“I am proposing a new approach to mental illness and to mental retardation. This approach is designed, in large measure, to use Federal resources to stimulate State, local and private action. When carried out, reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability. Emphasis on prevention, treatment and rehabilitation will be substituted for a desultory interest in confining patients in an institution to wither away.”
-- John F. Kennedy
Special Message to the Congress on Mental Illness and Mental Retardation
February 5, 1963
This deservedly famous speech led to a renewed responsibility for the American family – specifically, the need to take care of our brothers and sisters with mental health problems and mental retardation. It is nearly impossible to read this speech fifty years later without reflecting upon its form and content, its practicality and poetry, and President Kennedy’s relationship with his developmentally disabled sister Rosemary. A young John Kennedy took his sister to a tea dance and made her feel at home among the other dressed-up teenagers. President Kennedy called for Comprehensive Community Health Centers that would support families caring for their mentally disabled members and allow them to “be restored to useful life.” It is clear that his relationship with his sister, the oldest of the Kennedy girls, deeply influenced the man John F. Kennedy would become.
Before The Community Mental Health Act of 1963, which was the result of the speech, many mentally disabled Americans were sent to asylums, the ‘custodial isolation’ referenced above. There was little opportunity for therapy or constructive activity inside these asylums; for the most part, their purpose was to uphold ‘community standards’ by simply keeping people with mental illness out of sight. Care and housing standards differed greatly from state to state, with virtually no federal oversight.
Kennedy proposed a three-part plan for mental health care, with Comprehensive Community Mental Health Centers at the core. The development of these centers, available in virtually every community in every state, relied less upon federal dictates and rule making than the encouragement of available federal funding. The idea was for states to develop community mental health facilities that best fit their own needs, in terms of geographic availability, inpatient/outpatient mix and deployment of professional staff and other factors. An emphasis upon community-based care remains at the heart of American mental health care system to this day. President Kennedy also proposed steps to improve care in state mental institutions and increased research for mental health issues and increased training for professionals and staff who work in the field. For the “mentally retarded” -- the term itself is no longer used, another powerful example of how the environment has changed -- the president proposed increased prevention, community care centers and further research in to the causes and remediation of mental retardation.
In 2008, Senator Edward Kennedy and his son Representative Patrick Kennedy, President Kennedy’s brother and nephew, respectively, updated The Community Mental Health Act of 1963 with The Mental Health Parity and Addiction Equity Act, which required that health insurers treat mental health and substance abuse problems in the same way they treated other illnesses. We asked Patrick Kennedy for comment about how the world of mental health care has changed since his uncle’s speech:
“President Kennedy gave us a great vision of what could be when he proposed and signed the Community Mental Health Act in 1963. As I travel around the country today, I hear from people affected by mental illness, addiction, or intellectual and developmental disabilities who are energized by the hope and promise President Kennedy introduced into their lives and their families’ lives. But we have to acknowledge that the execution of the vision was flawed, that fragmented implementation of the promise it held out allowed too many people to fall through the cracks. Too many people failed to receive the help they needed. Too many became homeless or were bypassed by our society.
“The parity law I co-sponsored in 2008 and the Affordable Care Act give us new tools and a new opportunity to do what President Kennedy intended. But we have to hold ourselves and each other accountable for their implementation. I believe that if all of us work together -- the mental health, addictions, and I/DD (Intellectual Disability and Developmental Disabilities) communities -- we can achieve the purposes my uncle outlined fifty years ago.”
We can see how this community approach has made for a different world in our own neighborhoods. The street this author lives on has a halfway house and an assisted living facility for the mentally infirm. Once when teenagers were harassing a resident of the assisted living facility, I saw a middle-aged woman pull her car over, get out and cross the busy street, only to warmly greet the man and ask him how he was doing. The teenagers got the message and drove away. This is the legacy of a speech given by John F. Kennedy fifty years ago.
Source: John F. Kennedy: “Special Message to the Congress on Mental Illness and Mental Retardation.” February 5, 1963. Online by Gerhard Peters and John T. Woolley, The American Presidency Project http://www.presidency.ucsb.edu/ws/?pid=9546.
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