|
Abstract
|
An Editorial earlier this year described how a US$1 billion mental health and wellbeing initiative in New York City, which began in 2015 and is known as ThriveNYC, aimed to engage every sector of society. Despite the large investment, ThriveNYC--in common with other, similar broad-based initiatives--failed to translate to tangible mental health benefits for the population or better outcomes for people with the most severe psychiatric illnesses.
Psychiatric services in the USA are substantially underfunded, resulting in increased risks of homelessness or imprisonment among people with severe psychiatric illnesses such as schizophrenia and bipolar disorder. As a counterfactual historical question, we can ask what if the New York City administration had devoted US$1 billion entirely to improving outcomes for people with severe psychiatric illnesses over the past 6 years? Housing availability and employment levels would probably have increased, and incarceration rates would probably have decreased.
Inspired by so-called mission creep in the USA, in which the focus is moving away from services for people with severe psychiatric illness, governments in other high-income countries are increasingly directing new funding towards programmes similar to ThriveNYC. In New Zealand, for example, this policy has been labelled as a shift from big psychiatry (for people with severe illnesses) to big community (for a larger proportion of the population who report mild psychological distress). As was shown with ThriveNYC, this approach can result in a profusion of interventions without carefully measured outcomes, and massive capital outlay. With such policies, funding for big-community programmes will increase while gross funding for psychiatric services remains static, declining in relative terms because of a failure to adjust for inflation and population growth.
People with severe psychiatric illness are particularly vulnerable to such diversions of new funding because they are reliant on government-funded healthcare and social support
Language: en |