Mental Health Advocacy: Tough Challenges for 2002
by Michael B. Friedman, CSW
Mental Health News - Winter 2002 Issue Vol. 4 No. 1

Michael B. Friedman, CSW

ental health advocates in New York State will face very tough challenges in the coming year, and to meet these challenges we will have to press for new funds for mental health at both the federal and state levels. That is probably the only chance we have to prevent a sacrifice of the priorities we have pursued over the past decade to the priority, which has emerged since September 11.

Terrorism has engendered new mental health needs. Many people are experiencing levels of fear and distress which create significant personal suffering, strain family life, and have dreadful social and economic consequences. The rise in bigotry towards Muslims is fueled by fear; the rise in unemployment is caused by loss of business, which is fueled by fear; the loss of consumer confidence, which leads to declines in purchasing, is fueled by fear. In addition, research from prior incidents of terrorism--particularly in Oklahoma City--makes it clear that over the next year there will be a significant rise in mental illnesses--especially post-traumatic stress disorders. Responding to these needs is a clear public responsibility, and public mental health authorities at the federal, state, and local level, have responded by making it the central mental health priority.

But the old mental health needs, the needs that have defined the main mental health agenda for the past decade or longer, have not disappeared. Children and adolescents with serious emotional disturbances, who could not get the service they needed before September 11, still cannot get what they need. Adults with psychiatric disabilities waiting for decent housing are still waiting. The community mental health infrastructure, which was eroding because of lack of funding to keep pace with inflation, is still eroding. The principle of reinvesting savings from reductions of inpatient services in state hospitals, which got lost in the budget battles of 2001, still needs to be re-established. People with psychiatric disabilities who want to work still cannot because they would lose their health coverage. And people with serious mental illnesses who reject traditional mental health services still need innovative outreach programs to engage them in services, which they will accept.

Mental health advocacy agendas this year will need to reflect a balance between the urgent needs created by terrorism and the chronic needs which have continued unmet for many years. Not either-or, but both-and.

But how do we realistically pursue a "both-and", balanced agenda in the context of an economic recession? Governor Pataki has announced a multi-billion dollar shortfall for this year and for the coming year. Mayor Giuliani has called for a 15% cut from almost every New York City department, including mental health. The County Executive in Westchester has called for a tax increase to preserve services. Who knows whether he'll get it? Nassau County faces the double whammy of years of fiscal excess and an economic downturn.

Even though 2002 is a state election year, when we'd ordinarily expect a very rich budget, this is going to be a very tough year, except for a very few of the highest political priorities.

The best hope of being able to respond both to the mental health needs engendered by terrorism and the mental health needs which have been a serious and persistent problem in New York State is for the federal government to take full responsibility for the response to terrorism. This is not an idle fantasy. The Federal Emergency Management Agency (FEMA) has already provided $23.1 million for the first two months of Project Liberty, the state's program to provide outreach, crisis counseling, and mental health education to people experiencing emotional distress in reaction to terrorism. And the state has recently requested $132 million for the next nine months of the project. If that money comes through, it will be a big help.

But it will not be enough to meet all the mental health needs engendered by terrorism, because FEMA funds can only be used to provide crisis counseling and education to people suffering emotional distress. It cannot be used to provide treatment or rehabilitation for people who have developed diagnosable mental illness due to terrorism--as many will. (Believe it or not, that's the federal rule.) Who will pay for treatment and rehabilitation?

A substantial portion will be covered by the private sector because it is likely that the majority of the people who develop mental illnesses will have health insurance through work. But there still will be a substantial cost to the public sector. The good news is that the Federal government has announced its intention to provide funds for services for both adults and children who develop mental illnesses due to terrorism. The bad news is that the amounts committed so far are not nearly enough.

Mental health advocates have to focus, therefore, on pushing the federal government to cover the costs of terrorism. It was an attack on the United States, not just on New York City. And, if the main goal of terrorism is to create psychological reactions, which disrupt a society, then overcoming the psychological consequences must be a critical component of the war on terrorism--clearly a federal responsibility.

At the same time, mental health advocates have to work to remind a nation now dominated by the need to reduce the risks of terrorism that social needs that were paramount before September 11th are still paramount today. More specifically, we need to remind the leadership of New York State that the state has a responsibility to adults with psychiatric disabilities and children with serious emotional disturbances, which is rooted in American social history and still is one of the primary responsibilities of state government.

(Michael B. Friedman is the Public Policy Consultant for The Mental Health Associations of New York City and of Westchester County. The opinions expressed in this essay are his own and do not necessarily reflect the positions of the Mental Health Associations.)

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