Politics & Policy

Focus on Mental Illness

The mass shootings of recent years — in Newtown, Aurora, and elsewhere — have drawn attention to America’s decrepit mental-health system. The fact that mentally ill men are routinely perpetrating acts of mass murder is the most shocking sign of our neglect of a major social problem. Two others: the 200,000 people with serious mental illness on the streets and the 300,000 in our prisons.

Part of the problem: The billions that the federal government spends each year to help the mentally ill deliberately bypasses effective treatment strategies for the most seriously ill and practically ignores the worst mental-health problems.

Representative Tim Murphy (R., Pa.), a psychologist, has introduced the first federal legislation to reform these misplaced priorities. The Helping Families in Mental Health Crisis Act would push federal funding away from where it’s currently spent — mostly on providing social services to people with mild common mental-health problems, such as anxiety disorders and mild depression — and toward treating people with serious mental illness (schizophrenia, bipolar disorder, severe depression, etc.). It would also give law-enforcement officials, to whom the government has largely left the task of dealing with America’s mentally ill, a role in setting policies, and empower families to get seriously ill relatives the treatment they need. These reforms can be done at relatively little cost, because the money is so poorly allocated right now; in fact, effective treatment for the mentally ill would save money elsewhere, especially in our criminal-justice system.

Our mental-health system’s problems have much to do with the “deinstitutionalization” movement, which unfolded during the middle of the 20th century. The rights revolution of the 1960s and 1970s was illogically extended all the way to the very small segment of society whose members lack the faculties to exercise their own liberty, and one result was to weaken the ability of families and doctors to help people who could function with proper treatment.

At the same time, the system changed its focus from treating truly serious mental illness to diagnosing mild mental-health problems across huge swathes of the population. The federal approach has gone from evidence-based treatment for the most seriously ill to a nebulous “recovery” philosophy, in which a patient sets his own goals and course of treatment, with psychologists playing an ancillary role at best.

Mental-health agencies are happy to devote their resources to a broad range of social-service priorities and cater to the wants of the community at large rather than the needs of the seriously mentally ill. New anti-bullying counselors, for example, make a more welcome addition to a town than housing for schizophrenics.

President Obama’s efforts, characteristically, involve pouring more resources into a failed, perversely designed system. He has boasted of allocating more than $100 million in funds to mental-health programs in existing community health centers, which run mental-health programs but perform almost no evaluation or data-driven treatments (those proven to reduce the symptoms of serious mental illness, rather than those based on modish theories). He was also proud to announce that private health insurance will now be required to cover mental-health treatment as generously as treatment for other ailments — a step with little relevance for the seriously mentally ill, who rarely have private insurance.

They usually end up in our great national health-care slum, Medicaid, which doesn’t cover long-term hospitalization for mental illness. States thus have every incentive to push patients out of psychiatric hospitals, where the states bear the whole cost, and into the community, where federal Medicaid dollars can pay for half of whatever “treatment” they receive. That’s why states are closing their psychiatric hospitals — converting ex-patients to prisoners, selling off the properties, and using the proceeds to plug their budgets. Representative Murphy’s bill undoes this perverse restriction on Medicaid funding.

Murphy’s bill will encourage federal funding for programs that have been shown to work, providing a greater role for the National Institute of Mental Health, which has made great strides in researching mental illness. The system now is deplorable: Large parts of the federal government’s $3 billion mental-health bureaucracy, SAMHSA, question whether serious mental illness is even an affliction that can be treated, instead of just a different way to order one’s mind, or something to recover from or learn to cope with. Five percent of the 3 million Americans with schizophrenia will eventually take their own lives; SAMHSA’s 41,000-word strategic plan does not mention the disease once.

The bill will also reform federal privacy laws that prevent physicians from telling families when their relatives need more intensive treatment. These restrictions leave potentially life-or-death decisions to the one person who cannot properly make them.

Americans with mild mental-health problems deserve our sympathy and support, but federal resources should be concentrated on the worst cases. The federal government long ago decided to turn its attention elsewhere. Representative Murphy’s bill would be a big step back in the right direction.


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