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America’s Mentally Ill Have ‘Nowhere to Go’



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That’s part of the title of a big story from USA Today this week, the first of a series on America’s failure to treat its mentally ill. Tuesday’s piece, by reporter Liz Szabo, intertwines crushing personal stories from families of the mentally ill, the mentally ill themselves, and the professionals who want to help them with statistics on the mentally ill’s miserable plight. States and the federal government have cut spending on mental-health programs, but they’ve also abandoned effective treatments and spread such spending to much less serious mental-health problems rather than focusing on serious mental illness.

That’s why nearly 40 percent of the 10 million or so Americans with serious mental illness received no treatment in the past year. That’s partly why people with serious mental illness die 23 years younger than the average American — making up as many as 90 percent of suicides, and a disproportionate number of deaths from accidents and neglect, too.

To take an example: Since Hurricane Irene destroyed Vermont’s one state psychiatric hospital in 2011, it hasn’t had one at all. One Vermont woman, who suffers from severe depression and has attempted suicide three times, swallowed a bottle of pills just to force the state to admit her to a psychiatric hospital. Her doctors eventually found a way to send her to a hospital in Massachusetts on Medicare. She was somewhat lucky — because funding for beds for the mentally ill has been cut so deeply, some of them end up staying in the only part of a hospital that will take them, the emergency ward.

This isn’t just about stingy budgets, it’s about a failure to fund effective treatment at all and a huge effort to spend precious mental-health dollars on ancillary problems like school bullying. Medicaid, for instance, doesn’t pay for long-term hospitalization for psychiatric problems, when it’s precisely the mentally ill who are so likely to be unable to earn enough or hold down a job to get private insurance. Providing treatment in jails and for the seriously mentally ill elsewhere jail should actually save money — and make their lives immeasurably better — as would prioritizing the treatment models that the National Institutes of Mental Health have found effective.

A broken mental-health system has turned jails and the streets into mental wards, as USA Today shows in a graphic:

The good news is that there is a way to start fixing this: More funding might be necessary, but the federal government already spends billions of dollars every year on mental health. It just spreads it around(by some estimates, 30 or 40 percent of Americans have some form of mental-health issue) and on ineffective treatment models, rather than focusing on serious mental illness. There’s a bipartisan bill in Congress right now, the Helping Families in Mental Health Crisis Act, to help prioritize federal spending on the most severe, most costly cases, introduced by Representative Tim Murphy, a Republican psychologist from Pennsylvania. (It has the endorsement of the Washington Post and National Review, for what that’s worth.)

As Ramesh explained in a recent Bloomberg column, while Murphy’s bill has bipartisan support, congressional Democrats have introduced a competing piece of legislation that, rather than re-allocating spending to evidence-based treatment, doesn’t prioritize serious mental illness at all and essentially just increases spending across the board.

This isn’t quite a liberal vs. conservative issue: It’s about differing approaches to mental illness — one that’s been proven to work, and one that appears to fail — and what the government can afford to do right. Starting in the second half of the 19th century, America decided it was the responsibility of state and federal governments to help out with the treatment of the mentally ill. It’s doing a deplorable job of it today.



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