How important is the “recovery model” for SAMHSA? In its three-year plan, the word “recovery” is mentioned 206 times, when not a single study shows that it is effective for individuals with severe mental illness. By contrast, assisted outpatient treatment is not mentioned once, despite the fact that the Department of Justice classified it as an evidence-based program that reduces crime and violence, and 20 studies have reported that for individuals with severe mental illnesses it is effective in markedly reducing hospitalizations, arrests, homelessness, victimization, and violent behavior. (It also saves money. For example, for every dollar invested in assisted outpatient treatment in one California county, officials estimated that they saved $1.81. A recent study of assisted outpatient treatment in New York showed that there too assisted outpatient treatment yielded dramatic savings, especially of Medicaid funds.) And so the federal agency charged with reducing the impact of mental illness promotes a solution that, by definition, would be ineffective for severely mentally ill individuals such as Cho, Loughner, Holmes, and Lanza and ignores a solution that has proven to be effective.
But, alas, the situation is even worse. SAMHSA does not merely ignore effective treatments for individuals with severe mental illness. It also funds programs that attempt to undermine the implementation of such treatments at the state and county level. One such program is the Protection and Advocacy program, a $34 million SAMHSA program that was originally implemented to protect patients in mental hospitals from abuse. It was kidnapped by civil-liberties zealots and has been used to block the implementation of assisted outpatient treatment, funding efforts to undermine it in at least 13 states. For example in Connecticut, following the Newtown massacre of schoolchildren, the federally funded Connecticut Office of Protection and Advocacy for Persons with Disabilities testified before a state-legislature working group in opposition to the proposed implementation of a proposed law permitting court-ordered outpatient treatment for individuals with severe mental illness who have been proven dangerous. The law did not pass.
Another SAMHSA-funded program that works to block effective treatments for individuals with severe mental illness is its consumer-grants program. For example, the SAMHSA-funded California Network of Mental Health Clients, which receives at least $70,000 per year from SAMHSA, has lobbied successfully to block the widespread use of assisted outpatient treatment in that state. In Pennsylvania in 2011, the SAMHSA-funded Pennsylvania Mental Health Consumers’ Association testified in opposition to a bill that would have made it easier to treat individuals with severe mental illness. Indeed, SAMHSA may be the only federal agency that not only fails to remedy the problem assigned to it but actually opposes efforts likely to ease it.
So what does SAMHSA do with its $3.1 billion, other than promote ineffective approaches for the treatment of severe mental illnesses and attempt to block the utilization of effective treatments? It focuses much attention on three population groups, which it apparently considers to be in great need of improved mental health: Native Americans, residents of American territories (most of whom live in Puerto Rico), and the lesbian, gay, bisexual, and transgender (LGBT) community. The first two each received 132 separate mentions in the SAMHSA three-year plan, and the third received 50 mentions. This is the same plan in which individuals with schizophrenia, bipolar disorder, and other severe mental illnesses are not mentioned at all.
SAMHSA also devotes much of its resources to the prevention of substance abuse and mental illness. For substance abuse, there is a modest scientific basis for prevention activities, but for severe mental illness there is virtually none. The idea of preventing mental illnesses was popular in the 1960s and 1970s, as part of the community-mental-health-center movement, but it was later discredited when we realized that we did not yet understand the biological causes of these disorders. Nevertheless, SAMHSA requires its grantees, including the states that receive block grants, to spend the federal funds on prevention. The states are instructed to “make general prevention and primary prevention priorities.” In addition, the states are told that “the focus is about everyone, not just those with illness or disease, but the whole population. The focus is on prevention and wellness activities.” And those should include “community-wide interventions, changing [sic] in cultured norms, or other types of efforts [to] reach broad segments of the population” — language reminiscent of 1960s social activism.