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After Newtown
The existing federal mental-health agency actually opposes efforts to treat mental illness.

Mourning the victims of the Newtown shootings, December 16, 2012.

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Many of SAMHSA’s internally initiated programs do indeed focus on such “prevention activities for persons not identified as needing treatment.” It produces and distributes free of charge reading books for children, such as Play Day in the Park for three- and four-year-olds and Look What I Can Do! for five- and six-year-olds; coloring books, such as Wally Bear and Friends; and “mental well-being sticker sets” with stickers saying “My smile is beautiful” and “I listen well.” SAMHSA’s website also makes available online children’s games such as The Great Weather Race and Boogie Band Studio. SAMHSA also makes freely available hundreds of publications including everything from Oil Spill Response: Making Behavioral Health a Top Priority and Hurricane Recovery Guides Preparedness Planning to What a Difference a Friend Makes and American Indian and Alaska Native Culture Card. There are six publications on “peer pressure,” eight on “social marketing,” 25 on “employment services,” and 40 on “health promotion.” However, if you query the SAMSHA website for publications on schizophrenia or bipolar disorder, you will be told that these are covered by a single generic product: Core Elements for Responding to Mental Health Crises. But it is out of stock.

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Even though SAMHSA is contributing almost nothing to the improvement of mental-health services in the U.S., it has taken on responsibility for advising other countries regarding theirs. SAMHSA has its own “international officer” and has been actively engaged in helping to plan mental-health services for Iraq and Afghanistan. In 2004 and 2005, it sponsored “Action Planning Conferences on Iraq Mental Health” in Amman, Jordan, and Cairo, Egypt. Since 2008, SAMHSA has funded visits by at least eleven Iraqi “behavioral health providers” to SAMHSA-designated facilities in the United States, including those specializing in “trauma-informed care” and “school-based mental health services.” One outcome of these visits was a decision by Iraq to close its main mental hospital, despite the fact that virtually no community treatment facilities exist for the sickest patients. In 2006, SAMHSA also began discussions with Afghanistan. According to the SAMHSA administrator at that time, Charles Curie, “SAMHSA can use its expertise . . . to help Afghanistan build its mental-health programs and capacity.”

Finally, in keeping with its emphasis on “prevention activities for persons not identified as needing treatment,” SAMHSA cares for its own employees’ mental health. The agency’s average salary, $109,000, surely helps. In 2011, SAMHSA commissioned for its headquarters a $22,500 painting of Native Americans by a Native American artist, “to help raise awareness about the roles of families and the community in mental and substance abuse disorder prevention.” Until recently, SAMHSA also put on an annual musical each December to celebrate World AIDS Day. The 2010 musical, which was attended by most of SAMHSA’s 574 employees, cost over $80,000 to produce.

Pity, then, President Obama, who would like to address the problem of untreated mental illness and prevent future tragedies like Tucson, Aurora, and Newtown. Saddled with SAMHSA as his lead federal agency, his efforts have predictably come to naught. The Biden task force ultimately made two recommendations for “increasing access to mental health services”: (1) “Ensure coverage of mental health treatment” by clarifying coverage under Medicaid and private insurance plans; and (2) “Make sure students and young adults get treatment for mental health issues,” by early identification and referral of such individuals. Neither of these recommendations is likely to have any effect on future tragedies, because they ignore the main issue.

Insurance coverage for mental-health treatment has not been a problem in any of these tragedies. Seung-Hui Cho at Virginia Tech and James Holmes at the University of Colorado were covered by their university health services; Jared Loughner in Tucson was covered under his mother’s medical-insurance plan with Pima County; and Adam Lanza’s family was financially able to cover all psychiatric-treatment costs. Similarly, the early identification of these mentally ill individuals has not been a problem. Cho, Holmes, and Loughner were all identified as having major psychiatric problems by their educational institutions. Indeed, Loughner’s problems were so overt that one of his Internet acquaintances even told him that he probably had schizophrenia. Lanza’s problems were also apparently visible to the multiple schools and special classes in which he was placed. Almost none of the perpetrators of these increasingly frequent tragedies were flying under the radar. On the contrary, most of them were like Goodyear blimps flying a sign saying, “I need psychiatric treatment.”



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