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  • Promises Unkept

  • An Op-Ed by, David A. Sperling, M.D.

  • Medical Director, BHcare

    Mental health and drug addiction services have undergone a systematic dismantling over the last 20 years. The closing of three state hospitals placed an increasing burden on outpatient psychiatric services which continue to be underfunded and subject to annual threats of further reductions. The most recent Connecticut budget bill follows suit. While some of the funding for outpatient treatment remains, $7 million was cut from grants for outpatient mental health services and $2 million was cut for substance abuse treatment.

    What is sometimes lost in the budget proposals is the impact on the clients we serve. Outpatient Mental Health Clinics are the last bastion of support and treatment for a population that has few other options. Our clients are frequently burdened by poverty, unemployment, and chronic mental and physical disabilities that interfere with their quality of life resulting in despair, hopelessness and worst of all, resignation. These clients include your coworkers, neighbors, friends and family.

    The premise of the closing of the state hospitals was to provide services in a less restrictive environment. The funds previously spent on maintaining large inpatient psychiatric hospitals was to be distributed to outpatient psychiatric clinics to provide treatments, case management, housing, vocational services, and outpatient medications. The premise was sound, but the promise has not been kept. It is critical that we refocus and hold state government to their promise. Everyone, including Democrats, Republicans and the Governor must be held to the assurance our community was given. If that promise remains unkept, the burden will further overload already overloaded emergency departments, and there would be a marked increase in requests for inpatient psychiatric admissions, both of which are significantly more expensive, and often avoidable.

    An unrecognized complicating factor in the budget discussion is the impact of stigma on psychiatric patients, especially the severe and persistently mentally ill, who are our most vulnerable clients. The entire April 2016 issue of Community Mental Health Journal was devoted to stigma and its effect on the populations we serve. Stigmatizing beliefs about severe mental illness are based upon stereotypes and unrealistic ideas about the mentally ill, especially those with severe and persistent mental illness. The research shows that our clients internalize the stigma of the cultural stereotype and it becomes a “Self-Stigma”. Those clients who most internalize this Self-Stigma are more likely to suffer more preventable illness burdens and poor health. Factors associated with poor health and problem behaviors increase such as smoking, poor diet and less physical activity. Probably the most compelling is the increase in avoidance and withdrawal from treatment and society. Each year, Connecticut’s budget is sending the message that our patients, CT residents with severe and persistent mental illness aren’t a priority. That message will lead to more Self-Stigma, greater health risks and greater costs.

    Both lay and professional mental health advocates have targeted the overcoming of the stigma of mental illness as major initiatives. They have advocated for increased mental health funding, to improve access to treatment and require parity in mental health coverage. The outcome of elimination of funding for mental health will go a long way to increasing stigma, further pushing clients into the shadows of isolation, withdrawal, and further marginalization. Now is the time for Connecticut to renew its pledge to support outpatient mental health services, and this time, Connecticut needs to follow through on that promise. The alternative will be a giant step, in the wrong direction that will increase Self-Stigma, avoidance of treatment and despair.