Wednesday, June 24, 2009

General Convention 2009: Mental Health (Health Issues 7)

In my last post on General Convention and health, I highlighted resolution C071, titled “Health Care Coverage for All,” submitted by the Diocese of East Tennessee. I also noted that there was a second resolution on health from East Tennessee. That resolution is C073, titled, “Re-evaluation of Care for Mentally Ill.” The resolution itself is brief enough to include in full.

Resolved, the House of _______ concurring, That the 76th General Convention recognize the urgent need to find a way to effect a re-evaluation by the appropriate federal, state and local agencies of the care and long-term treatment of the chronically mentally ill members of our communities; and be it further

Resolved, That this resolution be the beginning of a mission for our country led by the Episcopal Church to develop an action plan with the help of mental health professionals, government officials and church leaders, and other appropriate partners to find ways for communities to move forward with concrete steps to deal with these issues without moving backward into the abuses of the past.

In the explanation, the writers of the resolution made reference to the Community Mental Health Center Construction Act of October 31, 1963. The point of the act was to reduce the number of psychiatric patients were kept, and often simply warehoused, in state psychiatric institutions, and to make treatment available to those patients in their own communities. The thought was that this offered several benefits. It would make it possible for patients to have access to family support. With psychiatric care centralized in state hospitals, often far from family, this could be difficult (and still can be; in Kansas there are two state hospitals still open, both in the easternmost quarter of the state. For families living in the western half of the state, it can be a long drive.). Second, it was thought that with new medications many patients could function in society, well enough to live at home, and sometimes well enough to live alone and be gainfully employed.

I grew up in East Tennessee, and I well remember the state hospital in Knoxville, then known as Eastern State Psychiatric Hospital, or more often just Eastern State. I also well remember when some effort was made to implement the principles of the Community Mental Health Center Construction Act. In Tennessee that took place in the early 1970’s. The governor at the time, Winfield Dunn, was a dentist; and he appointed a psychiatrist to be his Director of Mental Health Services. There was great enthusiasm at the time.

Unfortunately, as the writers of the resolution note in the Explanation, “The mental health care centers that were developed lacked the resources necessary to accomplish their task, thus creating in these past 46 years a large group of people living in degrading homelessness where those with emotional and mental problems have few resources and services, very little follow-up care and no long-term care.” As I recall, state legislators found it exciting to save money by reducing expenses at the state hospitals. They just didn’t find it sufficiently exciting to spend that money in developing community mental health resources. Oh, the centers were built and programs were established; but never with enough staff and never with enough money. The results were in fact two-fold. On the one hand, there weren’t enough community mental health resources to really support those who could live in the community. On the other, there were no longer sufficient resources for those whose friends, families, and caregivers learned really couldn’t live in the community, because the programs of the state hospitals were so curtailed. That was the squeeze that resulted in the “degrading homelessness” the writers identify.

While there have been other issues, that homelessness has been a problem of particular note. It has resulted, I believe, not only in the significant percentage of the chronically homeless who have psychiatric needs, but also in the number of people incarcerated who need psychiatric care. And, notwithstanding the frequent comment that the largest providers of mental health services are now correctional institutions, it’s care that they don’t always receive.

This is a subject General Convention has addressed in the past. Resolution 1985-D127, “Support Ministry to the Homeless Who Are Mentally Ill,” directed

That the 68th General Convention instruct appropriate Executive Council staff to develop and make available to the Church educational resources regarding the plight of homeless people, including those who are mentally ill; to establish, in cooperation with dioceses, Jubilee Centers, local parishes, the social agencies of this Church, other social agencies and the mental health care delivery system, a means of providing assistance for these individuals who are without an adequate support system to meet their needs for care and supervision; and to develop a program of advocacy with other existing organizations on behalf of such homeless people.

Resolution 1991-D088, “Encourage Understanding of Mental Illness and Respond to the Needs of the Mentally Ill,” called for Episcopalians “to become knowledgeable about mental illness…, to reach out, welcome, include and support persons with a mental illness…, to equip the clergy and laity for ministry to the mentally ill and their families and that clergy and lay ministers seek out training and opportunities to minister to the spiritual needs of those who are affected by a mental illness…” among other steps. This was reaffirmed in resolution 2000-C032, “Urge Congregations to Commend and Support Mental Health Support Groups,” with the added suggestion that congregations offer facilities to such support groups. In addition, the important resolutions of past General Conventions on universal access to health care have consistently called for equal and adequate care for mental health as for physical health.

Adequate mental health care continues to be an important issue for our society, with many ramifications. If we can make progress toward universal access to health care, and especially toward parity between care for physical and mental health, we can hope for meaningful changes. This resolution would reaffirm the Episcopal Church’s support for adequate mental health care for all, and especially for those who are homeless or living in inadequate circumstances. Sounds worthy to me.

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