Congress is being misled by the nonprofit mental health industry, which argues that ordinary life events like bad grades, being unemployed, having an unhappy marriage, and this year's cause célèbre, bullying, are the mental illnesses worthy of congressional funding. They ignore the homeless and psychotic who can't get treatment, sleep on the streets, forage dumpsters for food, and scream at voices that only they can hear.
Prior to the 1960s the U.S. mental health budget was primarily spent on providing treatment to people with serious mental illnesses. Today, at the behest of the mental health industry, we've largely abandoned the most seriously mentally ill and use the budget for everyone else. In 1955 there were half a million public psychiatric beds for the seriously ill. Today there are less than 50,000. Because of the shortage, about 200,000 mentally ill are homeless, and according to a recent report by the Treatment Advocacy Center and National Sheriff's Association, 10 times as many mentally ill persons are incarcerated as hospitalized.
The community-based mental health industry is not serving the same populations as those who would be served by hospitals. Community programs only accept voluntary patients and generally choose the higher-functioning. Instead of providing services to treat the seriously ill, many community programs focus on creating stigma campaigns. Michael Biasotti, the immediate past president of the New York State Association of Chiefs of Police, recently told Congress that this shunning of the seriously mentally ill is forcing police to pick up the slack:
We have two mental health systems today, serving two mutually exclusive populations: Community programs serve those who seek and accept treatment. Those who refuse, or are too sick to seek treatment voluntarily, become a law enforcement responsibility. ... [M]ental health officials seem unwilling to recognize or take responsibility for this second more symptomatic group.
Money is not the problem; mission creep is. Mental health spending totaled $100 billion in 2003, representing 6.2 percent of all health care spending. By 2014 it is expected to double to $204 billion. The elephant in the room is getting treatment to the most seriously ill. Instead of treatment, the nonprofit mental health industry argues for Congress to fund public education. This is based on the mistaken assumptions that the reason that people do not get care is that they are so asymptomatic that the public needs special training to identify them, and that once they're identified, treatment will be available. Neither assumption is true for the seriously ill. As Creigh Deeds learned, families can -- and do -- beg for treatment for loved ones already identified as being ill. And yet they still can't get it.
If Congress wants to improve care, save money, and reduce violence, it should stop funding groups working to improve people's mental health and use the savings to treat people with serious mental illness. Replace mission creep with mission control.
That's the idea behind H.R. 3717, the Helping Families in Mental Health Crisis Act. Introduced this past December by Rep. Tim Murphy (R-Pa.), with the support of 74 other representatives from both parties, the legislation would:
- Get treatment to people who are too sick to accept voluntary treatment. H.R. 3717 requires states to have an assisted outpatient treatment (AOT) program in order to access federal mental health block grants. AOT is limited to the most seriously ill who have a past history of violence, incarceration, or needless hospitalizations caused by going off treatment. It allows courts, after extensive due process, to order them to stay in mandated and monitored treatment as a condition of living in the community, and equally importantly, to order community programs to provide the care rather than turn them away. New York's AOT program (also known as "Kendra's Law") reduced homelessness, arrest, and incarceration in excess of 75-percent each and cut costs in half by reducing the use of more expensive incarceration and hospitalization. The Department of Justice certified AOT as an "effective crime prevention program."
There is a crisis. Solving it requires getting treatment to people with untreated serious mental illness, not all others. Throwing money at mental health as Congress has done will not help those with serious mental illness. Passing H.R. 3717 is the best chance Congress has at addressing the real problem.
This is an updated version of a post that originally appeared in the Ripon Forum, published by the Ripon Society. It is reprinted with their permission.
DJ Jaffe is Executive Director of Mental Illness Policy Org., a nonpartisan, science-based think tank focused on serious mental illness (not mental health).