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Resolution Adopted by the CCAR
RESOLUTION ON ESTABLISHING A COMPLETE SYSTEM OF CARE FOR PERSONS WITH MENTAL ILLNESSES
Adopted by the Board of Trustees
Mental illness can shatter lives. It is a condition often lacking explicit physical manifestations, and thus is both easily hidden and easily denied. Like physical illnesses, and perhaps even more so, the ramifications of mental illnesses are experienced in every sector of life. Whether or not people with mental illnesses receive treatment, such illness is therefore best considered not only as a medical issue, but also as an important social one with far- reaching economic and human welfare implications. Judaism concerns itself with the health and well being of the mind and the soul as well as the body. Maimonides wrote:
When one is overpowered by imagination, prolonged meditation and avoidance of social contact, which he never exhibited before, or when one avoids pleasant experiences which were in him before, the physician should do nothing before he improves the soul by removing the extreme emotions.
Likewise, in the mi she-beirach prayer for the sick, we pray for a refuah sheleimah - a complete recovery - and further specify refuat ha-nefesh u'refuat haguf, a healing of the soul and the body. Our tradition recognizes a distinction between mental and physical health, but treats them on an equal plane, recognizing that both are necessary for us to be complete.
In this context, we examine the issue of mental illness, and its multiple and far-reaching manifestations for individuals from all walks of life.
Mental illness strikes often, affecting millions of men, women and children across North America, in both our communities and in our synagogues. Approximately 23% of American and Canadian adults (ages 18 and older) suffer from a diagnosable mental disorder at some point during their lives, but only half of those report impairment of their daily functioning due to the mental disorder. Of this number, approximately 5% are diagnosed as having a serious mental illness, such as schizophrenia, major depression, or bipolar disorder. In addition, between 25% to 50% of all people with mental illnesses are believed to have a substance abuse disorder. While the definitions and terms are varied, we here refer to both those defined as have a diagnosable mental disorder and those with a serious mental illness, as well as those with co- occurring substance abuse disorders, when using the term "people with mental illnesses."
Almost 20 percent of the U.S. population age 55 and older experience specific mental illnesses that are not part of the "normal" aging process. The elderly population is also the demographic group within the U.S. most likely to commit suicide. We, thus, must seek to draw special attention to the elderly within our population who suffer from mental illness.
Mental illness is also prevalent among children and teenagers within North America. Approximately 20% of children and adolescents, 11 million in all, are believed to have mental health problems that can be identified and treated. At least one in twenty children - 3 million in all - may have a serious emotional disturbance, defined as a mental health problem that severely disrupts a juvenile's ability to function socially, academically and emotionally. Each year, almost 5,000 young people, ages 15 to 24, commit suicide in this country. We will here refer to children with both mental health problems and serious emotional disturbances as "children with mental illness. "
An important issue today facing North America today is the lack of availability and access of individuals to mental health treatment, and the need for mental health insurance parity, defined as the requirement that health plans provide the same annual and lifetime limits for mental health benefits as they do for other health care benefits. The Reform Movement has consistently supported health care for all, declaring in 1975, for example: "In the United States there should be made available national comprehensive prepaid single-benefit standard health insurance with no deductible to cover prevention, treatment, and rehabilitation in all fields of health care." Currently, however, great inequities exist between coverage of mental health care and physical health care.
Employment and Mental Illness
According to a report by the Association for Health Services Research and the National Alliance for the Mentally Ill, employers bear significant costs due to mental disorders of their employees, probably more than they realize, because many costs are difficult to measure or are not easily recognizable as being caused by mental illness. Depression, for example, results in $30 billion a year in direct and indirect costs to employers. Depressed employees use 1.5 to 3.2 more sick days per month than other employees - lost time that costs employers $182 to $395 per worker per month, according to a study by the U.S. Centers for Disease Control and Prevention (CDC). Mental illness also takes many potential workers out of the labor force. Of disabled workers, more than 22 percent of who receive Social Security Disability Insurance (SSDI) benefits and 30 percent who receive Social Security Insurance (SSI) qualify because of mental illness. Yet research has shown that people with mental illness have high productivity potential and that they can work and remain in the labor market for significant periods of time. It is thus vital to advocate for increased attention to ways in which persons with mental illnesses can continue to serve as productive members of the work force, and advocate for protections of these persons once in the workplace.
