.” Berger said. “A lot of them were faking mental illness through drug use, and that's what changed. When you get someone clean, that person's mental illness starts to show, and then you start finding ways to treat both layers. ”
The purpose of the NACo Committee is to:
- Modify exclusion policies under Medicaid that cause residents to become ineligible for Medicaid before being adjudicated.
- Strengthen mental health equity and adjust disparities in mental health and substance use disorder coverage in public and private health insurance plans
- Develop and support mental health human resources
- Build and strengthen local crisis response systems
Both co-chair counties have enacted policies that address the needs of local emergency response systems.
King County's Crisis Care Center Levy raises $1.25 billion to build a network of centers where people in crisis can stay for 23 hours or two weeks and start on the road to recovery. There is.
“We are easing our most critical bottlenecks by increasing the number of treatment beds in our communities and bringing in the next generation of behavioral health workers who are representative of the communities we seek to serve. ” Constantine said.
Los Angeles County expanded its psychiatric evaluation team, which combines law enforcement and clinical psychologists or laboratory technicians, to respond on the road.
“Less than 1% of those situations end up in prison,” Berger said. “They can triage and de-escalate or refer to services and they don’t have to take someone in and arrest them.
“These types of programs (coordination between law enforcement and clinical psychologists or laboratory technicians) are important. Law enforcement knows how to enforce the law, but what do they do when someone has a seizure? I'm very proud of that because I've never been trained to do that. ”
They hope to find a better source of funding than property taxes.
“Whenever we need to respond to a community challenge, it means relying on one of these highly imperfect sources of income,” Constantine said.
“As a country, we need to resolve to tackle mental health and addiction in the way we have regularly tackled them, and not continue to sweep this under the rug for generations,” he added. Ta.
“Government alone cannot solve this problem,” Berger said. “I think it's important to recognize that we play an important role, but it's nonprofits that need to have a seat at the table to find better solutions, and different sectors. is a partner of the National Alliance on Mental Illness, how the system works from a government perspective. This may not always be reflected when you try to access the service in real time. ”
