The abysmal failure of the U.S. mental-health system to serve the seriously ill is apparent to everyone except those who work in it. As I documented in Insane Consequences: How the Mental Health Industry Fails the Mentally Ill, in spite of throwing $150 billion at mental health annually, there are 140,000 seriously mentally ill homeless and almost 400,000 behind bars. One-third of the seriously mentally ill get zero treatment. Families are being torn apart. The public has become inured to the steady flow of “mentally ill killer goes on rampage” headlines. Meanwhile advocates and the industry propose mental-health spending plans that have nothing to do with solving these problems, so the seriously ill continue to suffer.
Yesterday, Health and Human Services Secretary Tom Price delivered a brilliant speech urging mental-health leaders to bring this insanity to an end. He did so while convening the inaugural meeting of the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC). The committee was the brainchild of Representatives Tim Murphy (R., Pa.) and Eddie Bernice Johnson (D., Texas). It is composed of members from the top federal agencies and advocates and is charged with developing recommendations for Congress on serious mental illness.
Secretary Price distilled the problem down to its essence by instructing committee members to focus on the “ten, ten, ten problem”: Ten million people have serious mental illness, they die ten years earlier than others, and “ten times more Americans with serious mental illness are in prison than in psychiatric hospitals. . . . We replaced an imperfect and sometimes cruel system of institutionalization with a system that is in many cases even more cruel.” Bingo!
The problem is largely one of mission creep. For example, under the misleadership of director Paolo Del Vecchio, the Center for Mental Health Services (CMHS) unit within the Substance Abuse and Mental Health Services Administration (SAMHSA) has largely refused to focus on the seriously mentally ill. It has encouraged other agencies and the states to divert their own resources away from the seriously mentally ill and toward the pseudoscience and pop psychology that CMHS regularly promotes. CMHS encourages mental-health agencies to wrap poverty, divorce, bad grades, unemployment, and gender misidentity in a mental-health narrative — “trauma” — and use their state and local mental-health funds to solve those problems. Reducing homelessness, arrest, incarceration, violence, and victimization among the seriously mentally ill are not on the CMHS radar.
After Dr. Price left the room, certain committee members ignored his direction and trotted out their usual array of spending initiatives that do not reduce the homelessness, arrest, incarceration, and hospitalization of the seriously mentally ill. Some called for expanding prevention initiatives, in spite of the established fact that the serious mental illnesses that the committee is supposed to focus on, including schizophrenia and bipolar disorder, cannot be prevented. Others wanted to focus on “stigma,” which is far behind cost and lack of services in explaining why the seriously ill don’t get treatment. Someone proposed focusing suicide-eradication efforts on those under 24, who are the least likely to commit suicide. Reducing violence by the mentally ill? It did not even get a mention until the public-comments session, when one caller (myself) asked why.
At that point, several committee members pulled out the industry platitude that “the mentally ill are no more violent than others” — which is true. But the seriously mentally ill who go untreated, the group Secretary Price asked them to focus on, are more violent than others. Denial is not a solution.
One committee member proposed focusing suicide-eradication efforts on those under 24, who are the least likely to commit suicide.
Fortunately, this was not the first time Secretary Price has turned his eye toward the seriously mentally ill. One of his earliest acts was to work with President Trump to secure the nomination and confirmation of Dr. Elinore McCance-Katz as the nation’s first assistant secretary of mental health and substance use disorders. It was a smart, strategic, well-informed appointment that was opposed by many in the mental-health industry, specifically because of her well-known desire to see the industry focus a greater percentage of its resources on the most seriously ill. She leads ISMICC and encouraged participants not to ignore the reality of violence. She also called on them to find ways to keep the mentally ill out of jail and to address inadequate civil-commitment laws, emergency rooms that turn the mentally ill away, the lack of hospital beds and access to medications, and other core issues that really can improve the lot of the most seriously ill. She asked them to focus on the disincentive in reimbursement rates that cause programs to reject the seriously ill and doctors to refuse to show up for civil-commitment hearings. To government-funded programs that accept block grants but not the seriously ill, she made a veiled threat, explaining, “You agreed to take these people when you agreed to take block grants.”
The Interdepartmental Serious Mental Illness Coordinating Committee has a tight deadline. Their report could end up being a shopping list of candy for the mental-health industry. But if they follow the lead of Secretary Price and Assistant Secretary McCance-Katz, it will be a sharply focused plan that will reduce homelessness, arrest, incarceration, violence, and needless hospitalization of the seriously mentally ill. Let us hope.