It would not be unreasonable to argue that if we eliminated obesity and mental illness, just about everything would improve: Medical and social service costs would plummet, people would stay in school and lead productive lives, the prison population would decline by up to one third, government agencies would no longer need to compete for more and more funding to meet the needs of more and more medically and emotionally hobbled citizens. Heck, we might even find a path forward in the post-Newtown gun debate.
But it would be unrealistic, if not unreasonable, to assume that Oregonians could find the discipline and money required to tackle obesity and mental illness and to eliminate their threat to prosperity and government. But that’s what they are — a threat — when you put a meter on them.
Mental illness, especially, has caught the full attention of a sometimes fire-breathing Peter Courtney, the Oregon Legislature’s most veteran member and Senate president. He announced last week that “it’s game-changing time” in setting the state’s spending priorities and told The Oregonian’s Harry Esteve: “I don’t want to hear another statement about mental health” unless lawmakers are willing to put up money to back their rhetoric.
Courtney scaled the burden, by the way, at $331 million, identifying no promising new revenue sources.
But Courtney had been working up a head of steam on this for some time. He previously recalled to the Statesman-Journal of Salem that he felt overwhelmed with the pervasiveness of sickness in society and its corollary costs. The scale of the problem is such, he argued, that “we’ve really got to prioritize mental health in ways we cannot even imagine … and transition our civilization in ways we cannot comprehend.”
That’s a high bar anywhere, let alone among Oregon lawmakers considering their support for a new Interstate 5 bridge over the Columbia River. But we agree with Courtney’s sentiment and even more so with his admission that buying our way out of the mental illness problem is impossible — “The amount of money needed for this is unimaginable,” he’d said before tossing out the $331 million tag.
There are, however, things we can do without finding a fortune. The overwhelming mental illness problem becomes scalable when broken down into pieces that show affordable opportunities now that can pay off big-time down the line. That means getting to young people first.
A compilation of Multnomah County data on alcohol, drugs and mental health issues from 2000 to 2012 states: “Among adults reporting a mental or substance use disorder in their lifetime, more than half report the onset occurred in childhood or adolescence.” A 2005 report in the journal General Psychiatry is more stark: Half of all lifetime cases of mental illness begin by age 14, three quarters by age 24.
Early intervention helps not only the suffering child but society later, when families and jobs and citizenship call for fully functioning adults. Now, so many adults are lost to prisons or addictions, while even more are hampered to such a degree they need public assistance and treatment — most of it at the public’s expense, with new demands brought to the cash-strapped Legislature.
Investments in the state’s participation in a nationally recognized practice called The Wraparound — a team approach to integrate services for a troubled child and family — help. Oregon’s psychiatric hotline for kids, allowing pediatricians to manage treatment in collaboration with child psychiatrists, needs continued support. Screening for adolescent depression, implicated in suicidal behavior as well as lifelong depression and illness, comes relatively cheaply, as does a program that works directly with health care providers to identify trauma in children and help set for them the right path forward.
Courtney noted the bulk of mental health spending goes to programs serving adult cases and housing for the mentally ill, while a comparatively small share goes to services for children and young adults. We don’t want anyone of any age left out in the cold. We also recognize nothing’s free. But calculated steps to fund services in the early years are a bargain when the savings can be so large later.
The Legislature should heed Courtney’s railings about mental illness but also listen to experts already helping our young. The needs of the young, left unaddressed, become the adult challenges whose collective costs are unimaginable.