Representative Tim Murphy, a Pennsylvania Republican who’s Congress’s only psychologist (they could really use more) has a bill that tackles a few of the many problems with the way that the federal government handles mental health and the mentally ill. It would refocus existing federal efforts on addressing serious mental illness rather than diagnosing huge portions of the population with mental-health disorders, and emphasize evidence-based treatment for those with such illnesses. It’s appalling how badly our government deals with mental illness, and Representative Murphy deserves a great deal of credit for trying to tackle policies that cause an incredible amount of needless suffering.
The bill would reorganize the billions the federal government pours into mental health services, prioritizing initiatives backed by solid evidence and tracking their success . It would change the way Medicaid pays — or, in this case, underpays — for certain mental health treatments. It would fund mental health clinics that meet certain medical standards. And it would push states to adopt policies that allow judges to order some severely mentally ill people to undergo treatment.
Not everyone is satisfied. Some patients’ advocates have condemned Mr. Murphy’s approach as coercive and harmful to those who need help. The government should not be expanding the system’s capability to hospitalize or impose treatment on those going through severe episodes, they say. It should instead be investing in community care that heads off the need for more serious treatment.
We do not see those aims as mutually exclusive, and neither do the bill’s backers. It makes obvious sense for the government to back community-based clinics that promise to prevent individuals’ mental illnesses from spiraling out of control, when possible. But some people with very severe disorders do not know or do not admit that they are sick. For a small class who will not accept treatment between hospital visits or repeat arrests, states have good reason to require them to accept care, under judicial supervision.
For a more detailed explanation of what the bill would do, see D. J. Jaffe’s NRO piece on it.
This isn’t a topic on the fore of most people’s minds — who’s ever even heard of SAMHSA, the federal mental-health bureaucracy Murphy wants to fix? — but it really deserves much more attention than it gets. It might seem like conservatives point to mental illness after mass shootings as a way to distract from misguided calls to restrict gun ownership, but the issue is deserving of attention on its own. The suffering our broken bureaucracy causes on a regular basis is just as serious as the individual horrific events that you see on CNN.
If you don’t believe it, consider that prisons, as a recent report from the Treatment Advocacy Center found, the number of Americans in mental hospitals has fallen from 558,000 in 1955 to 35,000 now. This isn’t only about deinstitutionalization — some outpatient treatment does work, and Representative Murphy’s bill promotes those methods. But the seriously mentally ill aren’t getting treatment outside of hospitals. They’re going to prison, where they’re not getting treatment at all. There are 350,000 people with serious mental illness in our prison system, TAC reports; as Vox’s Sarah Kliff points out, that’s ten times as the number of mental-illness patients in public hospitals.
This isn’t really a liberal versus conservative issue, and it’s not about shrinking or expanding government. The federal government and the states have taken responsibility for the mentally ill for about 150 years now, they’re just failing very badly at that responsibility today. Tim Murphy wants to fix that, and so should you.