In Response to the Boston Globe Spotlight Team on the MA Mental Health System

By Nicholas A. Covino, PsyD, President July 01, 2016

Dear William James Community:

The series by the Boston Globe Spotlight Team on the Massachusetts Mental Health System has the potential to bring much needed change on behalf of people with serious mental illness. Those who have worked in the system know how frustrating it is for devoted clinicians to access beds, coordinate care, get medication reviews and secure services for their seriously ill clients.  Our Forensic students and faculty know the unfortunate default position that our jails and prisons have become as those with substance abuse, anxiety, PTSD and depression are caught up in the legal system.  Likewise, it is very sad to pass homeless and jobless people in the streets who have no place to go for care and shelter due to their chronic mental illness. 

It is important to have the kind of media attention that focuses upon the care that our folks do not get. There really is no system of mental health care, but a collection of services that are difficult to access with little coordinated aftercare and less follow-up.  It will require a great deal of work to raise our collective will to create a compassionate and accessible mental health system.  Hopefully the “Spotlight” that is being directed upon this problem will facilitate some needed change.

That said, it is disconcerting that the literary device used to capture people's attention in the series seems to be the “danger” that we all should feel from the mentally ill and not the compassion we should feel.  Attention is called to the needs of cancer patients and the importance of research.  What eventually turned things around with the stigma of HIV/AIDS wasn’t fear of contagion, but education, public testimonials and committed acts of compassion.  We know that violence is a very small part of the picture of the serious mentally ill.  These folks are much more likely to be victims of violence than perpetrators.  Moreover, as we look at the broken system of mental health we know that about 4% of persons with mental illness are seriously mentally ill and greater than 16% of our population lack a system of care as well. 

As a “College of Psychology”, there are a number of issues in this story for us to be concerned about and to work to change:

  • Our country is almost reflexively focused on “danger” these days. To look to this emotion as a motivation for change rather than to enlist our better selves to assume responsibility to develop a system of accessible mental health care for all people runs the risk of further distancing and stigmatizing people who have suffered greatly from such insult. 
  • Mental Illness is much more common than cancer, heart disease or asthma and it will affect all of our families at some point in time.  It occurs early in the lives of young people and, even mild to moderate expressions of it, limit a person’s educational success, earning potential, relationships and quality of life. We need a “Jimmy Fund” for mental health care and the emotions and values of supporters who serve it.
  • The recommenced move of the Bridgewater State Hospital to the Department of Mental Health from the Department of Corrections, correctly positions Massachusetts in line with the majority of the country. These folks shouldn't be prisoners, but patients. Most states have that understanding and provide that kind of compassionate care. 
  • While the state system is central to the treatment of our Medicaid and Medicare populations, we must look at the private hospitals that do not budget their resources to deliver accessible mental health care. It is irresponsible to have depressed, confused or agitated patients ‘boarding’ in the EW for days. It is irresponsible to have limited staff available to triage psychiatric emergencies. Hospitals do an exponentially better job caring for patients with heart disease than for those with mental health problems.
  • It is equally irresponsible for non-profit hospitals in large systems of care to create concierge treatment options only affordable by the very wealthy. Everyone should get affordable care.
  • Insurance companies bear responsibility for the deficiencies in the system, since their reimbursement rates for both inpatient and outpatient care are so limited. Turnover rates in the U.S. are as high as 20% for those on the front-line of work in substance abuse, because their salaries are often so low.
  • Dual diagnosis continues to create the illusion that there are 'drug' problems and a 'psych' problems that do not coexist. We are long past the time where drug and alcohol problems should be seen as “Public Health’ issues and anxiety and depression as “Mental Health.” Issues.
  • Behavioral Health providers in the U.S. are about 85% non-Latino Caucasian. There is an urgent need to attract, educate and support people of color to take care of a country with more than 40% racial and ethnically diverse people. Graduate schools and the mental health professions have this responsibility.
  • In the 1970’s, with PhD programs kept small by research universities eager to devote resources to the remunerative sciences and with investigative priorities in psychology devoted to psychology theory, APA President, George Albee, and the national psychology training conference at Vail Colorado warned that psychology was about to become irrelevant.  They highlighted the profession’s disconnection from and ignorance of the social and emotional needs of the poor and called for the creation of professional psychology schools to educate professionals to meet these needs.  Sadly, most professional schools have failed in that mission by choosing to compete with academic research programs for primacy in psychotherapy training.  William James College is trying to do better.

Mental and Behavioral Health needs the light that investigative reporting such as that in the Globe can shine.  Much more, however, it needs a committed group of Mental Health Stakeholders who are willing to bring education and resources to create a diverse workforce of professionals and an accessible, comprehensive and effective system of care to ‘Meet the need’ and ‘Make a difference’ for the millions of us who require and deserve it.

As you meet with your families and friends over this holiday and as you have the opportunity to talk about the Globe Spotlight series, please see how you all can play a role in creating this Stakeholder group for mental health and the sea-change in care that is sorely needed by all of us. 

Respectfully and hopefully, 
Nick