Some federal-budget cutters claim that we have already picked all the low-hanging fruit. Those of us who work in Washington know better, although it is not considered polite to say so. One counterexample is SAMHSA, a federal health agency distinguished by the fact that the health of its clients would improve if it went out of business.
The acronym stands for the Substance Abuse and Mental Health Services Administration, a $3.6 billion component of the Department of Health and Human Services. It employs 537 people, who have an average salary of $107,760; almost three-quarters have jobs rated a 13 or higher on the General Schedule, meaning their salaries start above $70,000. Its official mission is to reduce “the impact of substance abuse and mental illness on America’s communities” and increase access to treatment services.
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Given this mission, one might think that SAMHSA would have a major interest in the two most serious mental illnesses — schizophrenia and bipolar disorder — which together affect 7.7 million Americans, according to the National Institute of Mental Health.
An increasing percentage of homeless persons, as well as individuals in jails and prisons, are diagnosed with serious mental illnesses. This is a direct consequence of the continuing decline in the number of state mental-hospital beds, combined with our failure to provide treatment once these patients return to the community. However, judging by the just-released document “Leading Change: A Plan for SAMHSA’s Roles and Actions 2011–2014,” such individuals not only are not a priority for the organization, they do not even exist. Not once in the 41,804-word text of this three-year plan is either schizophrenia or bipolar disorder even mentioned. Instead, the nation’s mental-health ills are all subsumed under a vague category called “behavioral health problems.” Assuming this broad mandate has allowed SAMHSA to dabble widely and ignore the most serious disorders.
One might also think that SAMHSA would be concerned that 4.7 million individuals receive Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) because they suffer from “mental disorders, other” (as the category is named). The total federal cost for such support for these mentally ill individuals in 2009 was $45.7 billion. When I recently queried SAMHSA about what it knows about these 4.7 million people and why some states have three times as many mentally ill individuals per capita on SSI and SSDI as other states, the agency replied, “SAMHSA does not collect this information. . . . We have no data.”
One might also expect SAMHSA to exhibit concern about the fact that 3.5 million out of the 7.7 million most severely mentally ill individuals in the U.S. are not being treated, according to the National Institute of Mental Health. This includes a small number of individuals like Jared Lee Loughner, who become dangerous if not treated. It also includes many of those on SSI and SSDI, and one wonders how many of them could be removed from those rolls if they were properly treated. Yet SAMHSA gives many grants to organizations that oppose forcing the severely mentally ill to receive treatment.
For example, the Pennsylvania Mental Health Consumers’ Association, which receives a recurring grant of $70,000 from SAMHSA, is currently opposing a bill that could make it easier to treat seriously mentally ill individuals in Pennsylvania. Another SAMHSA grantee, the California Network of Mental Health Clients, has lobbied successfully to block the use of assisted outpatient treatment (AOT) in the state, even though AOT targets the sickest individuals who are not taking their medication and are potentially dangerous, and has been shown to decrease rehospitalization, incarceration, and violence among such individuals. SAMHSA-supported consumer groups in Maine and Vermont have also opposed improving their state’s mental-illness-treatment system within the past two years. Perhaps the best measure of SAMHSA’s lack of commitment to treatment of severe mental illness is the $330,000 per year it gives to the National Empowerment Center in Lawrence, Mass. Daniel Fisher, its director, has written that “the covert mission of the mental health system . . . is social control.” Laurie Ahern, a former co-director, believes that “mental illness is a coping mechanism, not a disease.”
This article is symptomatic of nearly all gov't. programs. There is almost never an attempt to mitigate a problem in society. It is to create programs that make people in DC feel better. Just as rehabilitating a murderer is nearly impossible, it is probably more difficult to help a mentally ill person when they are being freed from the bandage of the state that assists them in getting and taking medication that might actually help them to function in society.
Only here are those who need the help, freed from the bonds of gov't., while the rest of us are continually put under more and more restrictions.
The only programs that actually go away are ones in the military. Let's face it, we are still paying a telephone tax for the Spanish-American War, still paying for Rural Electrification (at least where the greenies will let us put up poles). How many other obsolete programs are there?
Maybe we need the Vice President and his staff study every program and cancel the duplicates (as well as attending funerals). Perhaps all programs should have stated goals and metrics. Every 5-10 years they get examined and if they don't meet the goals we cancel the program.
E. Fuller Torrey is upset. Can Rich Lowry be far behind? Is there hope that someday mental illness will be understood as the superstition of a former age?
