And some ideas that will
Ms. Clinton’s mental-health plan is doomed to fail, because, like many before it, it funds pop psychology and ignores the most seriously mentally ill. There are 43 million Americans who have some sort of mental-health “issue,” but only 10 million have “serious mental illnesses,” such as schizophrenia and bipolar disorder. Of the seriously ill, 140,000 are homeless, 365,000 are incarcerated, and 95,000 need hospitalization and can’t get it. That is the problem that needs addressing.
More money is not the immediate answer. The federal government already increased mental-health spending to $147 billion but, at the same time, made the ability to get care inversely related to the severity of the illness: The easiest to treat go to the head of the line for services and the seriously ill go to jails, shelters, and morgues. Trigger-warning counseling is available, access to psychopharmacology for schizophrenia is not. The Substance Abuse and Mental Health Services Administration (SAMHSA) encourages spending on irrelevant and useless programs and some that are actually harmful. The Clinton plan doesn’t address any of that. It simply gives the mental-health industry more money, without an obligation to treat the seriously ill.
The psychotic and delusional, those who are hallucinating and “know” they are the Messiah, need hospital beds. But there are so few psychiatric beds that a Catch-22 scenario has developed: Anyone with mental illness who is well enough to walk into a hospital and ask for admission is deemed not sick enough to need it. Compounding that, anyone who is so sick he doesn’t recognize he needs hospitalization (“The FBI planted a transmitter in my head”) cannot be treated until after he has become a “danger to self or others.” As ludicrous as it sounds, our laws require dangerous behavior rather than prevent it. The Clinton plan makes no attempt to ameliorate the lack of hospital beds or address the inadequacy of civil-commitment laws.
She fails to fix the Health Insurance Portability and Accountability Act (HIPAA) regulations that prevent doctors from telling parents of mentally ill children what their adult child’s diagnosis is, what medications he should take, and when his next appointments are. These regulations make parents powerless to see that prescriptions are filled and appointments kept. Instead of taking their child to appointments, they are forced to take out orders of protection when the child’s condition deteriorates. Another adult is made homeless. Parents who provide housing, case management, and transportation out of love need access to the same information that paid providers receive in order to continue providing those services.
Many of the seriously mentally ill need housing. The Clinton plan does endorse independent supported housing. But many of the most seriously ill are not well enough to live independently. They need small-group homes with 24-hour onsite support. Her plan does not provide that.
Ms. Clinton’s plan calls for yet another White House conference on mental illness. Presidents Kennedy, Carter, Clinton, George W. Bush, and Obama have all done that and they all made the problem worse. The seriously ill need services the higher-functioning ill do not, and at these gatherings of the usual suspects, those solutions are never proposed. The mental-health industry comes in trotting a laundry list of alleged “risk factors” like bad grades and low self-esteem, and tells the president that if he invests in their social-services programs that masquerade as mental-health programs, they can prevent mental illness. Nonsense. There is no way to prevent serious mental illnesses such as schizophrenia or bipolar disorder, because we don’t know the cause.
Useless and tangential ideas get funded and the seriously ill get shunned.
As a result of these conferences, numerous useless and tangential ideas get funded and the seriously ill get shunned. The only way for a White House mental-illness conference to succeed would be to gather police and sheriffs rather than mental-health-industry executives. Law-enforcement officers have become the real experts, because, unlike mental-health executives, they can’t refuse to serve the seriously ill. Police can explain to the president why opening hospitals, defunding SAMHSA, reforming HIPAA, and implementing outpatient civil commitment will keep patients, the public, and police safer.
Instead of coming up with her own tweaks to the existing failure, Clinton should endorse the Helping Families in Mental Health Crisis Act (H. R. 2646), sponsored by Representatives Tim Murphy (R., Pa.) and Eddie Bernice Johnson (D., Texas). It has already passed the House of Representatives in an astonishing 422–2 bipartisan vote. It makes major reforms to ensure that existing spending goes to solving real problems. Clinton, and Trump as well, should urge Senate majority leader Mitch McConnell (R., Ky.) and Democratic leader Harry Reid (D., Nev.) to bring that bill to a vote in the Senate immediately. Time is running out.
— D. J. Jaffe is the executive director of Mental Illness Policy Org and the author of the forthcoming book Insane Consequences: How the Mental Health Industry Fails the Mentally Ill.