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Some of the most prominent pioneers in American mental health advocacy include First Lady Rosalynn Carter and President Jimmy Carter. Rosalynn and Jimmy Carter’s mental health legacy involved decades as ahead-of-their-time trailblazers who built institutions and set precedents that are still making a difference today. Here, we’ll review their role in major historic turning points and the overall evolution of America’s mental health conversation.
Introduction to Rosalynn and Jimmy Carter’s Mental Health Legacy
The lingering impact of the COVID-19 pandemic on mental health in America was dramatic enough for Surgeon General Vivek Murthy to put out a 2023 advisory about a “loneliness epidemic” affecting over 60% of American adults. In a time when individual Americans and the nation as a whole struggle to rebuild the fundamentals of good mental health, reflecting on the legacy of pioneering mental health advocates becomes ever more relevant.
This naturally brings mental health advocacy by the Carters into the conversation. That advocacy dates back well before the trials and tribulations of 2020, motivated on the late First Lady’s part by her memory of instinctively fearing a cousin with mental health issues. Her awareness of the disconnect between “normal” people and the mentally ill lay at the root of her strong advocacy for the latter. During her husband’s term as Governor of Georgia, she was involved in the push for Community Mental Health Centers (CMHCs) and influential in high-level policy discussions. It was a role she would reprise as the honorary chair of the Presidential Commission for Mental Health (PCMH) in 1977.
Notable Contributions and Advocacy Efforts for Mental Health
President Carter’s Commission was diverse and manifested wide-ranging interests and perspectives. Its focus on “mental health” was itself a subtle shift in emphasis. America’s policy toward mental illness had, for decades, been more about providing some level of comfort for the “insane” rather than seriously attempting to treat or cure them. It was the Presidential Commission of the Carter years that would shift the emphasis toward the hope for successful treatment and that identified the specific ways the mental health system was falling short in helping sufferers.
One insight that came out of the PCMH’s final report was the extent to which mental illness and its sufferers had been stigmatized in American society. That report’s recommendations covered many bases to improving help for the mentally ill. Among other things, it noted:
- The lack of mental health services for rural areas
- The lack of adequate care for children and adolescents, seniors and sufferers of chronic conditions
- Lack of support for the cultural and linguistics traditions of Native Americans, Hispanics, African Americans and other minorities
- The presence of mild to moderate emotional disorders in some 25% of the American populace and the existence of over 40 million disabled Americans
The writers of the report stated a commitment to affordable and accessible mental health care, with specific attention to providing better care at a reasonable price for underserved communities. With a view toward human and legal rights, this care was to be provided free of discrimination. The administration was to require states to review their civil commitment and guardianship statutes to confirm they contained protections. It was to affirm unrestricted treatment for patients and confirm mental health care support for the incarcerated.
Impact of the Carter Administration on Mental Health Policies
As a governor, Jimmy Carter was a champion of “deinstitutionalization,” oversaw the creation of numerous CMHCs in Georgia and drastically reduced the population of mentally ill patients in hospitals. The PCMH represented an effort to follow up on that legacy, and although the deinstitutionalization movement proved to have mixed results in the long term, the Commission nevertheless raised important issues well ahead of the prevailing mental health standards of the day.
In fact, its reports contained more than a hundred major recommendations that, while difficult collectively to translate into legislation, would prove influential in shifting the consensus regarding mental health in Washington. Its ultimate outcome was the Mental Health Systems Act of 1980, which was a large-scale attempt to empower CMHCs on a national level just as Carter had previously done in Georgia.
The Mental Health Systems Act, S. 1177, provided grants for CMHCs, to mental health care ‘authorities’ and to other entities providing care and education for those with mental illness. It was considered landmark mental health policy in that it acknowledged and efforts to improve mental health care.
In 1981, shortly after the act had been put in place, most of the Mental Health Systems Act was dismantled with the Omnibus Budget Reconciliation act of 1981. The Regan Administration continued on a commitment from the the California Governorship to reduce enrollment and funding in mental institutions. The policy of the MHSA was mostly scrapped in favor of block grants for mental health needs that were 75-80% of the original funding levels. But one of the MHSA’s sections survived: a patients’ bill of rights that would influence a larger conversation about patient rights well into the current century. The Carter Administration’s efforts had two other important outcomes:
- It stimulated the development of active planning for the chronically ill within the federal bureaucracy.
- The climate of informed concern it created was a direct contributor to accelerating the rise of sophisticated epidemiology in a psychiatric field that was suddenly aware of how little it really knew about certain categories of patients, especially those in persistently underserved demographics.
Both these contributions would shape the paths of medical reform generally and mental health reform specifically through the creation of the Affordable Care Act in the Obama years and down to the present day. These impacts of the Carter Administration on mental health would be followed by the work of the Carter Center and its mental health initiatives.
The Carter Center’s Ongoing Initiatives for Mental Well-Being
The Carter family’s contributions to mental well-being continued vigorously post-presidency in the form of the Carter Center, which provided an outlet for the efforts and voices of both spouses. Their various interventions into the conversation surrounding mental health were helmed by the Carter Center Mental Health Program led by Mrs. Carter.
The program cultivated ties with people in a position to influence policymaking and focused on reducing the stigma associated with mental illness and increasing access wherever possible. Its supporting initiatives include the Rosalynn Carter Fellowships for Mental Health Journalism, which has proved to be the greatest success story in the Center’s battle against stigma.
The trailblazing efforts of the Carters and the lasting legacy of their advocacy has made major shifts possible in the national discussion about mental health and substance use disorders. The compassionate team at FHE Health pays tribute to those achievements every day through the treatment and guidance we provide for people in recovery. Contact us today to start your recovery journey and set yourself on the path to better physical and mental health.
