Do you wonder why America’s public mental-health system has fallen apart? Why seriously mentally ill individuals stand sentry on our streets like urban gargoyles, why they overrun emergency rooms waiting for days for a psychiatric bed, occupy one-quarter of our jail cells, and are responsible for approximately half of mass killings, such as those at Virginia Tech, Newtown, Tucson, and Aurora? Federal leadership for mental health and mental illness is supposed to rest in the Substance Abuse and Mental Health Services Administration (SAMHSA), a component of the Department of Health and Human Services. With 553 employees and a budget of $3.5 billion, SAMHSA’s official mission is to reduce “the impact of substance abuse and mental illness on America’s communities.”
How well is SAMHSA doing in its mission? The 2015 ranking of the Best Places to Work in the Federal Government, released December 7, provides an answer. This annual survey, administered by the nonprofit and nonpartisan Partnership for Public Service, is based on a questionnaire filled out by 433,300 federal employees in 320 federal agencies. It includes questions such as “considering everything, how satisfied are you with your organization?” Thus, it is a good measure of what federal employees think about their own agency.
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This year SAMHSA ranked 317th out of 320 federal agencies. The only agencies that ranked lower were the Secret Service and two other agencies in the notoriously troubled Department of Homeland Security. Other Health and Human Services agencies did fine, such as the Centers for Disease Control and Prevention (ranked 55th), the Center for Medicare and Medicaid Services (64th), and the National Institutes of Health (81st). SAMHSA’s rating in 2015 is worse than it was in 2014, when it ranked 298th out of 315 agencies. In fact, SAMHSA’s rating has dropped lower and lower every year since 2009. During that time SAMHSA has grown larger and larger, from 450 to 553 employees, suggesting that bigger is definitely not better, at least for this federal agency. The only category in which SAMHSA rated itself as above average on this survey was on pay: The average SAMHSA salary is $107,000, more than twice the average salary of the nation’s elementary and high-school teachers.
#share#The dismal rating of this federal agency is not a surprise. The House Subcommittee on Oversight and Investigations held hearings on SAMHSA in 2013, at which time Chairman Tim Murphy (R., Penn.) said that “it’s as if SAMHSA doesn’t believe that serious mental illness exists.” In 2014, the Government Accountability Office issued a scathing indictment of SAMHSA’s role in coordinating federal mental-health efforts, saying that “coordination related to serious mental illness has been largely absent across the federal government.” Despite its official mission, SAMHSA does not employ a single psychiatrist, the last one having exited six months ago in disgust. Pamela Hyde, SAMHSA’s administrator for the last six years, recently resigned, but the agency’s problems go much deeper than having the wrong person at the top.
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The one official who has attempted to provide federal leadership on mental illness, including by improving SAMHSA, has been Representative Tim Murphy. He has introduced the Helping Families in Mental Health Crisis Act (H.R. 2646), a bill that attacks the mental-illness problem on many fronts — for instance by designating an assistant secretary for mental health to oversee and improve SAMHSA. Despite having bipartisan support, with Eddie Bernice Johnson (D., Texas) as a co-sponsor and 123 Republicans and 47 Democrats signed on, Democrats in the House Energy and Commerce Committee have been holding up the bill. By now, we have reams of evidence that SAMSHA is one of the worst-functioning federal agencies our government has ever created; failure to pass legislation that will improve it is evidence of terminal political gridlock. It is also very bad news for the nation’s mentally ill, since $3.5 billion, properly spent, could significantly improve their well-being and increase the safety of all Americans, who dread reading front-page news of another Sandy Hook. The Democrats who are blocking this legislation hostage should be held accountable.
— 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.