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Improve Care For Mentally Ill: Eliminate Mental Health Agencies

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In this week's National Review, Dr. E. Fuller Torrey, of the Treatment Advocacy Center, argues that to improve care for people with mental illness, President Obama should eliminate the federal Substance Abuse and Mental Health Services Agency (SAMHSA).

Eliminating mental health agencies in order to improve care for people with mental illness is counterintuitive, but exactly what is needed. (Why is it conservative publications are better than liberal ones at improving care for the seriously ill?)

New York City subsumed its Department of Mental Health under the Health Department in 1999. The old Department of Mental Health was suffering unmitigated mission creep, spending vast sums on social programs and programs to help the worried-well, and little on serious mental illness. Voters said "enough" and decided to end the endless mission creep by putting mental illness under health. The medical orientation of the health department was the right prescription for the city's mentally ill.

California is now in the process of eliminating it's state mental health agency for much the same reason. Voters in California voted to tax the wealthy (Prop 63) to fund a Mental Health Services Act. According to Rose King, a veteran political and legislative consultant, the act was supposed to help people with serious mental illnesses, but the state is now wasting it on yoga classes, horseback riding, and endless meetings. Carla Jacobs, California's most determined advocate for people with serious mental illness, believes by eliminating the agency California can eliminate wasteful spending and refocus mental health dollars on the most seriously mentally ill.

An op-ed in the Albany Times Union called on Governor Cuomo to improve care for the mentally ill by eliminating the New York State Office of Mental Health.

Mental Health agencies and departments are usually founded to help provide care and treatment for people with the most serious mental illnesses like schizophrenia and bipolardisorder. But inevitably most have gravitated away from serving individuals with serious mental illness and instead provide social service programs to make people happier.

Many are following the lead of Michael Hogan, the commissioner of NYS OMH who was previously author of the President's New Freedom Commission on Mental Health. He championed the theory that people with bad grades, poor housing, rocky marriages, uncertain sexual identities or body images ultimately end up unhappy, i.e., have poor mental "health." So by improving grades, helping people get better housing, better marriages, better body images, etc. agencies can "prevent" mental illness.

As a result of this cruel movement away from mental illness there are now three times more seriously mentally ill people in jails and prisons than psychiatric hospitals.

Dr. Torrey's article resonated with me after reading SAMHSA's just released draft of a "National Framework for Quality Improvement in Behavioral Health Care." Like many agency heads, SAMHSA Administrator Pamela Hyde has abandoned use of the term mental "illness" and avoids the term "mental health" feeling these are too limiting to their agencies newly formed expansive mission. Instead they focus on "behavioral health." To quote SAMHSA,

By 'behavioral health,' SAMHSA refers to a state of mental/emotional being and/or choices and actions that affect wellness.

So much for people with serious mental illness.

While its official mission is to reduce "the impact of substance abuse and mental illness on America's communities" and increase access to treatment services, according to Dr. Torrey, SAMHSA has given virtually no attention to "the two most serious mental illnesses -- schizophrenia and bipolar disorder -- which together affect 7.7 million Americans, according to the National Institute of Mental Health."

Dr. Torrey writes about a different SAMHSA Plan, "Leading Change: A Plan for SAMHSA's Roles and Actions 2011-2014," and notes "Not once in the 41,804-word text of this three-year plan is either schizophrenia or bipolar disorder even mentioned."

According to Dr. Torrey SAMHSA gives out grants to prevent people with serious mental illness from being treated.

For example, the Pennsylvania Mental Health Consumers' Association, which receives a recurring grant of $70,000 from SAMHSA, is currently opposing a bill that could make it easier to treat seriously mentally ill individuals in Pennsylvania. Another SAMHSA grantee, the California Network of Mental Health Clients, has lobbied successfully to block the use of assisted outpatient treatment (AOT) in the state, even though AOT targets the sickest individuals who are not taking their medication and are potentially dangerous, and has been shown to decrease rehospitalization, incarceration, and violence among such individuals. SAMHSA-supported consumer groups in Maine and Vermont have also opposed improving their state's mental-illness-treatment system within the past two years.

Dr. Torrey goes on and on with specific facts and figures about how eliminating SAMHSA would save money and improve care for people with mental illness.

He's right.

Mental Illness Policy Org