‘How Do You Pay Your Rent?’ Social Policies And The President’s Mental Health Commission

Abstract

Mental health policy involves broad social policies related to housing, education, work disability and rehabilitation, welfare, and criminal justice. The modern era of community care has moved patients, clinicians, and policymakers from closed institutions into the mainstream of society and its health and human service systems. The importance of knowing about the broad array of human services and their policies is reflected in the deliberations and policy recommendations of the President's New Freedom Commission on Mental Health. It is hoped that these recommendations will provide a roadmap for further change to enable people affected by severe mental illness "to live, learn, work, and participate fully in their communities."T h e p r e s i d e n t 's New Freedom Commission on Mental Health has made key recommendations related to welfare, education, social security, labor, housing, and criminal justice policy. It also has made recommendations related to mainstream health programs, such as Medicaid, Medicare, and the Department of Veterans Affairs (VA), reflecting the importance of these programs and the participation of those agencies on the commission. In addition to the expected commissioners from the health and mental health fields from both inside and outside government, the commission had ex officio representation from the Departments of Education, Labor, and Housing and Urban Development (HUD). 1 The commission's interim report hinted at the reasons for this broad social policy agenda when it focused on a fragmented mental health system "in shambles," disconnected from the many agencies on which people with mental illness depend for service and support.2 Both the interim and final reports cite a series of human and social problems associated with mental illness: homelessness, unemployment and work disability, school failure, minor crime, and incarceration. The final report makes recommendations to address these areas.This Perspective was written in response to the paper by Margarita Alegría and her colleagues, which provides details on several specific mainstream social programs and their relationship to mental health disparities among racial and ethnic minorities. Here I describe the interest of the President's New Freedom Commission on Mental Health in some of the same social policies, and some related ones. Whereas the Alegría paper concerns the full range of mental health problems in ethnic minority populations, I focus on adults and children with severe and persistent mental disor-P e r s p e c t i v e : P u b l i c P o l i c i e s ders. I do not, however, focus on the commission's recommendations that pertain to the health and mental health systems and to more traditional considerations of treatment for mental illness.My own exposure to these matters originates with my earliest clinical experiences as a psychiatrist. I learned to ask each patient, "How do you pay your rent?" It was a simple question, but the answer was always revealing. Over time, in an effort to assist patients, I learned ...

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