The perennial debate on governance isn’t limited to politics; it also extends to the mental health sector—encompassing its administration, policy-making, and the implementation of state and federal regulations. While some advocate for democratic oversight, others argue that a single, decisive leader could enact urgent reforms. To address the current inadequacies of our mental health system, I propose the immediate appointment of a Health Czar.
The Challenges in Modern Mental Health
Our mental health system faces several shortcomings. For instance, in 2020, only 43% of adults with mental illness received treatment, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Issues of forced treatments, ethical dilemmas around patient autonomy, and overburdened providers exacerbate the crisis.
According to the National Institute of Mental Health, nearly 20% of U.S. adults experience mental illness yearly. Yet, less than half receive adequate treatment, leading to unnecessary suffering and economic loss estimated to be over $193 billion in lost earnings annually
Why a Health Czar?
Research on governance models, like the centralized authority in Singapore’s healthcare system, shows promising results in implementing swift and effective change. A Health Czar in the United States could cut through political entanglements, offering an insulated environment to enact essential reforms without partisan influences.
Countries like the United Kingdom have centralized healthcare systems that are more effective at delivering mental health services. A study by Lancet Psychiatry indicates that centralized governance can improve care quality by up to 30%.
The Taboos in Modern Mental Health Treatment
The subject of Assisted Outpatient Treatment (AOT), forced treatment, and other mandatory programs, including the need for involuntary inpatient care, have become controversial. The reluctance to address these issues stems from political barriers erected by stakeholders more interested in appeasing their base than fostering system-wide improvements.
Tear Down the Wall
To advance meaningful change, we must dismantle these barriers. The most effective way to do this is by appointing a Health Czar. In the United States, state regulatory bodies have appointed commissioners. However, their effectiveness could be improved by political entanglements. It’s time for a leader to steer this sinking ship back on course.
The Role of the Health Czar
While not a sovereign authority, the health Czar will be insulated from the shifting tides of political trends. This allows for a more focused approach to implementing necessary changes. The Czar will wield the power to cut through red tape and eradicate systemic inefficiencies. They will take charge of ethical and moral decisions, laying the groundwork for lasting reforms free from political gridlock.
The Czar would oversee a broad spectrum of responsibilities:
- Ethical and moral dilemmas: Instituting a panel of experts to develop ethical frameworks for treatment options, including involuntary interventions.
- Policy Change: Leading the effort in drafting new legislation for mental health reforms.
Transitioning of Powers
The Czar would systematically transition authority back to state and local bodies after mitigating the crisis. A multi-step plan would be enacted to ensure no disruptions during the transition, which could involve piloting new governance structures on a smaller scale before national implementation.
Concrete steps may include:
- Task forces focused on specific challenges like access to care, ethical treatments, and mental health stigma.
- We are piloting community-based mental health programs as alternatives to forced treatments.
The Transition of Power
Once the crisis is mitigated, the Czar will relinquish their emergency powers, allowing for a return to state and local governance. These bodies, too, will undergo restructuring to prevent future crises. The Czar will help draft new policies that can correct the flaws that have plagued the mental health system since the end of institutionalization.
A New Legacy
We are at a critical juncture in the history of mental health treatment. The appointment of a Health Czar offers a pathway out of this crisis and the possibility of leaving behind a legacy free of taboos, stigmas, and discrimination. This pivotal figure will catalyze a new era of mental health care—one that future generation can discuss openly and without fear.
Author Info:
Max E. Guttman
Max E. Guttman is the owner of Mindful Living LCSW, PLLC, a private mental health practice in Yonkers, New York.
