Bureaucratic Insanity
From the June 20, 2011, issue of NR.


Another SAMHSA-supported undertaking is the $36.4 million Protection and Advocacy (P&A) program. Originally created by Congress to protect mentally ill and mentally retarded individuals from abuse, it has largely functioned to protect them from treatment. One failure of the program was William Bruce. A P&A lawyer “coached him on how to answer doctors’ questions” to get discharged from Maine’s Riverview Psychiatric Center, despite psychiatric testimony that his schizophrenia was not under control and he was still “very dangerous,” the Wall Street Journal reported in 2008. Once discharged, Bruce promptly killed his mother with a hatchet. Properly medicated after the fact, Bruce condemned the P&A program: “The [P&A] advocates didn’t protect me from myself, unfortunately. . . . None of this would have happened if I had been medicated.”

So what else does SAMHSA spend its $3.6 billion in taxpayer funds on? About half goes toward block grants to the states, which use it to fund mental-health and substance-abuse programs. Theoretically, SAMHSA is supposed to provide oversight for these funds, but in fact little oversight occurs. One reason is that the agency has few people with relevant training and experience. The SAMHSA administrator is a lawyer; the deputy administrator is a dentist; the director of its Center for Mental Health Services has a master’s degree in education; and the director of the Center for Substance Abuse Prevention has no listed degree. The directors of two of the three divisions of the Center for Mental Health Services have no listed degrees, and the director of the third has a degree in education. The director of the Center for Substance Abuse Treatment, who is a medical doctor and has a master’s degree in public health, is the only member of the senior staff who appears to be sufficiently trained to oversee the almost $2 billion in federal funds being sent to the states.

SAMHSA also supports conferences. In 2011 it is partially supporting the Fifth Annual Conference on Health Communication, Marketing, and Media. This conference is primarily funded by the Centers for Disease Control and Prevention (CDC), the federal agency that has the primary responsibility for disease-prevention programs. As with its other legitimate functions, SAMHSA’s contribution to disease prevention is duplicative of the functions of other government agencies. In the past, SAMHSA has supported and approved a conference at which one speaker claimed that “schizophrenia is a healthy, valid, desirable condition — not a disorder. . . . What is called schizophrenia in young people appears to be a healthy, transformational process that should be facilitated instead of treated.”

And SAMHSA puts out hundreds of publications — 194 on alcohol abuse alone. Its publications cover the spectrum of human behaviors, including bullying (two publications), peer pressure (five), grief (three), anger management (five), stress prevention (nine), and violence (48). Other publications discuss specific events, such as “Hurricane Recovery Guides Preparedness Planning,” “Oil Spill Response: Making Behavioral Health a Top Priority,” and “Helping Iraq Restore Its Mental Health System.” What does SAMHSA publish on schizophrenia and bipolar disorder? There’s one generic brochure called “Core Elements in Responding to Mental Health Crises,” but it is out of stock. Several divisions of the National Institutes of Health do publish brochures on these diseases — once again rendering SAMHSA’s efforts duplicative and unnecessary.

When looking for low-hanging fruit, then, budget analysts should peer closely at SAMHSA, whose branches are touching the ground. This agency should be abolished, with its few arguably worthwhile components, such as data collection, transferred to the National Institutes of Health. The agencies of NIH have research as their primary mandate, an appropriate federal role. SAMHSA, by contrast, is concerned with mental-health and substance-abuse services, which are best left to state and local governments. If SAMHSA were abolished, nobody would notice that it was gone, and the mental-health and substance-abuse treatment systems would improve.

— Mr. Torrey, a psychiatrist, is the founder of the Treatment Advocacy Center in Arlington, Va. This article originally appeared in the June 20, 2011, issue of National Review.