Mental Illness: No School or Workplace Untouched

by Herbert S. Cromwell

At age 13, J.J. watched with his family as his house burned to the ground. The next 29 years brought diagnoses of schizophrenia and depression, crack cocaine and alcohol addiction, 15 arrests as a juvenile and 19 as an adult, homelessness, and suicide attempts. He lost count of the number of his psychiatric hospitalizations. After his last discharge at age 41, J.J. found Channel Marker, a nonprofit psychiatric rehabilitation program in Easton, that not only helped him get treatment and housing services but also gave him hope and a chance at a productive life in the community. Today J.J. lives in his own apartment, works, attends community college, and has been drug and alcohol free since 1998. He's a karaoke singer, a volunteer and, according to an article in the local newspaper, “ a successful role model for others.”

J.J. is one of thousands of Marylanders with mental illnesses whose lives are being restored, and even saved, with the support of nonprofit community mental health agencies across the state. Nonprofits deliver front-line services to most of the 93,000 children and adults who use Maryland's public mental health system. They also serve both Marylanders with private insurance and the uninsured. Their outpatient treatment centers, rehabilitation programs, specialized housing and in-home services keep children with depression and other severe disorders out of costly residential treatment centers, and help families maintain their children at home and in school. These mental health organizations enable adults with schizophrenia, bipolar disorder and other disabling conditions to obtain employment and community housing, access needed medications, and avoid confinement in state hospitals, where annual costs now exceed $180,000 per bed.

Recovery from mental illness is not only possible, it is an every day reality.

A Widespread Issue

The July 2003 report of the President's New Freedom Commission on Mental Health revealed that mental illnesses rank first among illnesses that cause disability in the U.S and Canada. In any given year, five to seven percent of adults have a disabling mental illness and five to nine percent of children have a serious emotional disturbance. As the Commission stated, mental illness “can happen to a child, a brother, a grandparent, or a co-worker. It can happen to someone from any background. It can occur at any stage of life. No community is unaffected. No school or workplace is untouched.”

Sadly, limited public resources and restrictions in private insurance and Medicare create significant barriers to the community-based mental health services many people need to avoid costlier inpatient care. In Maryland today, general hospital emergency rooms are experiencing a surge in use by children and adults with mental illness, state psychiatric hospital beds are full, and community mental health waiting lists are growing. Here and across the country, large numbers of people are ending up homeless or in jails, prisons or juvenile detention centers as a result of overstretched and underfunded community mental health services.

Financial obstacles and the social stigma still attached to mental illness keep many people from even seeking treatment. The U.S. Surgeon General reports that only one in three adults with a diagnosable mental disorder, and even fewer children with such disorders, receive any mental health services. The results can be tragic: nearly 20 percent of people diagnosed with bipolar disorder and 15 percent with schizophrenia die by suicide, according to the Federal Center for Mental Health Services; more than 90 percent of people who commit suicide have a diagnosable mental disorder.

Progress Is Being Made

Still, through the efforts of policy-makers and nonprofit agencies, considerable progress is being made. The number of children and adults able to access the public mental health system in Maryland has doubled since 1997. Supportive housing, crisis services, mobile treatment and in-home rehabilitation teams are available in nearly every region of the state. Modern medications and clinical practices enable people with even the most persistent and disabling illnesses such as schizophrenia to live meaningful dignified lives.

Nonprofit mental health agencies supplement public funds and insurance reimbursement with fundraised dollars. In fact, charitable contributions often make the difference in whether or not a job placement program, a treatment center for co-occurring mental illness and substance addiction, or a school-based outpatient clinic will be there for your daughter, your father, your neighbor, your co-worker and everyone who needs help in your community.

Jeremy, who struggled with depression, often skipped school, ran away from home repeatedly, and got into trouble with the police. He became so ill and felt so hopeless that he attempted suicide. Referred by his doctor to Archway Station, a nonprofit community agency in Cumberland, Jeremy received the help he needed to turn his life around. A counselor visited him at home regularly. As Jeremy learned to trust her, he began to confide in her. She helped him work through his problems and he learned to make better choices. She coached him in social skills and taught him ways to do better in school. He made some good friends and learned to believe in himself. She encouraged him to go to school and find a hobby to keep him busy so he would stay out of trouble. Contrary to earlier expectations, he graduated from high school, and now considers his counselor from the community mental health program “the most important part of growing up.”

Herbert S. Cromwell, Executive Director, Community Behavioral Health Association of Maryland, a professional and advocacy association for Maryland's network of community-based psychiatric treatment and rehabilitation agencies.