Harvard Kennedy School was a fitting setting, noted former Senator Roy Blunt, to have an important discussion on mental health. It was President John F. Kennedy who signed into law a sweeping piece of legislation to address the bleak environment of developmental disorders by closing institutions and turning to community-based care, hoping “the cold mercy of custodial care would be replaced by the open warmth of community.”
Blunt, a former Republican senator from Missouri and a current fellow at the Institute for Politics, was a guest at the John F. Kennedy Jr. Forum to discuss how treatment of mental health issues has evolved over the last 60 years. He was joined on stage by Vikram Patel, the Paul Farmer Professor and chair of the Department of Global Health and Social Medicine at Harvard Medical School.
“As you look at President Kennedy’s law, it was really designed to do two things: close the asylum-like facilities that really weren't serving anybody very well and replace those facilities with community-based high quality behavioral health centers,” Blunt said.
He noted that the country did a great job with the first half of the law: during the rest of the 1960s and through most of the 1970s, states were closing state hospitals and mental institutions. “But I think no state—almost no community—really came back and said, ‘Now what we need to do is create freestanding, full-time mental health facilities so that people can live and work in the community, those with diagnosable and treatable behavioral health issues,’” Blunt said.
Patel asked about Blunt’s own legislation, the 2014 Excellence in Mental Health Act, a bipartisan bill created with Michigan Senator Debbie Stabenow, a Democrat, and how it furthers this mission.
“Our bill created a 10-state pilot to let any state that could meet the criteria move forward with these community behavioral health centers. Twenty-three states immediately stepped up and said we'd like to be part of that, with 19 going through the entire process,” explained Blunt.
"Each state got $1 million to spend a year and come up with a proposal of why they'd be one of the best states to begin to pilot this idea of community behavioral health centers.”
Revitalizing federal funding was a key element, following years of administrative budget cuts. It was a lack of funds that forced those in crisis to turn to emergency rooms, homeless shelters, or end up in prison. The success of the pilot program not only showed how addressing mental crisis at the community level reduces health care costs, Blunt said, it also freed other public service providers such as police, emergency medical care practitioners, and educators to do the work they are trained to do.
Patel asked if some Republican policies could be contributing to the crisis by denying health care many may need, specifically trans youth seeking services. “When we speak to people from sexual minority groups, they often feel that their mental health is being affected by attitudes that prevail in certain parts of the country regarding those rights,” Patel explained.
Audience members during the Q&A asked about Republican votes on reproductive rights, marriage equality, and gun violence. While Blunt did not address the specifics of party policy, he did acknowledge that suicide rates in young people are concerning: “Suicide is second highest cause of death for all Americans under 35 (after accidents), and a higher number for people who are in the kind of crisis you are suggesting.”
To close, Patel asked what gave the former senator hope. “I can see, even in the last 10 years, a much greater willingness to talk about these problems. And these problems must be easier to deal with if you can include your friends, if you can include the people you worship with, if you could include your family in a greater way,” Blunt said.
“This is a problem we're going to collectively sympathize with, empathize with, and help solve together. And I think I can see definite and significant steps in that direction, and I feel good about that.”
Photos by Martha Stewart