NEW YORK, NY – Americans have a more negative view of the mentally ill than decades before; headlines about suicides and overdoses, mass shootings, and psychotic episodes on public transit only serve to exacerbate public perception. Meanwhile, our mental health-care system’s inability to address serious mental illness means those individuals afflicted by such conditions burden other public programs and systems, such as criminal justice and transit, and pose threats to public order in communities across the country.
In a new report for the Manhattan Institute, senior fellow Stephen Eide and adjunct fellow Carolyn D. Gorman articulate a Continuum of Care to address this deficiency. This concept aims to develop a more effective mental health system that exercises greater responsibility over untreated serious mental illness by assisting individuals before, during, and after crisis.
Eide and Gorman describe the Continuum of Care concept as a system of programs and services that are community-based, community-oriented, and coordinated with one another to work toward, measure, and account for defined intended outcomes. Moreover, the framework is anchored in residential programs, understanding that people in mental crises require supervision to remain stable, which often, if not always, requires psychiatric hospital beds. This makes the drastic decrease in beds at public specialized hospitals – from a peak of 560,000 beds in the 1950s to 30,000 beds currently – an important concern.
After examining premodern versus modern mental health policy, Eide and Gorman identify two general challenges that must be confronted for a robust Continuum of Care, while providing policy recommendations for each:
- Financing: insurance is the primary payer of most mental health care, thus, reforming public insurance needs to be a near-term focus of mental health reform. Most notably, that reform must include removing the so-called IMD Exclusion, which would authorize billions in funding for specialized psychiatric hospitals. Removing the Medicare 190-day lifetime limit for patients who require stays at inpatient psychiatric facilities would also allow Continuum of Care programs to develop more comprehensively. Longer-term, however, policymakers should explore the development of more targeted, non-third-party-payer programs to address the lack of system capacity in some communities.
- Data sharing and stewardship: to function as a system, elements of local Continuum of Care programs must share data. This will require cross-agency and cross-stakeholder collaboration, as well as legal agreements for data sharing with defined purposes and uses. A Continuum of Care able to take ownership and accountability for meaningful outcomes must be able to coordinate delivery of services while also defining and tracking those outcomes across programs.