The Need for Mental Health System Reform

Americans have generally come to terms with the fact that their health care system is somewhat broken, but it is time to face the fact that our mental health system is downright 'busted."

Our mental health system arose out of an American health care paradox: people suffering from emotional distress - which might include every one of us over the course of a lifetime - are often more deeply damaged than people with physical illness, yet the value placed on the prevention and treatment of mental conditions is inferior to the value placed on the prevention and treatment of physical disease. Even when the failures of our mental health system become painfully tangible through incidents such as Columbine and Virginia Tech, mental health care in our country continues to be relegated to lower-priority status. There have been some advances over the past decade, to be sure, but these have been limited in scope. The system remains structurally fragmented, financially inaccessible, and socially ostracizing. This is a system crying out for attention and repair.

Unfortunately, as much talk as we've heard from our President, politicians, and pundits about health care reform, mental health is generally absent from the most prominent conversations. Most recently, Glenn Close discussed her grassroots advocacy organization Bring Change 2 Mind here on Huffington Post. Despite the positive discussion generated by Ms. Close's blog on Huffington post, awareness campaigns like hers are limited in the leverage they can provide in the absence of bold political support. As such, too many admirable efforts like Bring Change 2 Mind have been born and since died, waiting for a political champion to intervene at the 'systems level'. The question is who on Capitol Hill will dare to be great when it comes to championing systematic mental health care reform?

For the cynics who think mental health reform is impossible, we offer this reason for hope: the United Kingdom's mental health system has gone from 0 to 60 in the past ten years, suggesting that mental health is just as amenable to reform as any other aspect of health care. We recently traveled to England to visit several mental health sites managed by the South Essex Partnership Trust (SEPT). The quality of care that the National Health System provides for a population that mirrors our own demographically is nothing short of astounding.

Anchored in the knowledge that mind and body work together, and that attention to mental health is indispensable in promoting physical health and general wellbeing, SEPT's leadership began by spearheading a public education and de-stigmatization campaign that has helped to shift perceptions of mental illness. Grounded in the understanding that our physical surroundings have an impact on our ability to heal, SEPT's stellar management has developed acute care psychiatric facilities in South Essex that serve as a national best-practice. At SEPT, those that were once referred to as 'psych patients' have become 'service users', and each is given a single room, attractive linens and curtains, an hour-by-hour schedule of recovery activities ranging from meditation to dance, and fresh food prepared on-site daily. What were once long, drab corridors have been painted and adorned with modern art, creating a home-like environment that promotes recovery. Healthcare providers see themselves as much more than short-term caretakers or harm-reducers; these people identify with being part of a long-term recovery process.

These facilities and programs arose out of a 10-year National Strategic Framework, published by U.K.'s Secretary of State for Health in 1999 at the outset of the National Health Service's revitalization. That year, mental health was prioritized as one of four key areas of improvement (, and the political rhetoric was backed by more than 700 million pounds over the first three years. History has already buried, to some extent, the name(s) of the political champion(s) responsible for mental health's prioritization in the U.K., but mental health frameworks never create themselves. Someone took on the responsibility of being an agent of change, and the political momentum surrounding mental health in the UK since then has only grown. This momentum has been directed not only at the national level, but also to local level where influential leaders have been able to create transformational change within mental health organizations. These leaders are perhaps best represented by SEPT's Chief Executive, Patrick Geoghegan, whose contagious enthusiasm, keen business sense, and unyielding commitment to social justice recently won him the 2009 NHS's Leader of the Year award.

Of course, the ideological differences between the two systems demand the US to approach our reform specifics differently than our UK peers have approached theirs. But what matters here is that mental health reform is possible. In 1999, after decades of grass roots efforts on both sides of the pond, the two countries stood still, side by side on the start line of mental health reform. The US pursued a tactical approach and has achieved only modest successes. In contrast, the United Kingdom addressed mental-health care reform strategically and has therefore moved swiftly forward thanks to its willingness to place a high political priority on whole-system reform. In this way, the UK provides us with a counter-narrative that demonstrates what can happen when grassroots efforts are augmented by courageous political and organizational leadership at all system levels.

Written with Silvia Gosnell, PhD, Clinical Psychologist & Clinical Instructor, Harvard Medical School.

Written also with Lauren Taylor, MPH, Program Manager, Yale Global Health Leadership Institute, Yale University.