The Politics of Care

B. is a quiet and seemingly gentle man, with a soft spoken voice that is difficult to understand. He walks, like a lot patients do, around the inpatient unit with a distant gaze but when you call his name he responds and on good days, he smiles. B. was admitted to a psychiatric inpatient unit in September 2011 because his brother lowered his medication dosage. B’s chronic illness and poor economic and social support complicate matters.

The Politics of CareThe mental health team has diligently worked to find B. care but the wait-list for such a resource is quite long. Other available mental health centers require an interview but B. has been said to have trouble with that. When discussing his case, to lighten the mood and sense of helplessness, the team jokes that B. could “stay forever.” He is quite pleasant and the staff know him quite well. But the laughs become stale because everyone knows, that nobody knows, what to do with patients like B. It seems they just have to wait.

The current climate that B. is situated in is somewhat paradoxical. Before short-term treatments and limited insurance coverage, long term care or an absence of care were the only options. In fact, psychiatric institutions for long term stay were developed under moral stipulation: to provide care to those who can’t care for themselves. Activist *Dorothea Dix * was a prominent fixture that advocated for the development of asylums in the United States. By the end of the 19th century with the effects of industrialization in full swing in the United States, institutions became overcrowded and care deteriorated. It seemed anyone who was admitted to the hospital either couldn’t get out or was subjected to abuse and neglect.

By the mid-twentieth century, as medication began to provide fast results, and the public conscious shifted, a new paradigm emerged and institutions started to close. In fact, President Kennedy put policy in place to fund this new paradigm, the community health center. In theory, the community health model makes sense. It argued that removing patients from the mental care system and reintegrating them back into the community, patients will benefit most. It also argues that by building up and empowering a community, the residents within that community will thrive. But community centers were at the whims of politics and as institutions began to disappear, community centers didn’t receive enough funds. Today the current system is still under funded. What we have now is few long term mental health care options with the majority of possible treatment centers under copious amounts of stress.

This past January Governor Cuomo proposed saving over $750 million by limiting increases on mental health programs and social services. This will include cutting cost-of-living increase for nonprofit providers of services like foster care and adoption. There have been mixed reactions. On one hand, Governor Cuomo provides a bold and innovative response to New York State’s debt but on the other it fuels concerns that individuals who need broad intensive care may not get the support they need. Some argue that Cuomo’s attempts at changing the allocation of funds will give rise to a new kind of mental health care reform. If anything, it further highlights the hole we’ve dug ourselves in. It seems that two opposing sides share a bed: politics and care. While Governor Cuomo attempts to solve New York’s fiscal problems, there still seems to be much undecided about the steps that need to be taken for individuals with more complex and long standing mental health issues, like B.

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