Establishing a Complete System of Care for Persons with Mental Illnesses, Resolution on

Resolution Adopted by the CCAR



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.”

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.



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


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


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.


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.


the Central Conference of American Rabbis resolves to:

  • Call

    upon its member rabbis to:

  • Participate in communal

    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;

  • Work with persons

    afflicted with mental illness and their families so that they may feel

    welcome within our synagogues;

  • Prepare materials for training

    synagogue, religious school, camp and youth program personnel to

    recognize and deal appropriately with members and participants with

    mental illnesses.

  • Work with other groups performing mental health

    outreach within the Jewish community toward persons with mental


  • Call for increased governmental and community support

    and development of programming for caregivers of those with mental


  • Call on the United States and Canadian governments to

    maintain and increase funding for federal programs aimed at treating

    those with mental illness and assisting them to live healthy and

    independent lives;

  • Call on the United States and Canadian

    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;

  • Encourage governmental

    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;

  • Call for federal and state legislation

    to require parity between physical and mental health coverage by

    health insurance carriers, both private and public;

  • Call for increased

    attention to the many inmates in our nation’s prisons with mental

    illnesses, focusing on the need to:

  • Encourage

    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


  • Call upon law enforcement agencies to develop policies,

    practices, and specialized training for police officers and

    corrections officers to recognize and deal appropriately with persons

    with mental illnesses;

  • Call for increased governmental attention to the

    youth within the justice system, and the need for increased funding

    for community-based treatment programs for mentally ill juvenile

    offenders; and

  • Call on state and federal jurisdictions within the

    United States that retain the death penalty to exclude from

    consideration for the death penalty persons with mental illness.

  • Encourage

    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.

  • Call for an increased focus

    on the mental health needs of children, including teenagers, by

    advocating for:

  • The necessity of a coordinated system

    of care for children and teenagers with mental health problems;

  • An

    emphasis on early recognition, prevention and intervention, especially

    focusing on the prevention of suicide;

  • Increased research on the mental

    health problems of juveniles; and

  • Increased attention towards mental

    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


  • Call for increased focus on the recognition,

    prevention, intervention, and treatment of depression and other

    related mental illnesses in the elderly population.