Indeed - untreated mental illness has real-life consequences, especially with regard to schizophrenics. I can't believe that any "expert" would claim that schizophrenia was acceptable in any way. Was this expert wearing a foil hat?
With a close relative who suffers from schizophrenia, I feel I've gained considerable insight into the disease. It's caused by chemical and (possibly) structural defects in the brain, and the only practical way of treating it at present is through medication.
Anyone who considers it a superstition is himself delusional.
Herman Cain is looking better and better. If he can't get elected, maybe he should have a reality show where they give him the Budget and a huge red marker and let him go at it.
We tax people and companies to death to pay for this abuse. We let the government do this because most people never deal with government directly, so they don't understand how broken it is. But don't worry. Obamacare will fix that!
If government was only inefficient then we really wouldn’t have any problems.
I can accept the inefficiency of government if they limited themselves to the basic tenets of governance.
But government is not interested in governance, it is interested in creating programs designed to improve the general welfare...
This has become an ad hoc authorization for Government to provide every conceivable service any person could want.
This article serves as yet another example that the government is not only incapable of providing programs to improve general welfare, the programs do more harm than good. And we the taxpayer pay the salaries of those who are doing the harms.
Leave it to the people to provide for their own general welfare and we all will be better off.
I've been a full time clinician in the mental health/substance abuse field since 1987 and Mr. Torrey's assessment is dead on.
SAMHSA is yet another of those bloated federal agencies set up, perhaps, with good intentions, but long gone the way of serving people based on the agency's needs, not the patients'.
I twice made the mistake of attending SAMHSA sponsored trainings to garner recertification hours and was appalled at the level of ignorance of the presenters hired to provide the training. No, it was worse than ignorance - it was so mindbogglingly wrong, their assertions and assumptions would lead directly to patient harm if applied in the field.
Surely almost all, maybe all, of SAMHSA's $3.6 billion budget is wasted. But the story is built on the fallacy that government can force schizophrenics and bipolar patients to take their meds.
It says the ax-murdered was released and "medicated after the fact." Well, sure. Once he's in prison, he has no choice. I'll bet anything the guy left treatment with meds or at worst a prescription and failed to take them.
You can't force someone into a hospital or other institution - or force them to stay - unless they're a danger to themselves or others. That's a high hurdle.
I would agree to some aspects of both sides of this argument. There need to be specific directives that address populations whose diagnosis falls in the SMI category. In the past this has been addressed through SAMHSA block grant requirements to the States. However, I think it is misguided to believe there isn't need for public support of mental health concerns. Mental Illness and Substance Abuse are real. They impact our communities beyond the scope of treatment: corrections, homelessness, unemployment, and other areas of fiscal impact. It is a right for individuals to live in the least restrictive manner possible (via Olmstead / ADA)which should include opportunities to work, own homes, etc. Discontinuing assistance is not the answer.
I understand the frustration with SAMHSA. What I don't understand is using them as a scapegoat for budget concerns to the extreme of discontinuing support to the detriment of individuals with serious mental illness and/or substance abuse concerns.
For those of you who are jumping on the "all government programs are bad" bandwagon, Dr. Torrey is not saying government does not have a role in helping to ensure there are services for people with severe mental illness and addictions; he is saying that the states - meaning state governments - are better equipped at doing so. Also, he states that many of SAMHSA's programs are redundant because other federal agencies are also providing similar programs, etc.
Dr. Torrey and Treatment Advocacy Center are the few who have the guts to speak about this issue. Thank you Dr. Torrey and TAC!!!
Now, if we can just get the Medicaid Institutes for Mental Diseases (IMD) Exclusion mentioned in more of these discussions, it would be icing on the cake!
I believe that SAMHSA is partly responsible for allowing discriminatory Medicaid IMD Exclusion to continue to be law because they continue to ignore the needs of the most seriously ill and listen too closely to the anti-treatment groups.
Repealing the discrminatory Medicaid IMD Exclusion will not lead to re-institutionalizing people with severe mental illness who can manage their illness in the community. What it would do is remove the undue financial burden on providers of long-term in-patient rehabiliative treatments, for people who are otherwise Medicaid eligible. This affects not only people with severe mental illness, but also for people with addictions.
The federal ban on payment for long-term in-patient treatments creates a financial dis-incentive to provide long-term in-patient treatments when it is medically necessary. It has meant that states have balanced their budgets on the backs of people with severe mental illness and limits access to long-term residential substance abuse treatments for people who are Medicaid eligible - with disastrous results!
