Focus instead on the seriously mentally ill.
While the number of Americans suffering some sort of mental-health problem is large — nearly 40 million — the form and consequences of those problems vary widely. Although serious mental illnesses, such as schizophrenia and bipolar disorder, directly affect less than 5 percent of the population, they are overwhelmingly responsible for some of our most grievous social ills, from homelessness to mass shootings. Focusing limited government resources on serious mental illness should be the priority of our mental-health apparatus. But Hillary Clinton’s newly released “Comprehensive Agenda for Mental Health,” while distinguishing between those who suffer mental-health problems and those burdened by serious mental illness, neglects the latter almost entirely. She proposes to maintain, or even bolster, the policies that have left the seriously mentally ill untended for decades.
The prevailing framework for mental-health treatment is largely the product of the unhealthy relationship between the mental-health industry and the failed Substance Abuse and Mental Health Services Administration (SAMHSA). Together, they have perversely incentivized mental-health providers to take only the easiest cases of mental illness — leaving untreated the seriously mentally ill, who often become dangers to themselves or to others and require the intervention of law enforcement.
Clinton apparently is disturbed by this situation, noting that “our criminal justice system is increasingly becoming the ‘front line’ of engagement with individuals with mental health problems,” but she proposes policies that will do nothing to change that fact. She advocates enforcing mental-health parity, which requires insurers to provide the same level of benefits for mental-health care that they do for physical-health care. But parity policies are largely irrelevant to serious mental illness. Far more important are provisions in federal law that prohibit Medicaid or Medicare monies from going to mental-health treatment in facilities of a certain size. These provisions are largely responsible for the shuttering of psychiatric hospitals and the increased dearth of care for the seriously mentally ill. And about them, Clinton is silent.
Meanwhile, she “will support and expand funding” for one of the most pernicious aspects of the federal mental-health bureaucracy, the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program. Originally intended to supply “patient advocates” who would protect patients from abuse and neglect, the program now more often enables people who are not in their right minds to avoid treatment.
Unsurprisingly, Clinton demonstrates a clear preference for political posturing over seeking real solutions for the neediest populations. Her emphasis on “early diagnosis and intervention” is almost wholly irrelevant to serious mental illness (it applies primarily to disorders such as ADHD), and her suicide-prevention efforts target high-school and college students, with a special emphasis on “students of color and LGBT students.” While that is admirable, high-school- and college-aged individuals are in fact among the least likely victims of suicide. (Most suicides occur among the elderly, prisoners, and people with previous diagnoses of serious mental illness.) So while Clinton’s effort has the appearance of urgency, and may improve outcomes for a certain cohort at the margins, it, like the rest of her plan, does not target those most at risk.
And, of course, Clinton opens and closes by touting a showpiece: a “White House Conference on Mental Health within her first year in office.”
Actually addressing the needs of the seriously mentally ill will require, among much else, increasing the availability of hospital beds, enabling authorities to treat the seriously mentally ill before they become dangerous, reforming the Health Insurance Portability and Accountability Act provisions that keep family members of the afflicted from receiving crucial information about their kin, and reforming SAMHSA. Clinton has nothing to say about any of this. But others do have something to say: The House has passed the Helping Families in Mental Health Crisis Act (H.R. 2646), sponsored by Representative Tim Murphy (R., Pa.), which would refocus the mental-health bureaucracy toward helping the most seriously ill; and Republicans Lamar Alexander (Tenn.) and John Cornyn (Texas) have put forward substantive legislation in the Senate.
These bills promote what should be the obvious end of a humane society, when it comes to mental-health efforts: to mitigate the public consequences of serious mental illness, and, as much as possible, to alleviate the suffering of those afflicted. Hillary Clinton’s agenda promises more of the grim status quo.