Mental illness is a major, and largely unaddressed, problem both nationally and in northern Manhattan. Although the 1999 Surgeon General report noted that fifteen percent of the adult population used some form of mental health service during the year, nearly half of all Americans who have a severe mental illness do not seek treatment. Northern Manhattan, home to an estimated population of 400,000 is among communities across the nation faced with daunting mental health challenges. Northern Manhattan is comprised of Central Harlem and Washington Heights/Inwood, two communities well known for having low employment rates, high incidences of poverty, and poor health indicators; all factors identified as contributors to poor mental health.
Resources to address the epidemic of mental health problems in northern Manhattan are neither adequate nor equitably distributed. In spite of the community's significant growth in population, poverty levels and poor health indicators, the status of its mental health care system has not changed since the last community assessment conducted over a decade ago:
Central Harlem and Washington Heights/Inwood receive from the Department of Mental Health the third and fourth smallest allocation of resources respectively, a disproportionate distribution.
State legislation related to Medicaid neutrality that limit the expansion of services have hindered the ability of mental health care providers to meet the overwhelming need to expand services to meet demand.
Providers continue to receive low reimbursement, while psychiatric emergency room visits have increased by 40%- mostly among children and adolescents.
There is an increasing number of seniors suffering from untreated mental health related illnesses that are erroneously attributed to old age.
Community-based providers feel they are disproportionately bearing the burden of caring for the uninsured.
There is great need to carry out treatment in a culturally competent manner.
Many mental health problems are best prevented and addressed by adequate social service networks. These critical networks need to be strengthened and expanded. Notwithstanding the importance of social service networks, there is a critical shortage of mental health treatment capacity. Even if social services were massively expanded, existing psychology and psychiatry treatment services lack the capacity to treat individuals in need of these services. As a result, problems are addressed late and treatment is often sub-optimal with inadequate follow-up after crisis intervention. Expanding the capacity of the mental health system to meet increased demand in a timely fashion is critical.
This paper presents a series of recommendations aimed at fostering the development of provocative and innovative initiatives that address mental health funding, changes in local and state policies and service coordination. These recommendations call for an increased commitment by local institutions involved in the provision of mental health services and research. Such commitment will not only benefit individuals with much needed services, but will serve as a way to amend strained relationships between these institutions and community residents.
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