Politics & Policy

Let’s Get Moving on Treating the Seriously Mentally Ill

(Lucian Milasan/Dreamstime)
A bipartisan House bill that would refocus treatment on those who need it most is bottled up in committee.

The next time there is a major tragedy caused by someone with untreated serious mental illness, and you want to know why government didn’t do anything after the last one, two, three, four, or five similar tragedies, ask Representatives Fred Upton (R., Mich.), chair of the House Energy and Commerce Committee, and Frank Pallone (D., N.J.), ranking member of that body’s Health Subcommittee. A smart bipartisan bill to address the issue is being bottled up, and they show no sign of moving it . . . at least not until it’s weakened beyond recognition.

Homelessness, hospitalization, arrest, incarceration, suicide, and violence are often associated with people who are known to have serious mental illness and were allowed to go untreated. The pressing importance of getting treatment to these individuals led 118 compassionate Republicans and Democrats to co-sponsor the Helping Families in Mental Health Crisis Act (HR 2646), proposed by Representatives Tim Murphy (R., Pa.) and Eddie Bernice Johnson (D., Texas). Rather than throw more money at the ephemeral issue of “improving the mental wellness of all Americans,” which is what the mental-health industry wants, this bill increases the efficacy of existing mental-health dollars by redirecting them towards serving the 4 percent of patients who are the most seriously mentally ill. It replaces mission creep with mission control.

The most important provision is the elimination of the Substance Abuse and Mental Health Services Administration (SAMHSA). The failure of SAMHSA to even attempt to help solve homelessness, arrest, incarceration, violence, hospitalization, and suicide among the seriously mentally ill is well documented and widely reported. SAMHSA believes recognizing these problems will cause stigma, and so downplays them. Even SAMHSA employees know there is a problem at SAMHSA. They ranked their leadership near the bottom of all federal agencies. SAMHSA funds anti-psychiatry and non-evidence-based treatments and encourages states to divert their federal mental-health block grants away from serving the seriously ill. This madness will end only when the agency is eliminated. But those who receive SAMHSA funds are lobbying to keep their sugar daddy alive, and by not bringing the measure to a vote, Representatives Upton and Pallone have sided with them.

Families of the seriously mentally ill are begging Congress to eliminate SAMHSA.

If passed, the Helping Families in Mental Health Crisis Act won’t be the first bill to eliminate a failed mental-health agency. In 1992 Congress eliminated the Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) and transferred some of its responsibilities to the National Institute of Mental Health, where, after it had floundered and become as irrelevant as SAMHSA, Dr. Tom Insel took the helm in 2002 and focused it on serious mental illness. The quality of the nation’s research portfolio greatly improved (Insel has just announced that he is stepping down). But the bulk of ADAMHA’s responsibilities went to SAMHSA, which refused to focus on serious mental illness then and continues to do so now.

The heads of SAMHSA and NIMH both recently stepped down, making this month the perfect time for Representatives Upton and Pallone to rejigger the system. HR 2646 allows doctors to share with parents of the seriously ill information they need to make sure that prescriptions are filled, appointments kept, and treatment maintained. It encourages states to fund assisted outpatient treatment, which has proven to reduce homelessness, arrest, incarceration, and hospitalization in the 70 percent range. No other program is as effective. It also sets the stage for eventually addressing the critical psychiatric-bed shortage, and it reins in anti-treatment lobbying by federally funded lawyers who are part of SAMHSA’s Protection and Advocacy program. But none of these reforms will take hold if SAMHSA is not disbanded and its fifth-column activities ended. Families of the seriously mentally ill are begging Congress to eliminate this agency.

There is a dangerous vacuum in the nation’s mental-health leadership. There is no one at the helm of NIMH, SAMHSA, nor apparently the congressional committee that is supposed to act on these urgent needs. Representatives Upton and Pallone should side with those who care about the seriously ill, not the mental-health industry, which shuns them. A strong Helping Families in Mental Health Crisis Act deserves a vote.

— D. J. Jaffe is executive director of Mental Illness Policy Org., a nonpartisan think tank on serious mental illness.

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