Declaring that minorities, women, the old and the young comprise a rising percentage of the mentally ill, the President's Commission on Mental Health urged yesterday that mental health care services be overhauled to bring these neglected Americans under their umbrella.
"We are impressed with the progress that has been made but we are equally impressed by what has not occured," the commission told President Carter after spending the last year studying the state of mental health in the United States. "There are millions who remain unserved, underserved or inappropriately served."
The commission said there is "new evidence" that one out of seven Americans needs treatment for a mental disorder at "any time." For years, the prevailing estimate was that one out of 10 Americans suffered a mental disturbance at "any one time."
The fresh evidence is the soon-to-be published survey of mental illness in the United States by the National Institute of Mental Health, which concludes' in an upcoming Archives of General Psychiatry that at least 15 per cent of adult America is suffering from some kind of mental affliction. The NIMH bases its conclusion at least in part on fresh sutdies of mental illiness in New York City and New Haven, Conn.
Who makes up the new estimate of one out of seven? Older people, bes set by money and family concern. Women, torn by the stress of their new status. Blacks and other racial minorities, wrecked by similar stress. The new victims of the nation's rising rates of divorce and drug and alcohol abuse.
"Alcohol abuse is a serious social physical and mentalhealth problem," the commission stated. "About 10 million people report having experienced recent alcohol-related problems."
In presenting the results of its one-year study to Carter yesterday, the commission gave its report special drama and status in the person of its honorary chairwoman, Rosalyn Carter. The first lady told the president that the 20-member commission "had worked very, very hard . . . hundreds and hundreds of hours.
"It's a plan and a strategy," Mrs. Carter said at a White House ceremony, "for the direction of mental health services for the next decade and I'm proud of it."
In response Carter said he would seek a modest increase in federal funds to emphasize prevention of mental illness, the training of mental health professionals, research into the causes of mental illness and better distribution of mental health care services.
"This will not be a costly program, but it will be a program that will save enormous amounts of public funds," Carter said. "It's an excellent investment in the future."
In its reports to him, the commission emphasized that high-quality mental health care" should be available to all who need it at reasonable cost."
"America's mental health problems must include the damage associated with unrelenting poverty and unemployment and the institutionalized discrimiation that occurs on the basis of race, sex, class, age, and mental or physical handicaps," the report went on. "They must also include conditions that involve emotional and psychological categories of service."
Calling for broad changes in the way mental health care is delivered in the United States, the commission stressted the importance of community health care centers instead of the traditional state mental institutions. The commission noted that the population of state hospitals had fallen from 550,000 in 1955 to less than 200,000 in 1975 and urged that steps be taken to speed up the decrease.
"In our judgment, people are usually better off when they are cared for within their communities, near families, friends and homes," the commission said. "Mental health care centers have moved services into communities where they previously did not exist."
The commission said the 647 community centers now operating provide 25 per cent of the mental health care in their communities and recommended a broad expansion of these servives.
The commission called for a first year expenditure of "at least" $75 million to finance new community centers, but noted that it should be enlarged to $100 million a year for the two years following.
"If centers are forced to cut back, there is real danger that many gains of the last 15 years will be lost," the commission said. "We believe the federal government has a responsibility to assure their continued availability."
Of the 117 recommendations made by the commission to the president, only six involved new federal financing. The biggest was the plan to expand the community mental health center service. The other five involved a new manpower plan and boosting research to investigate the causes of mental illness and establish a Center for Prevention of Mental Illness at the National Institute of Mental Health.
The commission suggested a starting budget of $10 million for the prevention center, "with a funding level of no less than 10 per cent of the NIMH budget in 10 years."
"At present our efforts to prevent mental illness are unstructured, unfocused or uncoordinated," the commission said. "If we are to changne this state of affairs, the prevention of mental illness must become a visible part of national policy."
The commission recommended increased spending across a hard spectrum of mental health research, including the abuse of drugs and alcohol. It suggested raising both budgets by $9 million a year and urged an increase in mental health research of $30 million.
"Our investment in mental health research is now so low the development of new knowledge is jeopardized," the commission said. "If the nation's research capacity is allowed to disintegrate, it will be far more difficult and costly to rebuild than to restore and improve it at present."
One of the commission's key recommendations was to include mental health care in any new plan for national health insurance and to amend Medicare and Medicaid legislation to cover the use of community mental health care centers.