Should community based psychiatric services be publicly funded?

Should community based psychiatric services be publicly funded?

08/07/26

Should mental health services be publicly funded as they have historically been with the old State Hospital System? In the 60s deinstitutionalization of services for people with psychiatric disorders occurred moving the required services to Community Mental Health Centers.

States promised that the money saved from closing their psychiatric hospitals would be reinvested in community based services and then reneged on their promise and used the saved money for other purposes. The costs of psychiatric services were shifted to health insurance.

Health insurance, though, said they would only reimburse for services that were “medically necessary.” Health insurance would not pay for what came to be called “wrap around services,: which many people with psychiatric disabilities need. Case management services were not “medically necessary” and so people with psychiatric problems were left to navigate an increasingly complex service system on their own and there was a rise in the criminalization of people’s behavior and homelessness.

A return to State Hospitals is not the answer, but state legislators keeping their original promise to fund community based services not covered by health insurance is.

Authoritarian parenting contributes to the development of lying and cheating in children.

Authoritarian parenting is a major factor in contributing to children lying and cheating. The lying and cheating is a coping mechanism to deal with shame, low self esteem, and sense of failure.

It is my observation in my professional and personal life that this coping mechanism extends into adulthood and can become quite dysfunctional interfering with the development of healthy interpersonal relationships. 

Lying and cheating undermine trust, credibility, and reliability.

It can take years to overcome this habitual response to dealing with situations in which there is a fear of disappointment and punishment from others from telling the truth and acting fairly.

I had a client who told me she had found and bought a book titled, The Courage To Be Disliked. Besides lying and cheating the fear of dissappointing and being punished by others for not living up to the external expectations is a major contributor to symtoms of anxiety, depression, and in the extreme homicidal and suicidal ideas. To overcome lying and cheating it does take courage to stand up for oneself and be honest.

There are many ways to change these habitual behavor patterns and perhaps one of the best is psychotherapy with a trusted nonjudgmental psychotherapist

For more click here.

Discussion book of the month, A World Appears by Michael Pollan

This month, August 2026,  the Allnonfiction book dsicussion group is discussing Michael Pollan’s book, A World Appears

You can join the Allnonfiction book discussion group by going here.

Talk therapy provides enduring relief from depression years after treatment, study finds

From PsyPost on 07/19/26

Talk therapy provides lasting relief from depression, with the benefits persisting for several years after treatment ends. A new, large meta-analysis evaluating tens of thousands of patients tracked these mental health improvements over time, mapping exactly how long people feel better. The research was published in the journal World Psychiatry.

For more click here.

A few note worthy points:

1. Talk therapy may be more helpful than medication.
2. Talk therapy benefits are long lasting over several years.
3. In general, maximum benefit is achieved at about 3 months.
4. "Talk therapy" is professionally referred to as "psychotherapy" and colloquially as "counseling."]
5. "Psychotherapy" is much different than simple conversation because the therapist knows the most helpful questions to ask to explore areas that will be most helpful to the client and is ethically bound to put the client's needs ahead of their own.

MAID, Medical Assistance In Dying, available in New York State as of 08/05/26

On 07/18/29 I took an online CEU course from the Wurzweiler School of Social Work at Yeshiva University on “Understanding Medical Aid In Dying: Clinical, Policy, and Caregiver Perspectives.” There are 14 jurisdictions that now allow MAID with New York State’s more recent law taking effect on August 5, 2026. MAID is also legal in Canada and many other countries.

Self administered end of life chemicals is not called “suicide” by people in the field. Terms such as “death with dignity” are preferred. Also, MAID is not euthanasia. Euthanasia is ending life by another and it is illegal in all jurisdictions in the US although allowed in some other countries.

Here is a brief YouTube video about Barbara Goodfriend’s MAID experience on CBS Eye On America broadcast on January 28, 2025.

This the first in a series of article on MAID which will be tagged MAID.

Psychotropic medications and human functioning.

There is a very good book entitled “The Social Worker and Psychotropic Medication” by Kia Bentley, Shannon Hughes, and Joseph Walsh which attempts to cover what Social Workers should know about psychotropic medications.

When I graduated with my MSW in 1972 psychotropic medications had not yet been formulated and used in the treatment of symptoms of mental health problems. Psychodynamic oriented psychotherapies and custodial care were the predominant treatment strategies. The bio-psycho-social model of assessing problems in functioning was not described until 1977 by Dr. George Engel at the University Of Rochester. The Social Work knowledge base has always focused on what Social Workers called the “person in situation” model. 

Over the course of my 58 year career as a Psychiatric Social Worker I have learned about psychotropic medications and their effects on human functioning from “on the job training” and reading journal articles and books. It is interesting how the predominant treatment of symptoms of mental health problems has shifted from the psychological to the pharmacological. Some of this shift has been beneficial and some of it has been harmful. A good Social Worker is aware and educated about both.

The key question from a Social Work perspective is “How do psychotropic medications affect human functioning?” A corollary question is “what professional discourse is most helpful in assessing how psychotropic medications enhance or detract from human functioning?”

Monitoring effects of psychotropic medications.

As a Psychiatric Social Worker, and not a physician, I still spend a lot of time and energy discussing with my clients their medications, especially their psychotropic ones with them. 

Knowing about the power of the placebo effect I am very cognizant and curious about what my clients think about their medications. Do they think they will help, are skeptical, or have mixed feelings? Will they be compliant and take them as prescribed or “forget” to take them or abuse them?

There is a fine line between medical and psychological effects of taking medications. Many of my clients expect medications to be a “silver bullet” and a “magical key” to ameliorate their symptoms and improve their experience of their quality of life.

Whether medications “work” has as much to do with psychological expectations as well as the pharmacological actions. Whose job is it to monitor the efficacy of the use of medications: the prescriber, the psychotherapist or both? 

Throughout my career as a Psychiatric Social Worker I have increasingly found that it is my job if I want to help my clients improve their functioning. I find myself surprised at the lack of supervision by the prescriber on the psychological dynamics of prescribing medications. They don’t seem to have the time for it or an interest or competence in this aspect of their patients' treatment. They leave it up to the psychotherapist if the patient has one.

For more on this topic click here.