The anniversary of the shooting of Representative Gabrielle Giffords by an allegedly mentally ill Jared Loughner should engender sympathy for Ms. Giffords, sympathy for Jared Loughner, and consternation with Congress.
The shooting was not an isolated incident. Congress itself was the target of another man allegedly with untreated mental illness who shot two police officers at the U.S. Capitol building in 1998. Every year an estimated one thousand individuals with severe mental illness who are left untreated kill. Over 170,000 people with untreated severe mental illness wander the streets, many foraging dumpsters for food and screaming at voices only they can hear. Another 200,000 mentally ill live incarcerated.
Congress has the power to improve care and derivatively prevent violence. More money is not needed. Smarter spending is. Of the $100 billion spent for mental health, most comes from Congress with practically no direction on how it should be spent. As a result of this laissez faire largesse, mental health providers do not have to serve the most seriously ill. They can cherry-pick the easiest to serve for admission to their programs and ignore the others. Jared Loughner's refusal to accept treatment made him undesirable to mental health programs so they simply abandoned him, forcing the police to step in.
Community mental health providers readily make services available to those who need marriage counseling, feel sad and have "issues," while claiming no room at the inn for the severely mentally ill. As a result of Congress' failure to require mental health funds to be spent on the most severely ill, states can define social issues like poverty, bad grades, bullying, unemployment, and overcrowded housing as "causes" of mental illness and divert mental illness funds to wherever they want. California and New York are notorious for this mission-creep but few states have tutoring programs, employment programs, housing programs or public relations campaigns that are not being funded with federally provided mental health dollars. Meanwhile the severely ill go untreated.
Perhaps no government agency represents the consequences of Congress' abstinence better than the Substance Abuse and Mental Health Services Agency (SAMHSA), which receives $3 billion and no obligation to spend it on severe mental illness. Last month, after a year of research SAMHSA told states their goal should be to fund "recovery programs" which they defined as those that facilitate "a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential." Getting medications and treatment to the severely mentally ill did not make the cut. SAMHSA uses congressional funds to create, produce and distribute a catalogue of free video games, children's books, stickers, plays, and artwork all with funds that should be helping people with severe mental illness.
SAMHSA is not the only Congress-funded mental health program engaged in mission-creep. The oxymoronically-titled "Protection and Advocacy for Individuals with Mental Illness" program funnels money through states to lawyers who use it to prevent people with mental illness from receiving treatment until after they become "danger to self or others." The Medicaid program includes a provision that specifically prevents funds from being used for many mentally ill individuals who need hospitalization.
Congress can easily fix this by requiring funds allocated for mental health and mental illness be spent on the most seriously ill. Congress should adopt the National Institute of Mental Health's definition of "severe mental illness" which encompasses no more than 8% of the population and require that all, or a certain percentage of funds allocated by Congress for mental health and mental illness go to serve this severely ill population. This one piece of legislation could help end the madness Congress is causing.
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