Resolution Adopted by the CCAR
RESOLUTION ON ESTABLISHING A COMPLETE
SYSTEM OF CARE FOR PERSONS WITH MENTAL ILLNESSES
Adopted by the Board of Trustees
June,
2001
Background
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.
Adults
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.”
The Elderly
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.
Children
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.
”
Parity
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:
upon its member rabbis to:
efforts aimed at destigmatizing mental illness, and work with other
members of the Jewish community to develop resources and programming
aimed at addressing stigmatization of mental illness;
afflicted with mental illness and their families so that they may feel
welcome within our synagogues;
synagogue, religious school, camp and youth program personnel to
recognize and deal appropriately with members and participants with
mental illnesses.
outreach within the Jewish community toward persons with mental
illness.
and development of programming for caregivers of those with mental
illnesses;
maintain and increase funding for federal programs aimed at treating
those with mental illness and assisting them to live healthy and
independent lives;
governments to increase funding for mental health research and the
development and testing of innovative mental health programs,
including those focusing on the co-occurrence of mental health
disorders and substance abuse disorders;
integration and coordination of quality housing and mental health
systems to provide comprehensive assistance, with special attention
paid to the number of individuals with mental illness who live on our
streets and in our shelters;
to require parity between physical and mental health coverage by
health insurance carriers, both private and public;
attention to the many inmates in our nation’s prisons with mental
illnesses, focusing on the need to:
the diversion of non-violent, mentally ill criminal offenders into
community-based mental health programs, and also work to ensure that
individuals with mental illness sentenced to prison receive
appropriate and humane treatment, including access to appropriate
medication;
practices, and specialized training for police officers and
corrections officers to recognize and deal appropriately with persons
with mental illnesses;
youth within the justice system, and the need for increased funding
for community-based treatment programs for mentally ill juvenile
offenders; and
United States that retain the death penalty to exclude from
consideration for the death penalty persons with mental illness.
an end to workplace discrimination against the mentally ill, and also
encourage governmental development of further programs to assist those
with mental illness in returning to the work place, and assist
employers in working with them.
on the mental health needs of children, including teenagers, by
advocating for:
of care for children and teenagers with mental health problems;
emphasis on early recognition, prevention and intervention, especially
focusing on the prevention of suicide;
health problems of juveniles; and
health needs within the schools and among professionals dealing with
children in child care facilities and schools, as well as the
development and implementation of training programs for these
individuals.
prevention, intervention, and treatment of depression and other
related mental illnesses in the elderly population.