Homelessness and Mental Illness
According to the National Coalition for the Homeless, approximately 20-25% of the single adult homeless population in the United States suffers from some form of severe and persistent mental illness. In Canada, it is estimated that approximately one third of the homeless in major Canadian cities suffer from a mental illness. The problems of homelessness and mental illness exacerbate each other. Mental illnesses, without proper treatment, prevents people from carrying out essential functions of daily life, thus pushing individuals out of mainstream society, out of jobs and, ultimately, out of homes. Mental illness, and lack of medical treatment, also lead to the use of drugs and alcohol as forms of self-medication, increasing the inability of individuals to function within society. At the same time, homelessness prevents recovery or worsens mental illness; a mentally ill individual will often slip through the cracks of conventional programs and treatments, never obtaining the treatment and medication necessary to regain wellness. Many of these homeless, mentally ill individuals then end up in the criminal justice system, as discussed in the next section. According to the U.S. Department of Justice, mentally ill state prison inmates in the United States were more than twice as likely as other inmates to report living on the street or in a shelter in the 12 months prior to arrest (20% compared to 9%).
A shortage of affordable housing also exists, further challenging the ability of persons with mental illness to live off of the streets. Between 1973 and 1993, 2.2 million low-rent units disappeared from the market. These units were either abandoned, converted into condominiums or expensive apartments, or became unaffordable because of cost increases. Between 1991 and 1995, median rental costs paid by low- income renters rose 21%; at the same time, the number of low-income renters increased. A housing trend with a particularly severe impact on homeless persons with mental illnesses is the loss of single room occupancy (SRO) housing. In the past, SRO housing served to house many poor individuals, especially poor persons suffering from mental illness or substance abuse. From 1970 to the mid-1980s, an estimated one million SRO units were demolished.
Mental Illness and the Criminal Justice System
In addition, we must also be concerned where mental illness intersects adversely with the criminal and civil justice systems. In 1998, 283,800 people with mental illnesses were incarcerated in American prisons and jails. This is four times the number of people in state mental hospitals throughout the country. Sixteen percent (179,200) of state prison inmates, seven percent (7,900) of federal inmates, 16 percent (96,700) of people in local jails, and 16 percent (547,800) of probationers have reported a mental illness. According to a 1999 U.S. Department of Justice study, approximately 53% of mentally ill inmates were in prison for a violent offense, compared to 46% of other inmates. While many believe that these mentally ill offenders must be held in jail because of the serious, violent nature of their offenses, it is vital that they receive treatment while incarcerated. We must be concerned, as well, with the civil liberties consequences of some forms of treatment for mental illness within the criminal justice system, especially the use of mechanical and physical restraints and the imposition of mandatory treatments. It is equally important that non-violent offenders receive proper medical treatment, and that non custodial treatment programs are explored and made accessible to offenders with mental illnesses, who are often turned away from community treatment because of reluctance to treat them.
Further, while we have recently reaffirmed our opposition to the death penalty in all cases, we believe it to be especially unconscionable to execute the mentally ill even if the death penalty is otherwise to be imposed, and we will work to find common ground with supporters of the death penalty who oppose executing those with mental illnesses.
The prevalence of juveniles with mental illnesses within the juvenile justice system is astounding. Approximately 50-75% of youth in juvenile detention facilities suffer from mental illnesses, and approximately half of these youth with mental illness in the juvenile justice system suffer from co-occurring substance abuse disorders. Each year approximately 11,000 boys and 17,000 girls attempt to commit suicide while living within juvenile facilities. According to the Department of Justice's Office of Juvenile Justice and Delinquency Prevention, however, seventy-five percent of juvenile facilities do not meet basic suicide prevention guidelines, and many detention facility staff are never trained to recognize and respond appropriately to the symptoms of mental health disorders.
Coordinated Systems of Care
The absence of a coordinated system of care for individuals with mental illnesses has resulted in inefficient dispersal of responsibility for care and treatment of persons with mental illness. This is especially true for individuals with co-occurring substance abuse disorders, who are often turned away from mental illness treatment facilities. The United States government has begun to draw attention to the situation of the mentally ill in America today. In 1999, the President hosted the first White House Conference on Mental Health, calling for a national antistigma campaign. The Surgeon General issued a Call to Action on Suicide Prevention in 1999, and the Surgeon General's first Report on Mental Health was also issued in 1999. For decades, private and non- profit organizations have worked tirelessly to establish access to services and protect the rights of persons with mental illness and to call for a holistic system of care for those who are in need.
THEREFORE, the Central Conference of American Rabbis resolves to: