Dr. William C. Bell: Now is the time for real mental health care

Casey Family Programs President and CEO Dr. William C. Bell addressed the Project AWARE (Advancing Wellness and Resilience Education) grantee convening on July 27, 2017, in Washington, D.C.

Project AWARE is a grant program of the Substance Abuse and Mental Health Services Administration (SAMHSA) designed to help state and local education agencies increase awareness of mental health issues among school-age youth, train educators and other youth-serving adults to detect and respond to mental health issues and connect children, youth, and families who may experience behavioral health issues with appropriate services.

Dr. Bell traced the timeline of mental health reform in America from the Kennedy Administration to the present, described the pipeline to prison that has absorbed many victims of that reform and expressed hope that we will see real change in our lifetimes.

Prepared remarks

Thank you Lyman.

Good afternoon.

Undiagnosed and untreated mental illness has grave consequences for the people enduring mental disorders, their family members, the communities they live in and society as a whole. We are all impacted. And no matter what people may want to believe, our destinies cannot be disconnected.

One of the questions that we must consider is how did we get to the place that we are in today? Whether it is mental health, increasing foster care, overcrowded prisons, or distraught communities – how did we get here?

If you think about your own life and how you got to this moment in time, you will find that you’ve made a lot of decisions. Some of them may have been connected to each other, but many of them were not. They were made at different times in your life and many were made under very different sets of circumstances. But there is no debating the fact that it is the collective total – the accumulation of all of those decisions – that have gotten you to the you that you are today.

Many of us spend many nights and many glasses of wine wishing and wondering how things might have been different only if we had made some different decisions; some different choices. We also sometimes find ourselves contemplating what we could do or decide to do today or tomorrow or next week that might help us move to a better place.

In a lot of ways this picture is not that dissimilar to where we find ourselves today as a nation with regard to mental health and the work that you do in Project AWARE Now is the Time.

If you would allow me, I would like to just talk to you for the next 20 to 30 minutes on where we are as a nation, how we got here as a nation, and where I hope some of you in this room will be motivated to help us go as a nation when it comes to the future or children, families and communities that are struggling with the reality of mental illness and the reality of its impact on their daily lives.

I  The president: A 45-year-old President Kennedy and his speech.

II  The timeline:  The timeline on mental health reform in America.

III  The pipeline:  The pipeline that has absorbed many victims of that reform.

IV  The hope:  The hope that we will see real change in our lifetime.

I  President Kennedy – 54 Years Ago – Feb. 5, 1963

In 1963 – 54 years ago – in a special message to Congress on mental health and developmental disabilities, President John F. Kennedy declared both conditions to be among the nation’s most critical and tragic health problems. President Kennedy reflected on the advancements the U.S. had made in the diagnosis and treatment of diseases that afflict the physical body, and the president noted that the need for public action to understand, treat and prevent mental illness was far greater than the attention it had received.

Critical size of the problem:

  • As we know, today 50 percent of all lifetime cases of mental illness begin by age 14. (National Institute of Mental Health)
  • One of every five teenagers – 20 percent – live with some type of mental illness. (National Institute of Mental Health)

Tragic impact of the problem:

  • Fifty percent of students 14 and older with a mental illness drop out of high school. (National Institute of Mental Health)
  • Ninety percent of those who commit suicide had some underlying mental illness. (National Institute of Mental Health)

The susceptibility to public action is so much greater than the attention toward resolution the problem has received.

The problem requires a whole new national approach and a message to Congress.

The problems:

  • Mental health and
  • Mental retardation/developmental disability

The federal government has a responsibility to:

  1. Assist with attacking this public health problem
  2. Channel and coordinate the energy of the nation’s people in attacking this public health problem.

Great progress has been made to isolate, treat and defeat most major physical health challenges, but our nation’s efforts to understand, treat and prevent mental illness and other mental health challenges have not made comparable progress.  Mental health and developmental disabilities are among our most critical problems affecting our nation’s children.

  1. They occur more frequently.
  2. They affect more people.
  3. They require more prolonged treatment.
  4. They cause and impose more suffering on the families and communities of the afflicted.
  5. They drain significant levels of human resources.
  6. They drain significant amounts of government and public funding.
  7. They drain significant amounts of personal funding and family resources.
  8. The numbers associated with the affected are overwhelming, and our response system and methods are antiquated – we reach insufficient numbers of the affected and do not have the results and impact that we desire or need.
  9. The amount of public resources that we currently expend on controlling and resolving this public health challenge is insufficient to meet the need.
  10. The daily human experience of the individuals, their families and communities affected and consumed by the lifelong struggle with mental illness and developmental disabilities should drive our response as a nation more than the dollar amount associated with winning this fight.
  11. We must be driven by the fact that the vast majority of the onset and early impact of mental illness and developmental disability begins with our children, and that impacts them, their families and their communities for a lifetime.
  12. The time has come for us to act.

