This administration has already led the way on combating the drug addiction crisis. President Trump directed the declaration of an opioid public health emergency in 2017 and took action to confront the driving forces behind the crisis. Last week, the National Center for Health Statistics reported a decline in drug overdose deaths for the first time in 28 years. Life expectancy rose for the first time in four years.
Now, we must end the disgraceful way Americans with serious mental illness are treated. They are not receiving the care they desperately need. In 2018, 47 million people experienced some form of mental illness. More than 11 million of these Americans lived with mental illness of such severity that it impaired their ability to carry out normal life functions. And nearly 4 million Americans received no treatment at all. This is unacceptable.
In the 1950s, there were more than 550,000 state psychiatric hospital beds in the United States. By 2016, this number had dropped to 37,679. Instead of receiving care, the sick are locked behind bars, often after encounters with police officers ill equipped to manage these encounters effectively. There are more than 392,000 incarcerated individuals with serious mental illness. That means there are 10 times more individuals with serious mental illnesses in prison beds than in state psychiatric hospital beds.
We see the result of this crisis every day in America’s cities. There are at least 111,122 individuals with serious mental illness who are homeless, including 52,180 who have no form of shelter. We walk right past them as they suffer from exposure to the elements, inadequate nutrition, poor hygiene and lack of protection from violent thugs. The areas where these Americans live can also become public health nightmares when conditions there facilitate the spread of communicable diseases.
It is not compassionate, and it is not humane to discard these citizens and ignore their suffering.
That is why the president declared at the first White House Summit on Mental Health, “My administration is strongly committed to helping Americans suffering from mental illness.” And the administration has already taken action. Last year’s funding bill provided $3.9 billion for mental health programs, a $328 million increase. We invested in evidence-based programs including early detection, assisted-outpatient treatment and supported our law enforcement professionals. Finally, the administration solicited and approved the first-of-their-kind demonstrations for states to improve access to the full continuum of care these individuals desperately need.
But more remains to be done: President Trump is proposing to modify the outdated Institutions for Mental Disease payment exclusion, the long-standing Medicaid policy that prohibits federal reimbursement for many Medicaid-eligible patients who receive care in certain inpatient facilities dedicated to mental disease. These important changes will provide more than $5 billion in new federal funding to states that ensure a full continuum of care is in place to assist in getting people with serious mental illness the care they need and, in many cases, off the streets and out of prisons.
This is not only the right thing to do, but it also potentially saves taxpayer dollars down the road by investing in proven outcomes that keep these fellow citizens productive and in the workplace. The long-term economic benefits that will result from properly managing mental illness will ultimately lead to less government dependency and a more empowered and equipped citizenry. We will finally begin to improve access to inpatient care for Americans with serious mental illness without returning to the days of “warehousing” Americans with mental illness in large institutions.
Righting this wrong will not be solely accomplished by work at a federal level. It is vital that the states confront this issue as well and share in the financial obligations of caring for residents with mental illness. And they must reassess their civil commitment standards and processes to ensure that families have the tools to give their loved ones with serious illness the care they need. State and local leaders will be the ones who build mental health systems with crisis intervention services to meet the homeless on streets and create continuums of care so individuals with mental illness aren’t shuffled into prison. Lastly, all large metropolitan areas must end policies that contribute to keeping people experiencing mental illness on the streets.
For too long, our country has failed to open access to treatment and assistance for Americans with serious mental illness and their families. All Americans with serious mental illnesses have the ability to lead productive and dignified lives. It’s time they have access to the care they need. This week’s budget proposal — when enacted by Congress — will finally bring hope to those trapped in despair.