“According to Republican Representative, there has been a decrease in societal prejudice towards addressing mental health, as it is no longer the 1960s era.”Michael Burgess, a doctor representing Dallas’ affluent northern suburbs who sponsored a House bill

To alter the regulation.

On December 12th, the House approved a measure that would allow states to provide up to one month of treatment for addiction in a mental hospital under the government’s funding for Medicaid patients. The Senate Finance Committee also passed a similar provision in November, increasing the likelihood of its passing into law.

Burgess’ co-sponsor was Ritchie Torres, a Democrat from New York City’s poorest section, the South Bronx,
who has spent time in the hospital for his own mental health struggles.

The change is supported by public health organizations such as the Treatment Advocacy Center and the National Alliance on Mental Illness, along with state directors of Medicaid.

According to reports, the regulation implemented in 1965 that prohibits Medicaid – the government program that provides healthcare for those in poverty or with lower-middle income – from covering hospitalization expenses has resulted in unintended outcomes. One major issue is the shortage of psychiatric beds for those in need. As a result, individuals in vulnerable situations often end up homeless, seeking treatment in emergency rooms, incarcerated, or even dying.

It has been argued that this policy further perpetuates bias against individuals struggling with drug addiction and mental illness compared to those with physical ailments, as there is no similar exclusion for the latter.

Congressional Republicans are in agreement, while Democrats are divided.

New Jersey Rep. Frank Pallone

The leading Democratic member on the Energy and Commerce Committee, who guided the bill, opposed the modification due to concerns about a potential shift towards institutionalizing individuals with mental illness rather than providing them with home care, ideally with a team of trained healthcare and social professionals.

He stated that a key method to assist individuals in their recovery is by providing them with local access to healthcare.

Pallone ultimately gave in because the Republicans made concessions.

Enhance Medicaid benefits for incarcerated individuals suffering from substance abuse disorder..

Instead of incarcerating individuals with severe mental illness, offer them proper care.

However, the hospitals quickly became overwhelmed with patients, lacked sufficient staff and funding. A 1946 investigation published in Life Magazine revealed widespread abuse, such as patients being restrained for extended periods, placed in isolation, deprived of food, and even physically assaulted to the point of death.

In 1963, President John F. Kennedy stated in a speech that over 500,000 individuals were residing in state mental health hospitals, with half of them being housed in facilities that accommodated more than 3,000 people.

Kennedy presented a proposal for states to construct all-inclusive mental health facilities, with the assistance of the federal government. These facilities would offer a range of services such as diagnostics, emergency psychiatric care, inpatient and outpatient services, and rehabilitation.

Two years after the establishment of Medicaid, a law was passed that prohibited the use of federal funds to cover care in mental health facilities with more than 16 beds. This was done to prevent excessive spending on outdated institutional care, as stated by Kennedy. This regulation now applies to individuals between 21 and 64 years of age.

Advocates from both sides of the argument state that while numerous state hospitals shut down, the community mental health system, as envisioned by Kennedy, never fully materialized.

Individuals who oppose the repeal of the ban on Medicaid funding are in favor of directing resources towards improving the current system. On the other hand, those who support the removal of the policy argue that a combination of community and hospital care is necessary to meet individuals’ needs based on their specific situations.

Senator argues that individuals with mental health and substance abuse issues require hospitalization in order for medical professionals to effectively stabilize their condition.Bill Cassidy

A gastroenterologist and prominent member of both committees with authority over the policy, (R-La.)

Cassidy expressed concerns about those who strongly objected to this, questioning if they have ever truly experienced living with someone who suffers from severe psychosis and still insist on the outpatient approach.

Many states currently possess a waiver allowing them to provide treatment for individuals with substance use disorder, while twelve states have a waiver specifically for treating other mental illnesses in psychiatric hospitals.

Ann Carroll, spokesperson for the California Department of Health Care Services, stated that the state’s waiver to offer medication-assisted treatment in mental hospitals has been beneficial for individuals with substance use disorder who require intensive care for short-term stabilization of acute needs.

However, the current system is not effectively delivering top-quality care to numerous patients. For instance, the Health and Human Services inspector general reported that 1.5 million individuals enrolled in Medicaid and suffering from opioid use disorder did not receive medication treatment in 2021.

The 2018 SUPPORT Act is a significant legislation aimed at offering support for individuals struggling with opioid addiction through prevention, treatment, and recovery. It granted states the option to temporarily provide care in psychiatric hospitals for up to one month without requiring a waiver.

The choice, currently only utilized by South Dakota and Tennessee, came to an end in September. The reauthorization bill for the SUPPORT Act, passed by the House in mid-December, would renew the option and make it a permanent solution.

During a House Energy and Commerce hearing this summer, Pallone contended that the low usage indicated the adequacy of the waivers. However, Burgess and other members of the Republican party argued that the waivers were onerous and making them a permanent option would encourage more states to take advantage of them.

The option was made permanent by the Senate Finance Committee’s vote in November. Senator Maggie Hassan

Senator D-N.H., who co-sponsored the bill with Senators from the Republican party.John Thune of South Dakota and Marsha Blackburn

Tennessee’s representative stressed the importance of adhering to the 30-day time frame and the obligation to supply medication. She referred to the use of medication, such as buprenorphine, to gradually reduce patients’ dependence on powerful opioids, as the preferred method for treating addiction.

It is uncommon for Republicans to be in agreement with the public health establishment on an issue.

According to Jack Rollins, the director of federal policy at the National Association of Medicaid Directors, lifting the funding ban would not result in a revival of the 1965 mental health care model. This is because the current system, clinical understanding, and ongoing discussions have evolved since then.

Forced care and the slippery slope

However, there is still a prevalent belief among the general public that psychiatric hospitals are similar to prisons and that allowing for voluntary treatment will ultimately result in involuntary treatment.

When certain individuals envision psychiatric institutions, they may recall the depiction in “One Flew Over the Cuckoo’s Nest,” a novel written by Ken Kesey in 1962, or its subsequent 1975 movie adaptation where Jack Nicholson portrayed a patient who appeared to be more rational than his nurse.

Bossing from the Bazelon Center for Mental Health Law stated that it is a misguided belief to think that mental health facilities are similar to places of therapy. It is well-known that, in the past, institutions in this country have not always been conducive to promoting healing and well-being.

He referenced recent findings from a disability rights organization in Washington, which revealed instances of mistreatment and disregard at a public and a private psychiatric hospital in the city. Officials from the facilities have stated that they are looking into the claims and will implement any necessary reforms.

In 2021, the state of Virginia initially decided to shut down five of their eight psychiatric hospitals due to issues with overcrowding and lack of staff. However, this decision was quickly reversed.

Reinstitutionalization is occurring, albeit in a limited capacity.

New York has sent about 130 people per week, involuntarily, to hospitals

Since May, individuals have been undergoing psychiatric assessment as per Mayor Eric Adams’ initiative to assist those who are unable to fulfill their fundamental necessities.

In the western part of the United States, Governor Gavin Newsom of California has incorporated methods to mandate individuals to receive treatment in his reformation of the mental health system. In March, the residents of California will vote on a $6.4 billion bond plan proposed by Newsom to construct approximately 25,000 beds for psychiatric and addiction treatment.

Officials from mental health organizations in California will object to the proposed modifications.

A team of attorneys fighting for civil rights in New York City have initiated a lawsuit against Adams’ instruction. They are requesting additional information on how it is being carried out in order to determine if it is unfairly impacting individuals of color.

The percentage of individuals experiencing homelessness nationwide increased by 12% from 2022 to 2023 due to rising rent costs and the expiration of pandemic-related assistance. In January 2023, the Department of Housing and Urban Development reported that over 650,000 people were without a home on a single night.

California has the highest number of homeless individuals among all states, with approximately 181,000 people, followed by New York with around 103,000.

Elected officials are worried that the presence of outdoor drug markets and makeshift camps in their cities may negatively impact their chances in upcoming elections.

They are becoming more certain that providing care for a larger number of mentally ill people living on the streets in psychiatric hospitals will not result in the same political risk.

Cassidy stated that it should not turn into a warehouse like in the book or movie “One Flew Over a Cuckoo’s Nest”. It is incorrect and should not occur.