Bitter pills: the impact of medicare on mental health

There was a significant shift in mental health care when it moved away from large custodial facilities and into outpatient psychiatric wings. Making care more accessible in the community meant that the patient population expanded. Care was, arguably, more available to those who could not previously access it, and a variety of treatment options were now available without long-stay institutionalizations. But as with many changes, the shift resulted in some unexpected challenges.

Patients were, for example, increasingly expected to take responsibility for their own health care plans, which presented challenges that persist for patients today. These include setting and attending doctors’ appointments, taking responsibility for drug regimens, or needing to find sheltered employment, safe housing and a social support network.

In this paper, Erika Dyck examines some of the tradeoffs of this shift, and considers historical lessons that can contribute to today’s discussions on public policy and mental health care. She considers first-hand experiences, which suggest that despite the need for clinical care at times, the major challenges to independence are political and economic.

Read as published in Health Economics, Policy and Law Volume 13, Special Issue 3-4