Now is the time.

II  The Timeline

Deinstitutionalization and “community release”.

1955    Peak psychiatric hospital population: 560,000

1963    President John F. Kennedy’s Community Mental Health Act

1965    Passage of Medicaid incentivizes moving patients from institutions into communities.

1977    650 community health facilities serving 1.9 million people per year.

1980    President Jimmy Carter signed the Mental Health Systems Act to restructure and improve community mental health services.

1981    President Reagan repealed President Carter’s Mental Health Systems Act and established block grants, decreasing federal funding by 30 percent.

1984    Ohio-based study found that 30 percent of homeless suffered from mental illness.

1985    Federal funding for community mental health dropped another 11 percent.

2006    U.S. Department of Justice reports that mentally ill make up:

  • 45 percent of federal inmates
  • 56 percent of state inmates
  • 64 percent of local jail inmates

2009 – 2012    In the aftermath of the latest great recession, states cut $4.35 billion in public mental health spending – the largest reduction since deinstitutionalization.

III  The Pipeline

2006 U.S. Department of Justice Report

  • Survey of inmates in state and federal corrections facilities
  • Survey of inmates in local jails

2005:   Federal Prisons                       State Prisons                           Local Prisons

45%                                                     56%                                         64%

had mental illness                               had mental illness                   had mental illness

(705,600)                                            (78,800)                                   (479,900)


Populations that have symptoms of serious mental illness:

  • Homeless
  • Poor/income insufficient
  • Uneducated/under educated

American Psychological Association (October 2014, vol. 45, No. 9, page 56):

  • The United States has 5 percent of the world population
  • The United States has 25 percent of the world’s prison population – 2.2 million

The explosive increase in the United States’ prison population mostly occurred during the past 40 years.

Pew Center on states:

  • $60 billion spent annually on state and federal prisons

This is an increase of $12 billion during the past 20 years.

Factors contributing to the United States’ increase in prison population:

  • Declared war on drugs
  • Increased legal and judicial penalties for drug convictions
  • Mandatory minimum sentences
  • Three-strikes laws
  • Federal requirement that prisoners must serve at least 85 percent of their sentence

1973 federal and state prison population: 200,000.

2014 federal and state prison population: 1.5 million. Plus, 750,000 in local jails. Total: 2.2 million.

There is no scientific or research basis underpinning this increase in prison population.

Increase in prison population primarily driven by our nation’s political policy agenda.

This increase in prison population coincides with the movement to deinstitutionalize mental health facilities.

Race:                                      African American                    Hispanic/Latino

% U.S. population:                            13%                                         17%

% prison population:                        40%                                         20%

Use of private prisons:

  • Strong need for prisoners in order to be profitable.
  • Profitability not only benefits private corporations, but also those who invest in and trade their stock on the stock market.
  • Strong and successful lobbying machines.

Types of incarceration

  • Federal Prisons – run by the U.S. Bureau of Prisons; hold prisoners convicted of federal crimes, and pre-trial detainees.
  • State Prisons – run by state corrections departments; hold sentenced inmates serving time for felonies, usually longer than one year.
  • Local Jails – county or municipal facilities; hold defendants prior to trial, and those serving short sentences, usually less than one year.

Other types of incarceration

  • Juvenile detention facilities
  • Police lock-ups – small rooms in police stations where prisoners are held
  • Immigration detention facilities
  • Military prisons
  • State mental hospitals – for those who are civilly committed

The GEO Group

  • $29.84/share, July 27, 2017
  • 1984: Wackenhut Corrections Corporation
  • 1994: IPO (initial public offering), 2.2 million shares on Nasdaq
  • 2003: Bought majority stake in company; name changed to the GEO Group
  • 2011: New York Stock Exchange, $1.6 billion in revenue

Corrections Corporation of America (now named CoreCivic)

  • $27.33/share, July 27, 2017
  • 1983: Founded
  • Traded on New York Stock Exchange as CXW
  • 2012: $1.7 billion in revenue; 16,750 employees
  • The largest private prison company in the United States

Just who really benefits from these prison labor programs? Not the prisoner on any appreciable scale.

