Social Question

ibstubro's avatar

Why can't we fix America's broken mental health care system?

Asked by ibstubro (18765points) March 31st, 2016

The vast majority of liberals support universal health care, including mental health.

The majority of conservatives blame mass shooting with guns on America’s poor mental health care system.

Where’s the funding?

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26 Answers

janbb's avatar

You hit on it with your last statement. Where’s the funding? People pay lip service but nobody is motivated to come up with the ideas or the money.

zenvelo's avatar

It is the funding. It is also a personal autonomy issue, where there is a rigorous defense in some quarters for people who go off their meds to not be forced.

ARE_you_kidding_me's avatar

It’s a problem that requires bipartisan support. Good luck fixing it. Hate to be so pessimistic but it’s not going to happen until people can put down their politics and act like adults about it.

dappled_leaves's avatar

I don’t really understand the money argument. The US pays about double per capita what Canada pays for healthcare. Most of that money is presumably going to insurance companies. Cutting out the middleman should more than pay for a universal healthcare system.

How can the US be the only western country not to be capable of figuring this out? It’s not a question of where the money comes from, it’s a question of ideology.

janbb's avatar

@dappled_leaves It’s not a question of not having the money; it’s a question of many Americans, particularly but not exclusively Conservatives, not wanting to fund programs for the public good. We are polarized and stagnate, cf. this election cycle which is a shambles.

jca's avatar

Everybody wants lower taxes and better services. As a government worker, I assure you there’s a bit of a contradiction there.

CWOTUS's avatar

Allow me to ask a counter-question, not in rebuttal, but in genuine wonderment:

What makes you think that “fixing America’s mental health care system” is a matter of money – as if that’s all that’s wrong?

Consider that some of the most egregious mass murders in the country arise from some of the most well-off families, some of them presumably with plenty of money for health care, counseling and other forms of care. What do you propose to spend tax money on, and to what aim?

Consider also that we spend more per capita on public education than any other nation on the planet – and witness the results: children who can’t read or write the one language that they grew up hearing and seeing all around them every day; children who can’t even find their own home on a map; children who have no more idea of history than what was on television in the past few months. Instead of asking “why don’t we spend more money on education?” perhaps we could concentrate on “how can we get better results?”

I was going to insert a paragraph here on prisons, but I’m assuming that you get my drift.

Likewise, public mental health.

If you’re talking about mass institutionalization of the somewhat-to-totally deranged – similar to what was done until the latter decades of the last century – then I suggest you come right out and say that. That would be something we could discuss. It’s not very helpful to the inmates, but it does keep them off the street, so there’s that supposed societal benefit. Because, like education – and prisons, for that matter – it seems that we don’t really have a very good idea of how to accomplish the task of educating young people en masse, rehabilitating / confining criminal offenders and curing the mentally ill.

Your attention to money, as if that will resolve things, is misplaced.

janbb's avatar

@CWOTUS I believe I mentioned ideas as well in my answer. There is a paucity of both.

dappled_leaves's avatar

@janbb Well, then people need to stop saying “It’s the funding”. It’s not the funding. It’s that weirdly American notion that people don’t deserve better than whatever they can claw together with their own two hands, given the set of constraints they’ve inherited.

That is demonstrably a stupid and cruel ideology. But if the country is determined not to give it up for something more equitable, then there will not be a solution.

jaytkay's avatar

I don’t really understand the money argument. The US pays about double per capita what Canada pays for healthcare.

And that even kind of understates the amount Americans waste on “health care”.

US government health care spending per person is higher than Canada. That does not include what we pay for insurance and out of pocket.

If we weren’t supporting paper-pushing “health” insurance companies, we could cut our health care bill in half.

Espiritus_Corvus's avatar

In Canada, the government does not allow gouging, like you see in the states. I cite a 15 minute urinary catheter change out done by an RN in the ER without meds or anything other than a sterile Foley Pac that costs about $5 made in China. Cost to patient: $5,400. I was the patient. Of course our stats show we spend more money, but it’s not on healthcare, it’s to bouy healthcare stocks at the expense of he whole fucking system and it’s people. We could fix this if people would complain, but as long as their insurance covers it, nobody gives a shit in this fucked up country.

