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To fully benefit from ADA, community mental health services require further investment

In order for individuals with mental illness to reap full benefits from the Americans with Disabilities Act, the United States must provide and implement effective community services, according to Ira Burnim, JD, of the Bazelon Center for Mental Health Law in Washington, D.C.

“To realize the promise of the ADA for people with mental illness, the nation must substantially expand the kind of community services that advance and support their inclusion,” Burnim wrote in JAMA. “As the New Freedom Commission recognized, traditional service approaches are inadequate to the task. A wholesale transformation in the amount and type of services is required.”

Ira Burnim

According to Burnim, approaches that address unemployment, homelessness, criminalization and psychiatric crises such as supported employment programs, housing programs and diversion programs, exist and have been proven to be effective. However, they require more investment to make a significant impact.

“Collectively these kinds of approaches do not require spending much more money than is being spent today on individuals with challenging conditions. More than one study has demonstrated that the government spends on homeless individuals with mental illness — including emergency department, hospital, police and court costs — the equivalent of what the mental health system would need to find and subsidize an apartment and provide necessary on-site services,” Burnim wrote.

Investing in these approaches may benefit various facets of society outside the mental health system, including the social security system, criminal justice system and systems serving homeless individuals.

However, these systems have not made investing in community services a political priority, according to Burnim, and because of this, the mental health system’s efforts to invest have been subdued.

“There are many other reasons for the nation’s failure to invest in these community services. Among them are an aversion to social welfare spending, elected officials’ lack of familiarity with the elements of a well-functioning community mental health system, resistance from vested interests, the public’s skepticism that community treatment services are effective, and the public’s concern that it is unsafe to integrate people with mental illness into daily life,” he wrote.

Further, deficiencies in the general health system, such as reliance on late-stage interventions, failure to invest in prevention and poor care management, have stagnated investment, according to Burnim.

If the nation can address these obstacles to provide effective community services, Burnim believes the ADA can be fully utilized to successfully and efficiently include individuals with mental illness in the community. – by Amanda Oldt

Disclosure: Burnim reports no relevant financial disclosures.