Politics & Policy

Fixing America’s Mental-Health System

(Tyron Gillum/Dreamstime)
Federal efforts to treat the mentally ill are woefully ineffective.

Congress has been given another opportunity to fix the nation’s broken mental-health system, thanks to the bipartisan efforts of Representatives Tim Murphy (R., Pa.) and Eddie Bernice Johnson (D., Tex.). Murphy, the only psychologist in Congress, and Johnson, the only psychiatric nurse in Congress, understand the depths to which public psychiatric services have descended and are determined to do something about it. On June 4, they introduced the Helping Families in Mental Health Crisis Act, HR-2646.

The legislation contains a broad range of solutions, including addressing the shortage of psychiatric beds in community hospitals and expanding the mental-health workforce. It also proposes improvements in federal privacy laws to make it easier for families and law-enforcement officials to get the information they need to help individuals with severe psychiatric disorders. Perhaps most important, the bill proposes the creation of an assistant secretary for mental health in the Department of Health and Human Services (HHS). To ensure that someone competent assumes this post, the secretary of HHS will appoint the new administrator with the advice and consent of the Senate. Only a psychiatrist or a psychologist with clinical and research experience in mental illness and substance-use disorders will be eligible to fill the position. These protections should ensure quality federal leadership, which, at this time, is woefully lacking.

A December 2014 review by the Government Accountability Office (GAO) commissioned by the Subcommittee on Health of the House Committee on Energy and Commerce unearthed dismal findings about the inefficiency of our mental-health system. During a June 16 hearing on HR-2646 before the subcommittee, Representative Murphy cited the report’s key findings. “We are spending $130 billion a year over some 112 government programs and agencies that don’t work together, have little accountability, and in many cases not very good results,” he noted. It’s a painful litany of bad outcomes: 40,000 suicides last year; 10 million individuals with serious mental illness; 200,000 mentally ill who are homeless; and 1.2 million with mental illness in jails and prisons. This is all evidence, Representative Murphy said, of a “badly broken” system.

The congressman acknowledged that his proposed legislation “does not fix everything,” but, he said, it is “a big first step.” The legislation is a new version of a bill introduced by Murphy in the last Congress. Although that bill had impressive bipartisan backing, it was ultimately blocked by competing legislation introduced by Representative Ron Barber (D., Ariz.) with exclusively Democratic backing. Representative Barber was rewarded for his efforts by losing his House seat in the 2014 election in a close contest in which his opposition to Representative Murphy’s bill was one of the issues.

The importance of Murphy’s and Johnson’s efforts to reform federal mental-health services was highlighted by the release this month of yet another GAO report severely critical of the federal Substance Abuse and Mental Health Services Administration (SAMHSA). The GAO investigated how SAMHSA hands out $3.5 billion in taxpayer money each year and summarized its findings in a report titled “Better Documentation Needed to Oversee Substance Abuse and Mental Health Services Administration Grantees.” The GAO found that for every grant reviewed, “documentation used to oversee grantees was either missing or not readily available.” More than a third of the grants were awarded with no documentation by SAMHSA “of the criteria it used to award grants.” Grants given for SAMHSA’s Protection and Advocacy program, which has been considered to be especially problematic, in every instance were missing documentation “of its review of required annual program performance.” Translating federal jargon into simple English, SAMHSA is giving away taxpayer money to its friends using no standard criteria and is then not following up to ascertain how the money is being spent.

The problems are obvious among the homeless, in our jails and prisons, and in the epidemic of homicides committed by mentally ill individuals who are not being treated.

The December 2014 report severely criticized SAMHSA and its parent, HHS, for failure to provide leadership (“HHS Leadership Needed to Coordinate Federal Efforts Related to Serious Mental Illness”). For example, a task force set up in 2003 to provide coordination of the federal programs had not been convened by SAMHSA since 2009. Then, in March of this year, the federal Office of Personnel Management released a report titled “The Best Places to Work in the Federal Government,” based on surveys of federal employees. SAMHSA ranked a dismal 298th out of 315 government agencies. Again, part of the problem is a lack of leadership; the director of SAMHSA is a lawyer, and among its 574 employees there is not a single psychiatrist. This is inexplicable for the agency that has the primary responsibility for reducing “the impact of substance abuse and mental illness on America’s communities.” It is one of the problems that would be fixed by the proposed Murphy and Johnson legislation.

The failure of SAMHSA is merely one factor in the widespread failure of the nation’s mental-illness treatment system. The problems are obvious among the homeless, in our jails and prisons, and in the continuing epidemic of homicides committed by mentally ill individuals who are not being treated. Representatives Murphy and Johnson deserve great credit for focusing on these problems and proposing viable solutions. Members of Congress from both parties should get behind this proposed legislation.

— E. Fuller Torrey, M.D., is the founder of the Treatment Advocacy Center and the author of American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System. Sally Satel, M.D., is a psychiatrist and resident scholar at the American Enterprise Institute.


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