Where is the money for mental health after these gougers rape the system? This is also why people believe Medicare doesn’t work in the U.S. How can it when we allow it to be gouged like this? There’s nothing wrong with Medicare, and we could well afford to provide mental health treatment to the needy, if it weren’t for THE FUCKING LEGAL GOUGING!

Jaxk's avatar

I’m confused as to what you all want the funding for. Do we need more Ritalin for the kids, more insane asylums? We don’t seem to know how to fix mental issues so do we want to just lock them away. It seems to be getting more and more prevalent so maybe it’s a societal issue. Watch ‘Francis), the story of Francis Farmer and see if that’s what we want to go back to.

janbb's avatar

@dappled_leaves I wasn’t saying I don’t think we have the money; I was saying, as I said in my second post, that most Americans haven’t made spending money on any form of public health a priority. We have a corrosive mindset in this country. And of course it’s also putting minds to work on the problem as @CWOTUS says.

Seek's avatar

There definitely needs to be an increase in safe and assisted living facilities for people who need the assistance. I will cite my own family:

My brother is bipolar and schizophrenic. He can hold a job, but needs help monitoring his medication and how it affects him, whether it helps, whether he needs to change something. When he goes manic, he needs help with the voices in his head to keep him from doing something dangerous or violent. When he’s in a low, he needs someone to keep him from attempting suicide. He will be 28 years old this year.

My mother in law has epilepsy and dementia, and is otherwise able-bodied. She has to have her medication monitored for her. She will cheek pills and hide them. She will hide knives around the house. She compulsively breaks things trying to “fix” them. When whoever is in charge of caring for her tries to modify this behaviour, she becomes verbally abusive and occasionally physically abusive. She lives with me right now. I have my own untreated anxiety and depression issues, and frankly I’m on my last nerve. Do you have any idea how hard it is to find assisted living in Florida for a low-income 67 year old woman who is only disabled in their brain? They need the beds for people who can’t bathe themselves and use the toilet.

So, yeah, funding for assisted living for those needing safe, limited care.

CWOTUS's avatar

Okay, @Seek – you’ve actually mentioned something that has some real or at least potential value, so let’s talk about that. “Assisted living”. I’d buy that, and I’d recommend support for that with tax dollars – which I very rarely do. But that’s not all there is to it, and I’m pretty sure that your experience demonstrates that that’s not all there is to it.

What do you do when reasonable quality affordable assisted living is offered as an option – and let’s assume that we’re not talking about massive, uncaring institutionalized warehousing where “inmates” are strapped into beds and wheelchairs (never mind that absent families, that’s what will probably happen – let’s not go there just yet). How do you coax your brother or your mother-in-law to accept that arrangement when they say they don’t want it? How do you foist that on a stranger who says, “No thanks. I prefer to live on the street?” (I have a nephew who is in exactly this state.)

How do you get someone to ensure that people stay on their meds when – acting “rationally” and independently – they say, “No. I don’t want that”?

It’s a problem, isn’t it, when desires for “taking care of those who cannot care for themselves” conflicts so directly with people’s own autonomy, choice and freedom. And when we cannot point to a course of treatment and say “This will make you all better and obviate the need for additional treatment and assistance, and make you feel ‘normal’”, then what moral authority do we have to say “you must do this; you have no choice”?

Seek's avatar

Making the argument that some will choose not to use it is making the perfect the enemy of the good. There are many people who would use it, were such a thing available.

My brother would love to shut the voices up. He would love to have a safe place to live, where someone will stop him when he takes a knife to himself. He needs someone to take care of him, but he can’t keep a girlfriend when he has literal demons he’s talking to in the other room.

