Historical Context
Mental health significantly determines people’s quality of life, as it influences behavior and even physical health. Disorders limit the opportunities of people affected by them and, in more complex cases, threaten them and their surroundings. However, due to the separation of mental health problems from the general health care system, biases arose against individuals who needed help. As a consequence, occasionally, people do not receive the necessary treatment and support, and their condition worsens. According to 2016 data, about 18% of adult Americans suffer from mental disorders, and less than half of them are treated – about 43% (Mignon, 2019). Moreover, about 4% of the adult population has serious diseases such as schizophrenia, but only about 65% of them receive treatment (Mignon, 2019). The problem also extends to younger generations – about 12% of adolescents suffer from depression, and only 40.9% are treated (Mignon, 2019). Despite the threats that mental health problems pose, attention to them and regulatory policies have recently arisen.
Taking care of mental health was ineffective and even cruel for a long time in the past. The first attempts to organize systemic care were presented through 19th-century asylums (Larson, 2018). They took patients with acute symptoms, and treatment occurred through labor and nurturing useful habits. People with such chronic problems as epilepsy, schizophrenia, or dementia did not get into asylums but should have received the help of their communities. Even without accepting all people in need, the asylums quickly overflowed, and prevention attempts were made. Preventive measures were eugenics laws – some populations parts, particularly the people with mental disorders, low-income, immigrants, and other marginalized groups, received bans on marriage and parenthood and were also subjected to forced sterilization (Karger & Stoesz, 2018). Nevertheless, later in the 20th century, treatment methods began to develop faster, and in the modern world, help is more humane and functional.
As the treatment methods changed and concerned citizens were engaged in protecting the rights of people with mental disorders, policies on this issue developed. For instance, the National Mental Health Association (NMHA) condemned eugenic laws (Karger & Stoesz, 2018). After World War II, the Mental Health Act of 1946 was adopted, contributing to creating the National Institute of Mental Health (NIMH). Community Mental Health Centers Acts of 1963 and 1965 reformed the system distributing responsibility for mental health between federal, state, and local levels (Karger & Stoesz, 2018). The fundamental law to protect the rights of people with disorders was the Mental Health Parity Act of 1996. Moreover, NIMH and the American Psychological Association (APA) developed norms and standards for diagnosis and treatment – Diagnostic and Statistical Manual (DSM). Laws are also changing in response to new challenges, such as the COVID epidemic (Goldman et al., 2020). Thus, the mental health policy development history is short and covers mainly the 20th-21st century.
The causes of mental health problems vary and can affect anyone. Moreover, researchers, physicians, and other professionals involved in psychological health issues disagree on problem triggers, diagnostic processes, and treatment (Mignon, 2019). Among the potential causes may be physiological, such as genetics and brain chemistry. Another type of factor is an external one, like trauma or stress – even a discriminatory episode can cause problems. For these reasons, mental health policies need to be particularly thoughtful. However, difficulties in understanding mental disorders and their causes contributed to challenges in establishing the appropriate and uniform approach.
Policies
Modern mental health care is regulated by several laws and policies, which should complement each other. As mentioned, the Mental Health Parity Act of 1996 has become fundamental at the federal level. It established equality between physical and mental health in insurance coverage in the workplace (Karger & Stoesz, 2018). It was later expanded through The Mental Health Parity and Addiction Equity Act. However, the laws have a drawback – they exclude people not represented in the labor market and those who work in companies with less than 50 employees (Karger & Stoesz, 2018). Another influential federal law – the Americans with Disabilities Act, protects employees with mental disorders from discrimination in the workplace (“Mental health policy,” 2020). The policy also includes the 21st Century Cures Act, the Affordable Care Act of 2010, the Children’s Health Act of 2000, and federal regulations (Substance Abuse and Mental Health Services Administration, 2021). With federal policy, mental health issues are regulated at the state and local levels.
Changes in policy occur as a result of the activities of stakeholders. Many organizations of various sizes lobby for the interest of people with mental disorders. For example, Mental Health America is a large organization aiming to increase awareness of the issue and contribute to preventing mental problems. National Alliance on Mental Illness (NAMI) embodies educational programs and provides hotline services (“Mental health policy,” 2020). The National Council for Behavioral Health also holds political advocacy (“Mental health policy,” 2020). At the heart of the fight against mental disorders are also specialists helping people with problems. Different aspects of their work, especially clients’ treatment, are also regulated. For example, DSM’s fifth version is used for diagnosis and treatment (Karger & Stoesz, 2018). Standards of specialists’ behavior are indicated in ethical codes, for example, the code from the APA (2017). Thus, the existing policy and stakeholders seek to cover various aspects of mental health – treatment, prevention, insurance payments, and other issues.
