As a result of politics in Washington, we are likely to see more events like the killing of seven in Santa Barbara, Calif., by Elliot Rodger, a young man who had serious mental illness.
Before the killings, Rep. Tim Murphy (R., Pa.) proposed the transformative “Helping Families in Mental Health Crisis Act” (HR 3717). It ends wasteful mental-health spending and focuses the savings on getting treatment to the most seriously mentally ill — those most likely to become a headline. Murphy, who is a practicing psychologist, crafted a bill that earned 56 Republican and 31 Democratic co-sponsors, an amazing accomplishment in Washington’s toxic political environment.
Unfortunately, while well-intended, Representative Ron Barber (D., Ariz.) was misled by the mental-health industry into introducing a competing bill, the “Improving Mental Health in Our Communities Act” (HR 4574
). It gives the mental-health industry more money without requiring them to serve the seriously mentally ill. It languished with hardly any support until May 2, when Nancy Pelosi spokesman Drew Hammill told The Hill
that Pelosi wants a bill “that actually has the support of the mental-health community.” On May 24, Elliot Rodger killed four men, two women, and himself — causing 35 Democrats to sign on as co-sponsors to this industry-sponsored bill so they can be thought of as “doing something.” But unbeknownst to them, what they’re doing is feeding the industry, not helping the ill.
The Barber bill encourages mental health among the citizenry at large, perhaps many of whom would like their mental health improved, and it may help some of the 20 percent of adults over 18 who have a diagnosable mental-health issue. But it does little for the 4 percent who have a serious mental illness such as schizophrenia or severe bipolar disorder. This is part of a trend. Until the early 1960s, virtually all mental-health expenditures were spent on the most seriously ill in psychiatric hospitals. Today — at the request of the mental-health industry — dollars are instead spent improving the mental health of all citizens including people without any mental illness. As a result, 164,000 mentally ill are homeless and more than 300,000 incarcerated.
The Barber bill raises reimbursement rates for marriage counselors, which engendered the support of the American Mental Health Counselors Association. But having a marriage you want improved is not a mental illness. The Barber bill would also fund this year’s cause célèbre, bullying, which earned the support of Mental Health America. But bullying is not a mental illness.
In stark contrast, the bipartisan bill focuses on the elephant in the room: getting treatment to those adults known to have serious mental illness. It starts to reduce the nationwide shortage of beds in psychiatric hospitals so that more people with serious mental illness can get access to care rather than jails. It slightly loosens patient confidentiality protections so parents who care for adult children with serious mental illness can get the same information that paid caretakers receive. Barber should understand how important that is.
The bipartisan bill requires the Substance Abuse and Mental Health Services Administration (SAMHSA) to stop the current flow of money to groups that believe mental illness is merely “an extreme state of consciousness”; that romanticize psychotic thoughts, delusions, and hallucinations as simply “non-consensus reality”; that believe “the covert mission of the mental health system . . . is social control”; and that teach persons with mental illness how to stop taking medication and go off treatment.
The bipartisan bill reins in federally funded lawyers who are supposed to prevent mental-health systems from abusing persons with mental illness but instead “free” them from often-life-saving treatment. Such lawyers “freed” William Bruce from a Maine hospital over the repeated and strenuous objections of his parents, and William subsequently killed his mother.
And perhaps most important, the bipartisan bill gives states an incentive to implement Assisted Outpatient Treatment (AOT) programs. AOT is for the tiny subset of the most seriously ill who have accumulated multiple episodes of homelessness, hospitalization, arrest, incarceration, or violence associated with going off treatment. It allows judges to order them to stay in six months of mandated and monitored treatment while living in the community. AOT is proven to reduce serious violence 66 percent. It reduces homelessness, arrest, hospitalization, and incarceration each by over 74 percent. It saves taxpayers 50 percent of the cost of care by replacing expensive, liberty-depriving inpatient commitment, hospitalization, and incarceration with far less expensive community-based care.
The politics are mind-boggling. The bipartisan bill has the support of the mainstream, including numerous editorial boards such as the conservative Wall Street Journal and the liberal Washington Post. It has support from police, sheriffs, judges, and families of the seriously mentally ill. The co-sponsoring Democrats include Representative Eddie Bernice Johnson, a long-time Democrat champion of improving care for the most seriously ill. For too long, we Democrats (confession: I’m one of them) have been unwilling to admit unpleasant truths, such as: Not everyone recovers, and sometimes hospitals are needed; left untreated, a small subset of the most seriously ill do become violent; and throwing money at mental health overall does not lead to targeted treatment for the seriously ill.
Democrats who support the bipartisan bill will now come under pressure from Pelosi to withdraw support. Pelosi and Barber might be well intentioned. But their bill fails utterly to get treatment to people with serious mental illness, and it could kill a bill that would provide desperately needed solutions. Rather than looking for a bill that has the support of the industry, Democrats who truly care should look for a bill — such as Murphy’s — that helps the seriously ill.
— D. J. Jaffe is executive director of Mental Illness Policy Org., a nonpartisan, science-based think tank on serious mental illness. A comparison of bills is here.