If such a thing were available – a home, where he pays rent and there’s also a “help me” button on the wall, not a “One Flew Over the Cuckoo’s Nest” situation – he’d be all over it.

stanleybmanly's avatar

The issue is at bottom the same as all of the others facing us collectively. And things shift into focus when you stack some of our other social necessities up against the “perceived need” for adequate mental health regimens. The disheartening thing about our crumbling infrastructure, and clearly failing social net in our lingering “age of shortages”, is in the choices that are made as to where our dwindling resources are directed. It may be argued that money isn’t the problem with our slipping schools or paltry mental health programs. All I have to say about that is that a couple of days ago the DOD announced the cost of a single F-35 fighter had now fallen significantly to 108 million dollars.

ARE_you_kidding_me's avatar

That drives me crazy when I hear what we spend on a single fighter or warship yet wont even spend a few million on proper bridge inspections

NerdyKeith's avatar

I think part of the problem is that hospitals are run too much like businesses. There is not enough attention to actually helping people, without being greedy. There is a lack of middle ground.

Although if you have a lot of mass shootings, thats not going to help either. I think America needs to at least have a stricter policy in accruing guns. Maybe that does tie into metal health too.

As for the funding? You could have a health care tax that directly contributes to hospitals. I would also suggest taking a look at the way Canada finances their healthcare system.

Seek's avatar

@NerdyKeith – Those of us who agree with you on the healthcare tax are trying. Unfortunately we only have one vote each, and those votes are becoming increasingly meaningless. By the day, it seems.

NerdyKeith's avatar

@Seek Well that is perfectly understandable. You are an extremely big country and I would imagine it is difficult to get the democratic vote to create the change you desire. For what its worth, I hope your healthcare situation improves for you all.

I will add however, that the healthcare system in Ireland isn’t that great either. Our funding is not designated very efficiently. The government gives administration more funding than medical staff. And this is very wrong in my view. This has lead to disastrous situations of elderly people in dire situations being ejected from hospitals, to those living outside of Dublin being denied medical attention due to a serious lack of doctors and nurses.

josie's avatar

In my opinion, the premise is false.

While there may be an epidemic of sociopathy in the US, the fact that people do not know what to do about it is not evidence that the system (whatever you imagine the “system” is-system is sort of a modern bogey man) is broken (whatever that means).

And it is not a matter of money.

Nor is it a matter of guns. While the gun is certainly the weapon of choice for some sociopaths, the bomb is another. Someday it may be botulism or anthrax. Or a nuke.

The problem with sociopathy is the fact that there is no real legal or politically correct way of dealing with it before the sociopath commits mayhem.
An example of this is the problem with Islamism. Which muslims are killers. Which are normal folks. Nobody is comfortable with taking action before the fact, so they wait until after the fact. Many of the Islamist mass killers in recent times were known to authorities. But for legal and political reasons, they could not act.

Same with sociopaths. Mental health care professionals are not likely to call the cops and report that their client is capable of mass murder and thus should be arrested. And even if they did, what would the cops do without a crime? Nor do they really know how to treat the disorder.

You could spend all the money on Earth, and still not resolve this dilemma.

Seek's avatar

Maybe if we focused on removing the stigma of admitting mental health issues, and treated them like actual illnesses (they are), and providing the treatment for those issues, more people who might otherwise allow their illness to go untreated won’t, and we’ll have the happy side-effect of reducing the number of people who go snap and start shooting people.

disquisitive's avatar

The problem isn’t people getting care; the problem is that getting care is all too often not helpful. Right now we don’t know what drives the crazy people doing mass shootings other than “assuming” things the perpetrators seem to have in common. It isn’t a “funding” problem. It’s knowledge deficiency. How do kids of middle and upper middle class families become so angry and crazy to kill classmates and teachers? We have to look at harmful stimuli. I heard in the past couple of days that three first graders’ plan to stab and kill a classmate was
thwarted. Six year olds!!!

ibstubro's avatar

Yes, I agree that the problem is too many people “getting care [that] is all too often not helpful”.

But what’s the solution to that?
Removing the stigma surrounding mental health and increased funding for research seem to be the most logical steps put forth.

Americans live in a society that glorifies violence. It pervades the entertainment, it leads the news is a major factor in the political agenda. Do you wonder that 6 year olds are conspiring to act out a TV show/movie/song/news story?

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