It has been half a century since a member of Congress made our failure to treat mental illness a national issue. Representative Tim Murphy, a Republican congressman from southwestern Pennsylvania, has held a series of hearings over a one-year period, and last week he released the results. Murphy, a psychologist by training, took on the mental-illness issue as chairman of the Subcommittee on Oversight and Investigations of the House Energy and Commerce Committee, which has jurisdiction over most of the federal agencies involved in this problem.
The committee’s report makes clear why leadership is needed. Tucson, Aurora, Newtown, and the Washington Navy Yard turn out to have been merely the visible tip of the iceberg. Beneath the waterline sit approximately 350,000 seriously mentally ill individuals in the nation’s state prisons and county jails, and another 200,000 who are homeless. At any given time at least 40 percent of all individuals in the country with serious mental illness are receiving no treatment. Most disturbingly, Dr. Thomas Insel, director of the National Institute of Mental Health, told the committee that “treatment can reduce the risk of violent behavior 15-fold in persons with serious mental illness.”
So why aren’t we treating individuals? As many of the participants made clear in the various forums and hearings held by the committee throughout the year, it is not because we don’t know what to do. As one study showed, “violent crime fell by 45% in patients receiving antipsychotics and by 24% in patients prescribed mood stabilizers.” Testimony was also given regarding the effectiveness of using court orders, such as assisted outpatient treatment, in keeping patients on medication and thereby markedly reducing violent behavior.
As part of the committee’s investigation, Representative Murphy asked the Office of Management and Budget to collect information on the total federal expenditures for mental illness, data not previously available. The total in fiscal 2012 was $130 billion, including $76 billion as income support by the Social Security Administration and $40 billion under Medicaid and Medicare. Given such federal expenditures, which have increased rapidly in recent years, one would have thought there would be competent professional leadership in the Department of Health and Human Services (DHHS) to deal with this problem. The lead federal agency under DHHS for increasing access to mental-health services is the Substance Abuse and Mental Health Services Administration (SAMHSA), and one entire hearing was devoted to this agency’s role.
Testimony was also given regarding the effectiveness of using court orders.
The SAMHSA hearing made abundantly clear why the nation’s mental-illness-treatment system is broken. SAMHSA’s administrator, Pamela Hyde, acknowledged that her agency supports some grantees that, as a policy, encourage individuals with severe mental illness to stop their medication. The hearings also revealed that SAMHSA supports other grantees that have “actively impeded the implementation of improved treatment laws.” In other words, the federal agency in charge of improving the mental-illness problem is actually making it worse. The committee report politely summarized the shortcomings of SAMHSA by saying that it “was insufficiently focused on addressing those hardest-to-treat cases of severe mental illness for which inaction carries the greatest risks to the patient and surrounding communities.” Given the $130 billion per year in federal funds being spent on individuals with mental illness, the lack of professional leadership in the Obama administration is shocking.
What emerged from Representative Murphy’s year-long series of hearings and studies was a far-sighted bill to improve our mental-illness-treatment system, the Helping Families in Mental Health Crisis Act (H.R. 3717). The proposed legislation attacks the problem at multiple levels, including improving mental-illness-treatment laws, increasing the availability of public psychiatric beds, amending the privacy provisions under the Health Insurance Portability and Accountability Act, strengthening NIMH, and reforming SAMHSA. Murphy worked assiduously to make his proposal bipartisan, soliciting input from Democrats and from a wide variety of mental-health organizations. The bill has 49 Republican and 27 Democratic co-sponsors and has been endorsed by many organizations and newspapers, ranging from the Wall Street Journal to the Washington Post. Given the overwhelming evidence of the need to improve the nation’s mental-illness-treatment system, one would have thought that bipartisan common sense would prevail.
But that would underestimate the partisan sentiments and small-mindedness of some members of Congress. On May 6, Representative Ron Barber of Arizona and four other House Democrats introduced legislation aimed at directly competing with the proposed Murphy legislation. The Democratic bill provided funding for expanding the mental-health status quo while omitting all the provisions in the Murphy proposal that would produce actual change. It was widely rumored that Nancy Pelosi was behind the introduction of the Barber bill, to prevent the Republicans from taking credit for improving the system, a cynical move that the Wall Street Journal called “the basest form of Washington politics.”
It will be interesting to see whether members of Congress can rise above such games and carry out the mandate for which they were elected. As Representative Murphy noted: “Our investigative work revealed that those most in need of treatment — patients with serious mental illness such as persistent schizophrenia, bipolar disorder, and major depression — are the least likely to get the acute medical help they desperately need.” You would think that the information collected by Representative Murphy and the committee would be sufficient to convince his colleagues of the need for change, and that it should not take yet another Tucson, Aurora, or Newtown to turn the legislative tide. You would think. And then the killings in Santa Barbara happen. Although the details are not yet clear, Elliot Rodger was yet another mentally disturbed young man. But if this is not enough to push Congress into action, another tragedy will be along soon.
— E. Fuller Torrey, M.D., is the founder of the Treatment Advocacy Center and author of American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System.