After every mental illness related tragedy -- think: Jared Loughner, James Holmes, Unabomber, Navy Yard -- the media and politicians call on Dr. Fuller Torrey for his effective, informed and cost-efficient ideas on how to prevent the next mental illness-related tragedy. And then everyone goes on as if nothing happened.
American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment system is Dr. Torrey's latest and perhaps best effort to explain how the mental illness system went wrong, why we have so many tragedies, and more importantly, how to stop them. American Psychosis starts with the oft forgotten story of Rosemary Kennedy's multiple mental and developmental disabilities and how in 1963, these led President John Kennedy to establish Community Mental Health Centers (CMHC) in honor of his sister. Dr. Torrey, who also had a mentally ill sister, argues:
(T)he mental health centers legislation passed by Congress was fatally flawed. It encouraged the closing of state mental hospitals without any realistic plan regarding what would happen to the discharged patients, especially those who refused to take medication they needed to remain well... It focused resources on prevention when nobody understood enough about mental illness to know how to prevent them. And by bypassing the states, it guaranteed that future services would not be coordinated.
Dr. Torrey delivers an easy-to-digest explanation of Medicaid, Medicare, and every politically correct federal white paper, task force report, court decision, civil liberty pronouncement, and consensus statement that created and maintains the mess. He documents the disaster with hundreds of anecdotes involving real people caught up in needless homelessness, suicide, homicide, violence, arrest, incarceration, and death sentences. He intersperses his stories with horrifying statistics documenting the scale of the disaster and the $140 billion being spent to maintain it.
The saddest part is that American Psychosis is not just a history of how we got here, it shows how we are still repeating the same mistakes. Hospitals are still closing; the mental health lobby still demands and receives money to prevent mental illness when we don't know the cause. We still refuse to adopt changes in commitment policies that could help those too sick to maintain themselves safely in the community. CMHCs have been replaced by SAMHSA which like its predecessor allows wishful thinking and political correctness to trump science. President Obama, like President Kennedy before him still relies on mental health experts rather than mental illness experts to guide him. We still divert funding to pop-psychology plans to 'enhance mental health' rather than science based treatment.
American Psychosis ends with tangible practical solutions on how to create a sustainable, affordable system of care. Priority number one, according to Dr. Torrey, is to let the states or counties take charge by having federal funds meant to help patients go through them rather than through hundreds of disjointed, often counterproductive, finger-in-dyke federal programs that circumvent the states, not to mention people with serious mental illness. Other solutions include implementing assisted outpatient treatment, reforming Medicaid, and prioritizing the most seriously ill rather than the highest functioning.
This is a powerful book on how to prevent the high profile tragedies that galvanize national attention, and the thousands of other tragedies that pass under the radar. I highly recommend it to all advocates and policymakers who care about mental illness.
Disclosure: I once sat on a board of directors with Dr. Torrey and am an admirer of his work.