In his opening statement to Wednesday's Oversight and Investigations subcommittee hearings on the Substance Abuse and Mental Health Services Administration (SAMHSA), well-informed Dr. Tim Murphy (R-PA) noted
The Center for Mental Health Services, housed at SAMHSA, has a budget of approximately $1 billion per year. It awards most of these funds through a combination of competitive and formula grants. I'm concerned, because the committee has seen substantial evidence that too many of these grants are directed to advancing services rooted in unproven social theory and feel-good fads, rather than science.
He is right and he was joined by Ranking Member Diana DeGette (D-CO.) and Representative Bill Cassidy, who like Murphy is an M.D., in communicating the importance of basing SAMHSA programs on science.
The first panelist, Pamela Hyde, administrator of SAMHSA, largely defended SAMHSA and blamed sequestration. The problems preceded sequestration. Several representatives noted that sequestration makes it more imperative, rather than less to focus SAMHSA resources on the most seriously ill.
Joe Bruce's testimony was largely focused on SAMHSA's Protection and Advocacy for Mentally Ill Individuals program that lobbies to get persons with mental illness who need hospital care out of hospitals. Joe and his wife Amy were doing their best to get treatment for their son, William Bruce who has schizophrenia and had made threats against them. Against the parent's wishes, SAMHSA-funded lawyers got Willy released from the hospital and two months later he killed Amy with a hatchet. Joe suggested SAMHSA stop funding this activity.
Panelist Dr. E. Fuller Torrey testified that SAMHSA conditions -- and incorporates in their motto -- a requirement that millions in block grant funds be used to prevent mental illness ("prevention works"). In earlier testimony, Pam Hyde admitted we do not know how to prevent schizophrenia and bipolar, the two most serious mental illnesses. Dr. Torrey noted SAMHSA also pressures states to spend exclusively on 'self-directed' care. But there are people who are psychotic, hallucinating, and delusional and aren't well enough to self-direct care. Under SAMHSA's mandate, get no care.
Dr. Torrey pointed out SAMHSA funds groups that believe if a psychotic individual does not recognize their need for treatment, that person should not be allowed into treatment until after they become danger to self or others. Rather than preventing violence, these SAMHSA-funded groups believe in requiring it.
Our own research shows SAMHSA supports and/or funds groups that far from helping people with serious mental illness, don't believe it exists. The SAMHSA 2010 Guide to Celebrating Mental Illness Awareness Week suggests schools use the following organizations to teach students about mental illness:
- Mindfreedom: "There is not conclusive evidence or consensus that mental illness exists"[1]
- The Icarus Project: "We believe these experiences (commonly diagnosed and labeled as psychiatric conditions) are mad gifts needing cultivation and care, rather than diseases or disorders."
- National Coalition for Mental Health Recovery: (NCMHR) holds that "psychiatric labeling is a pseudoscientific practice of limited value in helping people recover."
Dr. Sally Satel's testimony focused on SAMHSA's National Registry of Evidence Based Practices [NREEP] which certifies programs as being effective and encourages states to implement them. According to Dr. Satel, less than five of the programs help people with serious mental illness who can't self-direct their own care; the programs do not improve meaningful measure like reducing hospitalization, incarceration, arrest, suicide, or homelessness.[2] Many are based on faulty research or research by the owner of the intervention. Dr. Satel noted SAMHSA has only one psychiatrist on the staff and just hired it's first Chief Medical Officer. Several representatives stated they believe the lead agency on mental illness should not oppose having people with medical expertise on staff.
Representatives and presenters highlighted how SAMHSA wastes money. Some focused on SAMHSA funding an Alternatives Conference where people with mental illness are taught how to go off medications. Others focused on SAMHSA using funds to publish and distribute children's books like A Day in the Park; brochures on Making and Keeping Friends] and Building Self-Esteem. They create, manufacture and market multicolor stickers kids can wear saying, "I am cool" and "I listen well." SAMHSA also makes online games.
Joe Park, Mental Health Director for Missouri testified that he appreciates the funds SAMHSA provides for Missouri and his own efforts and encouraged the use of mental health courts. All panelists, and the committee co-chairs supported greater use of Assisted Outpatient Treatment, a program designed for the very few who can not self-direct their own care. When asked by Representative Murphy, Hyde stated she supports all treatment that works.
Amen.
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[1] Their membership brochures lists "myths" about mental illness. The first one is: "You have a "mental illness" that is causedby a biochemical imbalance, or some kind of brain defect or brain disease, or by a genetic predisposition." Available at http://www.mindfreedom.org/truth/mfi-truth-200907.pdf
[2] Some are on substance abuse, not discussed in this paper.
To learn more on serious mental illness policy issues, visit http://mentalillnesspolicy.org.