A key goal of all existing laws and actions of stakeholders is improving the quality of life of people with mental disorders. However, much work remains to be done to achieve this goal. In particular, support for mental health requires significant funding resources. Funds are required for providing the necessary service – finding buildings, hiring employees, developing educational programs, and for citizens in need of expensive assistance. For these reasons, government intervention is demanded at the macro-level, which will increase funding for the sphere. For instance, changing the Mental Health Parity Act of 1996 and expanding its action will allow more people to receive the help they need. New changes should focus on the accessibility of mental health services.
Diverse Group
Existing mental health policies exacerbate discriminatory practices by placing unfairly heavy burdens on low-income people. According to Altiraifi and Rapfogel (2020), about 11.8 million citizens in America were unable to receive satisfactory treatment, and 38% of them – were due to its high cost. This problem, in turn, leads to a decrease in population activity and brings economic losses throughout the country (Leonhardt, 2021). Moreover, access to mental health also unfairly affects historically oppressed groups – African Americans, natives, and other population representatives (Altiraifi & Rapfogel, 2020). Restrictions are maintained geographically – most psychological services are concentrated in urban areas (Leonhardt, 2021). Minorities also have lower insurance coverage rates and lack confidence in the health care system due to discrimination (Altiraifi & Rapfogel, 2020). The high cost of mental health services does not allow everyone who needs it to get help.
Restrictions on assistance to specific population groups entail new manifestations of discrimination against people with mental disabilities – sanism. This group faces stereotypes in finding housing and work, and, in some cases, society tends to criminalize their behavior (Altiraifi & Rapfogel, 2020). Unable to get help, people with low incomes and mental disabilities cannot improve their economic situation and health. While steps such as Mental Health Parity Act demonstrate attempts to improve the situation, they have their disadvantages, and further expansion of services, for example, through the Affordable Care Act, has not yet been established (Karger & Stoesz, 2018). Thus, existing policies exacerbate discriminatory practices, particularly against low-income people, and widen the gap between rich and poor.
Global Perspective
Health systems and attitudes to mental health differ in various countries. One of the successful systems is the Swiss one, which seeks to ensure citizens’ full access to services. For example, Switzerland has a large number of mental health professionals – about 50 psychiatrists per 100,000 inhabitants, and a large density of establishments for the provision of services (“The healthcare,” 2021). At the macro level, the system is not taxable, while it is assumed that at the micro level, every citizen will pay for their health insurance (Schneeberger & Schwartz, 2018; “The healthcare,” 2021). As a federal republic, Switzerland is divided into 26 cantons, and they are responsible for the distribution of medical services in its territory (Schneeberger & Schwartz, 2018). Cantons finance medical facilities and give subsidies for people to buy insurance in case of financial difficulties. Mental health is an essential part of the overall health system.
Although citizens buy their insurance, they have a wide choice of companies providing them. Insurance offices offer their customers policies that include many medical services. At the same time, prices for services, including mental health, are regulated at the federal level through the TARMED tariff system (Schneeberger & Schwartz, 2018). People can obtain help by contacting a therapist, clinics, or visits to mental health nurses (The healthcare, 2021). The global pandemic challenges the Swiss system as well as the other world countries. The burden on mental health services is expected to increase, and to support their accessibility, various methods are proposed, for example, outreach services (Richter et al., 2021). Thus, the Swiss system makes considerable efforts to make all services, including psychiatric ones, available to residents.
The advantages of the Swiss system over the American one are that mental services are more affordable to all citizens. Accessibility is achieved through the inclusion of these services in insurance and through the government financing of the sphere – the creation of hospitals, support for employees, and other opportunities. Such measures are more beneficial for citizens since they have the chance to receive treatment without severe restrictions. Mental disorders can become significant obstacles to a fulfilling life, limiting an individual’s activity and capabilities, as well as reducing the overall quality of life for his family. Receiving treatment without additional problems, Swiss citizens become more active members of society and contribute to its development. Thus, care for the population should include not only physical but also psychological health.
References
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