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Tuesday, November 20, 2012

NHBPM #20: Don't get upset, Mr. McMurphy

11:00 AM Posted by Tiffany Taft , , ,
A couple days ago one of the prompts for the NHBPM was "I want to change THIS about healthcare..."  There are many issues with our healthcare system, and I don't claim to be an omnipotent being in understanding their intricacies nor their solutions.  And as we know, opinions are like...you know, and everyone's got one.  But if I could wave a magic wand and change one thing about healthcare, it'd be the state of affairs in mental health services for the poor.

I was born at the end of 1975, and the winner of the Best Picture Academy Award that year was One Flew Over the Cuckoo's Nest.  Jack Nicholson won Best Actor as McMurphy, an ex-con who opts to do time in a mental hospital in the 1950s rather than prison, and Louise Fletcher won Best Actress for her stellar performance as the much-hated Nurse Ratched.

I would love to say how much progress has been made in caring for people with more serious mental illness in the United States since we caught a glimpse into life, if you can call it that, in an asylum through this movie's lens.  President Kennedy had a lofty goal to close these hospitals and transfer care to community mental health centers, which unfortunately didn't work out as planned.  The resulting system of mental health services for the poor is abysmal, and unfortunately it doesn't seem to be getting much better.  There is some hope in mental health parity actually being enforced via the Affordable Care Act, which will put treatment for schizophrenia or bipolar disorder on the same level of coverage as that for bronchitis or cancer.

If you're poor and have a mental illness (which, unfortunately, often go hand-in-hand), your prospects are bleak for recovery.  Community mental health centers have seen repeated budget cuts (at least in my home state of Illinois). Staff is overworked, underpaid, and burned out.  Even services run by private hospitals that do accept Medicaid are hit or miss in terms of their quality.  And, dare I say, there are people in the mental health profession who don't belong here.  Maybe at one point they were dedicated to the cause, and time or circumstances led them to become jaded, but when you turn into this

It's time to retire.

So, if I could change one thing about healthcare it would be this.  I would remove the stigma that plagues mental illness, which is one of the major barriers to seeking care. I would divert needed funding to centers and agencies and somehow ensure that it was managed wisely.  I would fire the nurse Ratcheds and replace them with people who care about those they care for.  And I'd push for combination treatments that use medication and psychotherapy, because these lead to the best long-term outcomes. Actually, that's several things, isn't it?  Guess I should look for that magic wand, now....

"That's right, Mr. Martini - there is an Easter bunny."