Beyond 'Maryland's Shame'

Conventional wisdom indicates that a host of mental health issues will be up for discussion during the General Assembly's 2013 legislative session. This is welcome news for the one in five Marylanders living with mental illness who are struggling to access the services they need. The current attention to mental health speaks to the longstanding inadequacy of the community mental health safety net in this country.

More than 60 years have passed since we opened the wards of inhumane psychiatric hospitals for public inspection nationwide, as depicted with heart-wrenching clarity in the 1949 Baltimore Sun expose "Maryland's Shame." Soon thereafter we sent hundreds of thousands of individuals living with disabling mental illnesses into our communities with little or no mental health care and no reasonable way to survive on the streets. In response to this national tragedy, President John F. Kennedy championed and signed into law the Mental Health Act of 1963. Half a century later, we are still catching up.

The broken state of our public mental health system has been documented numerous times in the ensuing decades. Most recently, a 2006 Department of Justice report detailed with inarguable statistics the painful path of citizens with mental illness as they transitioned over several decades from our hospitals to our prisons. Now is the time to put this issue to rest once and for all.

Remarkable scientific progress has been made in recent decades in treating these illnesses, and capacity exists to enable the vast majority of individuals living with mental illness to take their place as productive members of society. Holding them back are systemic barriers, insurance discrimination, siloed government programs, and a number of related problems for which solutions exist — and our resolve is now required.

We are fortunate that Maryland's mental health system is one of the best in the nation and that several hundred thousand Marylanders will soon have access to health care thanks to O'Malley administration efforts to rapidly implement the federal Patient Protection and Affordable Care Act. These efforts alone, however, will not repair all of the holes in our public mental health safety net.

Luckily, the budget situation is not as dire as in recent years. Through steady leadership and careful planning, Governor O'Malley and the Maryland legislature have employed a balanced approach of spending cuts and revenue increases that has virtually eliminated the structural deficit. It is important that we take advantage of the healthy budget outlook and capitalize on these savings by reinvesting in vital mental health infrastructure needs.

When Maryland's elected officials sought to make fundamental improvements to the state education system in 1999, they convened a high-ranking commission and committed to fully implementing its recommendations. The Thornton Commission's goal was to ensure equity in Maryland's public education system, so that a quality education was available to all children. Today, our public education system is ranked No. 1 in the country, and this down payment on the future will reap positive results for future generations.

However, for the substantial number of children living with an untreated mental illness, this investment is for naught. They arrive at school each day lacking the basic readiness to learn that is an essential foundation for success in school. We can no longer ignore the fact that, through no fault of their own, so many children experience school failure and poor outcomes as adults because treatable health conditions have been left to fester.

We call on leaders in Maryland to make the same commitment to improving mental health that they made to improving education. As first steps, we urge immediate action on the following:

•full implementation of a comprehensive mental health crisis response system, providing services ranging from crisis hotlines to urgent care appointments and mobile crisis response teams that operate 24/7, with linkages to local law enforcement where appropriate;

•strategic and rapid implementation of mental health first aid throughout the state (a CPR-like program that trains people to recognize the signs of mental health problems and gives them the skills to reach out and assist someone who needs help);

•statewide implementation of school mental health services;

•rapid expansion of evidence-based services that promote recovery, including peer support, family education, supported employment, integrated mental health and addiction treatment, geriatric behavioral health consultation, and housing;

•and strategic investments to ensure that a comprehensive network of high-caliber providers is in place to provide the services people need.

Moments in time come along when leaders are called upon to right longstanding wrongs. We again find ourselves at such a crossroads for individuals living with mental illness. The problems are less publicly visible than in 1949, when individuals were chained naked to beds in filthy conditions — but they are no less real.

We call on all elected officials to take the decisive actions that are needed.

Linda Raines is executive director of the Mental Health Association of Maryland. Her email is

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