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The Agenda

NRO’s domestic-policy blog, by Reihan Salam.

Mental Illness Reform and Policy Innovation



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National Review has endorsed a new proposal from Rep. Tim Murphy (R-PA) for reforming the federal government’s approach to mental illness:

The Helping Families in Mental Health Crisis Act would push federal funding away from where it’s currently spent — mostly on providing social services to people with mild common mental-health problems, such as anxiety disorders and mild depression — and toward treating people with serious mental illness (schizophrenia, bipolar disorder, severe depression, etc.). It would also give law-enforcement officials, to whom the government has largely left the task of dealing with America’s mentally ill, a role in setting policies, and empower families to get seriously ill relatives the treatment they need. These reforms can be done at relatively little cost, because the money is so poorly allocated right now; in fact, effective treatment for the mentally ill would save money elsewhere, especially in our criminal-justice system.

Earlier on, D.J. Jaffe described the origins of the bill befoe describing its central provisions:

In 2014 U.S. spending, public and private, on mental health will total $203 billion. Because of mission creep and lack of coordination among agencies, the funds are now spent by the unregulated mental-health industry on “improving the mental health” of all Americans rather than focusing on the 5 to 8 percent with serious mental illness. Throwing money at mental health, as Obama proposes, will not result in more funds’ being spent to treat those with serious mental illness, because the mental-health industry disguises worthy social-service programs, like helping people get better grades, find better jobs, and feel more empowered, as mental-health programs to gain access to the mental-health budget. Rather than concentrating on delivering treatment to those with serious mental illnesses, such as schizophrenia and bipolar disorder, they deliver improved happiness to the 25 to 40 percent they claim have “mental health” issues.

The industry now routinely, regularly, unabashedly classifies ordinary life experiences like being unhappy, having an unsatisfactory marriage, experiencing the death of a loved one, or this year’s favorite, bullying, as major unmet mental-health challenges that the federal government should fund. Meanwhile those who have serious brain disorders are left to sleep on street grates and forage in trash bins for food. Some 200,000 are homeless, 300,000 are incarcerated, and many are living hellish lives locked inside hallucinations, delusions, and paranoia, contemplating how to take their own lives.

President Obama would never let the banks write his tax policy, but he has no problem letting the mental-health industry write his mental-health policy. Rather than funding mission creep, Representative Murphy focuses on mission control. When President Obama took office, he said he would listen to good ideas wherever they came from. Representative Murphy has good ideas. The two of them should talk.

Though I can’t speak to the wisdom of Murphy’s proposal as such, it strikes me as an excellent example of the kind of thing House backbenchers ought to do. Murphy drew on the expertise of scholars who’ve been critical of the mental-health industry, some of whom, like Sally Satel of the American Enterprise Institute, are affiliated with center-right think tanks that devote their efforts to crafting workable policy solutions. Mental illness is not one of the most pressing issues on the minds of U.S. voters, yet it is an issue that comes up every time there is a mass shooting or some other spectacular crime committed by a person plagued by mental illness. And when this happens, critics of expanding government as the first resort often find themselves at a loss. There is also a labor market dimension to mental illness, as people with severe mental illness often find it impossible to work, a problem that has grown in severity quite dramatically over the past quarter-century. So this is the kind of issue where you’d want an intelligent and resourceful backbencher to specialize, and to craft a proposal that can attract broad support within the caucus.

Murphy’s proposal, in broad outline, aims to achieve savings across the public sector as a whole by deploying mental illness resources more effectively. It does, however, involve restructuring existing government agencies, empowering some bureaucracies at the expense of others, and devoting resources to a segment of the population that generates large social costs. In short, Murphy’s bill has the federal government do more than get out of the way. Rather, it represents an attempt at making government more effective, one of the core objectives of reform conservatives. One hopes that Murphy’s bill will attract positive attention, as it might then convince other GOP backbenchers to pursue policy innovations of their own. 



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