To the list of things that are as predictable as death and taxes, add the ineffective—and often wasteful—government programs aimed at curbing violence by persons with untreated serious mental illness. Legislators in Congress, New York City, and in state capitols around the country are being misled by mental health industry claims that the mentally ill are no more violent than anyone else. As a result, the most seriously mentally ill are suffering needlessly, while putting the police and the public at risk.
Eighteen percent of adults have one of the more than 300 illnesses described in the American Psychiatric Association’s Diagnostic and Statistical Manual. Many of those illnesses are mild, time-limited, need no treatment, or are readily treatable. But 4 percent of those with mental illness are affected by serious ailments, such as schizophrenia or bipolar disorder, causing them to hallucinate or become delusional and psychotic. When these people go untreated they do have a higher incidence of violence than the general population. It’s an unpleasant truth that the mental health industry has encouraged politicians to ignore. Without recognizing the problem, policymakers won’t take steps to fix it.
Mayor Bill de Blasio and Governor Andrew Cuomo have so far refused to focus spending on the most seriously mentally ill. De Blasio’s $800 million ThriveNYC plan largely ignores the seriously ill and focuses on irrelevant sideshows, including training New Yorkers to identify the barely symptomatic. At the behest of the mental health lobby, Cuomo and the state legislature put a donation check-off box on tax-return forms that will raise funds for useless anti-stigma advertising. Not a nickel will go toward treatment of the seriously ill. Cuomo’s new budget will eliminate beds in psychiatric hospitals, thereby marching even greater numbers of the most seriously ill off to jails, prisons, shelters, and morgues.
Contrast the New York pols’ approach with that of Pennsylvania congressman Tim Murphy, a practicing psychologist who proposes to replace rampant mission creep with a dose of mission control. Along with Representative Eddie Bernice Johnson of Texas, the former head of psychiatric nursing in a V.A. hospital, Murphy has proposed the Helping Families in Mental Health Crisis Act (H.R. 2646). It eliminates or defangs federally funded mental-health programs that hurt the seriously ill. The most important is the Substance Abuse and Mental Health Services Administration (SAMHSA). Located with the Department of Health and Human Services, SAMHSA funds programs that deny the existence of mental illness, encourages states to spend federal block-grant funds on programs that don’t help the seriously ill, certifies programs lacking evidence as being evidence-based, invents new illnesses—and wastes money.
SAMHSA’s own employees rate it the 317th worst out of 320 federal agencies. One hundred of those federal agencies provide services to the seriously ill, so there are plenty of places to park the few useful programs SAMHSA runs. To coordinate and reduce duplication in those programs, H.R. 2646 largely subsumes SAMHSA under an assistant secretary for mental health, whose job it will be to consolidate and refocus programs across multiple agencies. The only support for maintaining SAMHSA comes from those getting funds from it. Legislators should stop listening to them.
H.R. 2646 also reins in the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program. Congress originally created it to protect the institutionalized seriously mentally ill from abuse and neglect. Its mission has been expanded over time, but it now concentrates on “freeing” the mentally ill from treatment. Many parents who wanted to provide care for mentally ill loved ones, or prevent a psychiatric hospital from prematurely discharging someone, have had to go up against federally funded PAIMI attorneys. In one of the most famous cases, Joe Bruce told a congressional committee how PAIMI “freed” his son Willie from a psychiatric hospital in Maine over the objections of Joe and his wife, Susan. After he was “freed,” Willie killed Susan with a hatchet. New York State and City mental health officials trying to expand services for the seriously ill find PAIMI lawyers putting roadblocks in their way. HR 2646 returns PAIMI’s mission to something closer to its original function and prevents it from engaging in federally funded lobbying for its anti-treatment agenda.
The Helping Families in Mental Health Crisis Act also addresses a critical problem in HIPAA, the patient-privacy law. HIPAA prevents families of the violent seriously ill from getting the information they need to help facilitate care. Families who provide housing need to know what the diagnosis is so they can learn about the illness and help their suffering family member cope. They need to know when doctors’ appointments are scheduled so that they can arrange transportation, and what prescriptions need to be filled. The public blames parents of seriously mentally ill adult children when something goes wrong, but privacy laws often prevent these parents from accessing vital information. H.R. 2646 carves out a small exemption in HIPAA so that family members who provide housing, case management, and medication can—when needed to protect health, safety, or welfare—access a subset of the information that paid providers already receive.
The Helping Families in Mental Health Crisis Act has so far garnered 186 bipartisan cosponsors and is awaiting passage by the Energy and Commerce (E&C) committee. If passed, it will give states with an assisted outpatient treatment program similar to New York’s Kendra’s Law a modest boost in their mental health block grants. Assisted outpatient treatment is only for those seriously ill who regularly go off treatment and have already accumulated multiple instances of violence, arrest, incarceration, or hospitalization. It allows judges to require these patients to stay in six months of mandated and monitored treatment while they continue to live free in the community. It is the only program with independent research showing that it substantially reduces homelessness, arrest, hospitalization, suicide, and incarceration.
The mental illness mess is not being caused by lack of funding. Washington spent $147 billion on mental health in 2014. New York State spends almost $4 billion. But too much of the money winds up diverted from the seriously ill. HR 2646 reduces waste by requiring programs to be evidence-based before they’re implemented. It requires the barometers of success to be reductions in homelessness, arrest, danger, suicide, and hospitalization among the seriously ill rather than “sense of wellness” and “feelings of hopefulness” in others. As long as funding keeps going to where the problem isn’t, rather than to where it is, all the money in the world won’t help solve it.
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