Politics & Policy

New Hope for the Mentally Ill

(Dreamstime: Nikki Zalewski)
Based on his statements, Trump understands what kind of help those with serious mental illnesses need.

The election of Donald Trump is an exciting turn of events for people afflicted with mental illness. That may sound like a strange thing to say, but I can explain. 

From 2013 to 2015 I served as the first chief medical officer for the Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the U.S. Department of Health and Human Services. When I took the position, my goal was to improve the quality of treatment for people who were suffering and extend its reach. I was greatly disappointed. What I found was an agency that had lost its way and largely ignored the needs of people with psychotic disorders such as schizophrenia and bipolar illness. There is within SAMHSA a perceptible hostility toward psychiatric medicine that contributes to a resistance to addressing the needs of those with serious mental illness.

Instead of setting the highest national standards, SAMHSA has supported programs that provide little help to those in greatest need. For example, the SAMHSA National Registry of Evidence-based Programs and Practices solicits “evidence-based practices” from the field, and SAMHSA encourages its grantees to use these practices. The problem is that there is little “evidence” in favor of many of these practices, leading to the use of interventions of questionable value. As another example, SAMHSA has put a major emphasis on developing a “peer workforce,” through which individuals with mental disorders offer support to those experiencing an acute episode of mental illness. However, someone who is in the throes of psychosis or suicidally depressed needs rapid access to psychiatric treatment, usually with medications and psychotherapeutic interventions. To focus scarce resources on programs that do not directly address treatment needs of the severely mentally ill trivializes the devastation that untreated mental disorders can produce for those affected, their families, and their communities.

Because of its singular mandate to reduce the impact of substance use and mental disorders on America’s communities, SAMHSA is an important agency and there are important issues it should be addressing. Some 9.8 million adult Americans (4.1 percent) are living with serious mental illness, but about one-third of those individuals do not receive any mental-health treatment. We lack adequate numbers of inpatient beds for those decompensating (i.e., experiencing serious psychiatric symptoms) due to their illness. We lack community programs that can offer critical medical and psychosocial treatments aimed at reducing homelessness, arrest, suicide, incarceration, and violence. These are the issues SAMHSA should be focusing on.

We now approach a new time, with a president-elect who has voiced support for the mentally ill and their families. Referring to restrictive privacy provisions in the Health Insurance Portability and Accountability Act, Mr. Trump’s policy platform correctly noted that “families, without the ability to get the information needed to help those who are ailing, are too often not given the tools to help their loved ones.” Referring to court-ordered outpatient treatment, he said, “We must expand treatment programs, and reform the laws to make it easier to take preventive action to save innocent lives.”

Mr. Trump refers here to the Helping Families in Mental Health Crisis Act, which passed the House by an overwhelming bipartisan vote of 422–2 but is stalled in the Senate. In addition to measures to support behavioral-health-care providers’ communication with families and fund court-ordered outpatient treatment, this bill provides a road map of necessary changes to provide the care and services needed by those with serious mental illness. Mental-health and medical services will be integrated, leading to cost savings. Newer, innovative, and cost-effective approaches to care, including telemedicine, will become more widely available to address the needs of those in rural areas with few providers. With funding for justice reforms and alternatives to institutionalization, the damage associated with leaving serious mental illness untreated will begin to be addressed in a meaningful way. Finally, this legislation will reform SAMHSA and make it accountable as to how its mental-health-care appropriations are spent.

We now approach a new time, with a president-elect who has voiced support for the mentally ill and their families.

Support from our president-elect for the provision of essential resources to the seriously mentally ill and their families has the potential to change the life course of millions of Americans suffering with these disorders and to help get the homeless and psychotic off the streets and into treatment. SAMHSA should be an important part of that equation, but reform of this agency is clearly needed. Appointing knowledgeable leaders committed to focusing the existing resources on the treatment needs of those with serious mental and substance-use disorders will be a milestone that will move the process of improving the lives of those who suffer with these disorders forward. Mr. Trump can do this.

— Elinore F. McCance-Katz is a professor of psychiatry and behavioral sciences at the Alpert School of Medicine at Brown University and is the former chief medical officer of SAMHSA.


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