While UNICOR’s revenues in 2016 were nearly a half billion dollars ($498.4 million), roughly 20,000 prisoner-workers earned:

  • Anywhere from 23 cents to $1.15 an hour performing jobs that are in decline in the outside world,
  • A 14 percent better chance of getting employed than the non-UNICOR participant,
  • And a 24 percent better chance of never returning to prison than the non-UNICOR participant.

In 2012, Congress allowed UNICOR to expand its operations to manufacture consumer goods that are currently being produced overseas by other companies, if UNICOR can show that its prison labor model can produce those same goods at lesser costs in the United States. Not only made in America, but made in prison.

If it proves cost effective, UNICOR will be able to enter agreements with companies to bring their offshore manufacturing operations of consumer goods back to the United States, providing work for more inmates, some of whom may have served time in juvenile detention, may have dropped out of school, may have once been in foster care, or may be struggling with mental illness.

IV  The Hope

For too long we have avoided our obligation to our children, their families and their communities on the grounds of:

  • Inadequate funds
  • Need for more research
  • Promises of future innovation


  1. Combined/integrated response – an integrated government response system that includes public health, child well-being, juvenile justice, physical and mental health, law enforcement, education, courts, among others.
  2. Integrated five-sector collaboration – elected public sector; business sector, especially pharmaceuticals; non-profit sector, including faith-based institutions; philanthropic sector; general public and community sector.
  3. Challenging, changing and reconstructing our social well-being conceptual framework.
  4. Changing the streets. A willingness to acknowledge that we have allowed the creation and development of toxic ZIP codes (geographic hopelessness).

Willingness to change and reconstruct the communities and condition where we as a nation have become too comfortable watching our children grow up and die in the midst of hopelessness.

  • 33,000 residential ZIP codes
  • 20 percent – 6,600 ZIP codes contain:
    • 80 percent of the children living in poverty
    • 76 percent of the adults age 25 years old and older whose highest level of academic achievement is less than a high school diploma or GED

Everything that follows:

  • Unemployment
  • Under employment
  • Lifetime earnings
  • Insufficient income
  • Crime
  • Imprisonment
  • Violence

I repeat:

  • Unemployment
  • Under employment
  • Lifetime earnings
  • Insufficient income
  • Crime
  • Imprisonment
  • Violence

We as a nation have long neglected the mentally ill and the mentally retarded. This neglect must end, if our nation is to live up to its own standards of compassion and dignity and achieve the maximum use of its manpower.

This tradition of neglect must be replaced by forceful and far-reaching programs carried out at all levels of government, by private individuals and by state and local agencies in every part of the Union. We must act:

–to bestow the full benefits of our society on those who suffer from mental disabilities;

–to prevent the occurrence of mental illness and mental retardation wherever and whenever possible;

–to provide for early diagnosis and continuous and comprehensive care, in the community, of those suffering from these disorders;

–to stimulate improvements in the level of care given the mentally disabled in our state and private institutions, and to reorient those programs to a community-centered approach;

–to reduce, over a number of years, and by hundreds of thousands, the persons confined to these institutions (now confined to penal institutions);

–to retain in and return to the community the mentally ill and mentally retarded/developmentally disabled, and there to restore and revitalize their lives through better health programs and strengthened educational and rehabilitation services; and

–to reinforce the will and capacity of our communities to meet these problems, in order that the communities, in turn, can reinforce the will and capacity of individuals and individual families.

We must promote — to the best of our ability and by all possible and appropriate means — the mental and physical health of all our citizens.

To achieve these important ends, I urge that the Congress favorably act upon the foregoing recommendations.


I applaud the work you are doing and the difference you are making in the lives of children, youth and their families. Through your work, you are saying, failing to meet the needs of our youth struggling with mental illness cannot continue to be tolerated in this great, resourceful and inventive nation of ours. We should not be despairing of solutions.

You are saying, mental health shouldn’t be so easy for us to ignore, and once diagnosed, it shouldn’t be so easy to postpone treatment.

You are saying, mental illness need not be a pipeline to prison, but that you will be the outlet valves on the multiple pipelines to prison children and youth with mental illness may find themselves on. You will be their escape valves to hope.

You are saying that this simply does not have to be. No child deserves to have their life derailed into multiple pipelines to prison simply because he or she has a mental illness. But every child deserves alternatives and choices. Every child deserves to have hope. Every child deserves an opportunity to dream and to have a real opportunity to make those dreams come true.

Thank you, and God bless.