The State of the Mental Health Care System in the US 

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Last December I wrote an article summarizing some of the consequences that the economic recession has brought to the Mental Health Care System and how the inadequacy of some policies and practices have surfaced along with it. Today I’d like to expand on that topic mostly centering in the challenges that Residential Treatment Facilities which provide treatment to adolescents are facing.
While children and adult programs are gushing with momentum and expanding, for teenagers it seems like nobody cares about them.
Right now between families and Residential Treatment Facilities (RTF) there’s nothing. No group homes, no half-way houses, not even hospitals to an extent (I’m generalizing here, it does not apply to %100 of the cases).
So, if a teenager needs to be discharged from a RTF agencies would rather have the kid return to his family (even when it’s not ready to take him/her back) than to continue treatment.
Something needs to be done but there’s nothing that us, mere mortals, can do. It must be something that comes from above, and by this I mean the Government who’s so far let the agencies do whatever they please as long as they keep trouble away from it. Basically it’s a consequence of liberalism (which I’m not against). The government letting the market regulate itself. The problem with this is that the market isn’t a lone entity on its own. It needs its components to make it work, such as people, products or services. When you disregard the components that make the system work, then you have a system that is not working the way it is intended to nor is serving the purpose it was created for.
As with a lot of other things, the problem is money; or the lack of it. If there’s no money the system has no means to continue its existence. If there’s little money, the system can keep functioning but in a crippled fashion.
Going back to the components, human beings in this case, they have been left out of the equation. Actually, what’s been left out is the “human being” part since they still represent money for the system. Not as capital, but as a loss of it. So getting people out of the Mental Health Care System is top priority to stop the losses.
Take this hypotetical situation (any resemblance to reality is just a coincidence):
RTF: Hi Mr. Agency. I’m planning the discharge of John Doe as you requested. 
Agency: Oh, yeah! About that. He’s going back to mom and dad. 
RTF: Hey! But he already tried to stab 3 of his peers last week, he beat up 2 of his caregivers just yesterday and he’s still reporting to be bitten by green elephants in his room while he sleeps. I don’t think it’s safe for him to go home yet. 
Agency: mom and dad will take good care of him. 
RTF: mom and dad sent him over to us because they couldn’t handle him. 
Agency: they’ll be able now. Trust me, you’ve done a great job. 
RTF: no I haven’t. He’s been with us for just 3 months as you mandated. I’ve had no time to do much. 
Agency: You are right, you are not doing your job. That’s why I think his parents should have another shot. 
RTF: any chance you could at least provide any services once he is home? 
Agency: yup! We’ll send a social worker every now and then to make sure everyone’s still alive.
This is basically the picture right now. Meanwhile, while referrals are at an all time low RTFs are struggling to stay on budget, forced to decrease staff to client ratios to keep FTEs down which impacts service delivery; also slashing budgets on supplies and food, and at the same time being unable to expand its programs to increase their income.
What looks like is that a particular segment of the Mental Health Care System is being impacted (teenagers) while the others children (specially with autism) and adults seem to be flourishing despite the economic recession.
A possible solution could be downsizing RTFs to decrease demand (for beds) in sight of the short supply (of clients), though I’m not getting into all the problems (including unemployment) that this would generate.
So, if we rule out downsizing, what’s left is a bunch of organizations subsisting on life support waiting until better times come, and this is just not acceptable. It’s time for the government to step up and intervene by regulating the practices to ensure that proper care is provided to those in need.
I’m an Argentinean psychologist, currently working as Program Coordinator at the Devereux Foundation in West Chester, Pennsylvania.
I studied Psychology at the University of Buenos Aires and Human Resources Management at UADE (Argentinean University of the Enterprise). My professional experience includes working in HR for HSBC Bank Argentina and in two mental health facilities performing psychological evaluations and other clinical work.

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