Plan to improve Medicaid is much needed to help people in distress

When the names of people with serious mental illness become known to the public, it’s typically for the worst reasons: Either they’re victims of crimes or are accused of committing them. But those who struggle with schizophrenia, severe bipolar disorder and other serious psychological conditions, and who far too often fail to get the help they need, typically remain anonymous to the rest of us, neither culprits nor victims of crimes. Rather, they are victims of a mental health care system that’s endlessly bureaucratic and infuriatingly complex in all the wrong ways, generous on its face but stingy with care and pragmatic tough love when it matters most.

Enter Sen. Kirsten Gillibrand, D-N.Y., with federal legislation that aims to refresh the primary federal health care program for the poor, Medicaid, to deliver coordinated care to the indigent when they need it — which is to say, before they begin a free-fall that lands them in headlines, handcuffs, courts, jails, emergency rooms or body bags.

Her bill, introduced on the House side by freshman Rep. Dan Goldman, D-N.Y., with the support of Rep. Jerry Nadler, D-N.Y., and others, would create a new authority in Medicaid purpose-built to deliver services directly to people with serious mental illness. Those would include assertive community treatment, which aims to surround people in need with all the helping hands necessary to address their interlocking problems, from psychiatrists to social workers to nurses and more.

Too often today, those professionals don’t interact effectively, creating gaps through which patients fall; employment help, when that’s realistic and appropriate; housing-related services, to connect people to supportive housing; and much more.

Gillibrand’s legislation would put money behind the good intentions, and set standards for states to deliver these services, to make sure that high-quality care follows federal funding.

This is a policy that can benefit every community of every size across the United States. Wherever there are people, from America’s biggest city to its tiniest rural outpost, high-quality care and reliable funding is needed.

This is by no means the only policy fix we owe people with serious mental illness, their often beleaguered families, and those who can become casualties should untreated problems turn someone violent. For years, advocates and enlightened legislative leaders have urged Washington to put an end to the pernicious IMD exclusion, a provision dating back to the creation of Medicaid that prohibits federal funds going to treatment facilities with more than 16 beds. It was a well-intended regulation designed to stop the warehousing of the mentally ill — but the outgrowth has been the broad disappearance of precisely the kinds of facilities that can deliver intensive services to people in crisis.

The United States is blessed with some of the world’s best mental health practitioners, its most caring and effective social workers, its most innovative treatments. It’s also a place where, due to gaps in care and a culture that confuses individual freedom with community neglect, too many of us in crying need have no consistent access to that network. It’s past time to stop pretending serious mental illness will vanish if it is ignored.

Only concerted care — well-designed, well-executed systems connecting people and institutions from the private and public sectors, and all layers of government, working with one another — can rescue desperate people from the demons in their heads.