David Markham articulates his experience and perspective on the issue of whether publicly funded mental health centers worked. Having worked several years for Austin Travis County MHMR, I have firsthand experience with the situation Markham presents.

My experience in working in three CMHCS in the 70s, and 80s, is that they worked spendidly. People got excellent care. What killed them was the withdrawal of federal dollars, and the advent of HMOs who significantly restricted the reimbursement for mental health services causing CMHCs to loose money and have to lay off staff and close down programs. This loss of revenue was occuring at the same time that State Hospitals were “deinstitutionalizing” the “Severely and Persistantly Mentally Ill” (SPMI) and putting them into community based settings allowing State legislatures to close State Hospitals. Without resources to treat the disorders these patients struggled with, CMHCs floundered and stumbled. Without adequate treatment many of these SPMI patients were arrested, caught up in the criminal justice system, contributing to the expansion of our prison populations to record numbers.

The sad thing for me, personally, is to have experienced first hand the success of the CMHC system. As Dr. Applebaum and other psychiatrists quoted in the article say, CMHCs did work, and they worked well. The mess we have in this country today in providing services for mental illness and substance abuse is not because we do not know how to do it well, we simply do not have good financing mechanisms to pay for appropriate and effective services. The irony is that the taxpayers will pay one way or the other either in financing mental health services or by default, criminal justice services.

One reason I departed the agency was that federal funding had been slashed; scrabbling for billable hours seemed to eclipse the provision of good services. Also because, at some point, it is incredibly depressing to provide services to the destitute in such a meagerly funded capacity. A person gets tired and a bit shell-shocked.

I dearly wish this country — public and private funding sources — would embrace the need to provide support for the treatment of mental illness. The toll on us culturally, spiritually, and economically is huge.