As Jennay Ghowrwal and her brother prepared to leave their mother’s house in Bethesda, Maryland, in March 2011, they got ready for an ugly conversation.
For nearly two years, the Ghowrwals’ 65-year-old mother had been living alone with untreated schizophrenia. She refused medication. She wouldn’t see a doctor. The Ghowrwals’ Sunday visits were a critical part of the makeshift care system they’d created around their mother. And it was where they gave her a weekly allowance.
“That was the worst part,” says Jennay Ghowrwal, 28. “She always asked for more than she was going to get.”
But that spring afternoon, their mother’s demands were more extreme than usual. She demanded $2,000 because, she said, she needed a haircut. Frustrated, and weary of her mother’s emotional instability, Ghowrwal refused. “I said, ‘No, mom. I’m sorry. We can’t give you that.’”
Her mother went quiet.
When she started to talk, her speech was quick and difficult to decipher. The CIA was after her. Her kids were out to get her.
“If I can’t have control over my life, then they can’t either,” she screamed through tears. Then she grabbed a box of matches from the kitchen table, and lit one. As the match burned in her mother’s fingers, Ghowrwal remembers being relieved, thinking: “Finally. The moment we’ve been waiting for.”
In the last several years, national tragedies like the shootings in Newtown have put pressure on the US government to improve access to mental health treatment. This weekend’s violence in Santa Barbara has reignited the issue. But behind these headline-grabbing mass killings is a much broader crisis.
The most publicised reform came in November 2013 when the Obama administration issued regulations directing all private American insurance plans to cover mental health care in the same way as other medical care. These regulations mean, among other things, that co-payments and caps for mental health-related treatment cannot be more expensive or restrictive than for any other type of medical care.
There’s just one problem: while Obama may have expanded access to mental health benefits, the reach of the services those benefits theoretically provide hasn’t kept up. The availability of mental health care in the US remains woefully inadequate to handle current demand, never mind a potential influx of new patients.
Paul Appelbaum, a Columbia University psychiatrist and an expert on legal and ethical issues in medicine and psychiatry, uses a simple phrase to sum up the biggest problem.
“Right to care does not mean access to treatment,” he says. "Tens of millions of people who did not have insurance coverage may now be prompted to seek mental health treatment. And the capacity just isn’t there to treat them.”
“There really is no mental health system in the US."
'A system requires a vision. What we have is a shapeless void'