Politics & Policy

Federal Mental-Health Policy Needs Reform Now

Employees say the Substance Abuse and Mental Health Services Administration is failing.

Whether or not mental illness played a role in the crash of the Germanwings flight that killed 150, the importance of our own country’s having a sound and efficient mental-health policy cannot be denied. That’s why attention should be paid to a new report that shows the Substance Abuse and Mental Health Services Administration (SAMHSA), the lead agency for coordinating America’s mental-health policies, is rotting from the inside.

The failure of SAMHSA to do its job could explain why, in spite of spending $130 billion on mental health, America has ten times as many persons with serious mental illness incarcerated as hospitalized, why 165,000 seriously mentally ill are homeless, and why headlines are full of reports of seriously mentally ill people who, as a result of lack of access to treatment, become involved in horrific acts of violence — like the mom who was found with her dead baby in a New York City restroom on Monday. The problem is that the federal agency responsible for delivering treatment to people with serious mental illness is instead using its money to “improve the mental health” of all Americans. The seriously ill are being told to fend for themselves.

The new survey of federal employees by the Partnership for Public Service found that the problem is with SAMHSA’s leadership. SAMHSA employees ranked their leadership team the 266th worst out of 315 government agencies. Compare that with another health agency, the National Institutes of Health, which ranked 80th. When it came to empowering employees, SAMHSA ranked 298th, showing the problems are coming from the top. The survey also shows that failure pays well. While SAMHSA ranked below the median of other agencies on every measure of leadership, its median pay was higher. If SAMHSA were loaded with doctors, high pay might make sense, but in spite of increasing the number of SAMHSA employees by 18 percent between 2008 and 2013, the SAMHSA administrator, Pam Hyde, still has only a single doctor on her team. The lack of in-house mental-illness expertise could help explain why SAMHSA policies have been so ineffective, inconsistent, and wasteful.

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As a result of an investigation by Representative Tim Murphy (R., Pa.), SAMHSA’s failure to help the most seriously ill is now well documented. A General Accounting Office (GAO) report requested by Representative Murphy found that SAMHSA fails to coordinate national mental-health policy or evaluate results, and that most programs don’t serve the seriously ill. Speaker after speaker told committee members about how SAMHSA refuses to focus on helping the most seriously mentally ill and diverts its attention elsewhere. Mothers of people with serious mental illness told of their inability to get care for loved ones. Dr. Fuller Torrey told of SAMHSA’s commissioning a $22,500 painting for its headquarters. Dr. Sally Satel told the committee of SAMHSA’s ignoring its own advisory board and refusing to include programs that help the seriously ill in SAMHSA’s registry of effective programs. Mental Illness Policy Org. has documented SAMHSA’s diverting block grants away from people with serious mental illness and funding the anti-psychiatry movement, thereby making it more difficult for the most seriously ill to get life-saving and violence-preventing treatments.

In 2013, to fix SAMHSA and focus the nation’s attention on the most seriously mentally ill, Representative Murphy, along with 115 bipartisan cosponsors, including Representative Eddie Bernice-Johnson (D., Tex.), a former psychiatric nurse, introduced the Helping Families in Mental Health Crisis Act. It will soon be reintroduced. The bill would eliminate ineffective SAMHSA programs and send responsibility for useful programs to agencies that are more effective. The sole opposition to reform comes from those who receive funds from SAMHSA and want its budget increased. But the new survey of employees clearly shows that lack of money is not the problem at SAMHSA; lack of leadership is. Passing the Helping Families in Mental Health Crisis Act won’t solve every problem in America’s mental-health system, but it will go a long way towards fixing SAMHSA.

— D. J. Jaffe is executive director of Mental Illness Policy.Org and author of the upcoming book How the Mental Health Industry Kills the Seriously Mentally Ill: A Handbook for Change.

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