Obama's Mental Health Plan: Failure in the Making

To get good advice on serious mental illness, Obama should turn to the real experts: police and others in the criminal-justice system.
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The mental health plan just proposed by the Obama administration includes spending $130 million to "train teachers and other adults to help recognize early signs of mental illness," $50 million to train mental-health specialists who work in schools, and $25 million "to address the trauma experienced by children." None of these proposals will help solve the problem of getting treatment to people with serious mental illness because identification has never been the problem.

According to media reports, in almost all incidences of violence involving people with serious mental illness, the families knew their loved ones were desperately ill, tried to get the mental-health system to help, but were turned away. As I previously wrote in The Huffington Post, Jared Loughner, who shot Gabrielle Giffords; James Holmes, who shot up a movie theater in Aurora, Colo.; John Hinckley Jr., who shot President Reagan; Aaron Bassler, who shot a former mayor of Fort Bragg, Calif.; Ted Kaczynski, the Unabomber, who mailed explosive packages around the country; Ian Stawicki, who shot five others and then himself in Seattle; Eduardo Sencion, who shot five National Guardsmen at a Nevada IHOP restaurant; Russell Weston, who shot two guards at the U.S. Capitol building; and Adam Lanza, who shot his mother, 26 others, and himself in Newtown, Conn. -- all were known to be ill before they became headlines. The problem wasn't lack of identification. It was lack of treatment.

How did Obama get so sidetracked? The man who promised to listen to good ideas no matter where they come from is listening to bad ideas from where they usually come from: the Substance Abuse and Mental Health Services Administration (SAMHSA) and those it funds. SAMHSA is almost exclusively focused on the worried well, not the seriously ill, and most of the policies it espouses are either irrelevant to or actually dangerous to those with serious mental illness. The mental health experts the president consulted with got exactly what they wanted from him: more money without actually having to serve anyone with serious mental illness. That may solve their problem, but it doesn't solve ours.

To get good advice on serious mental illness, Obama should turn to the real experts: police and others in the criminal-justice system. Three times as many mentally ill people are incarcerated as hospitalized. The jails and prisons care for the seriously mentally ill whom the mental-health system won't go near.

Law enforcement would tell President Obama first and foremost, he should fund a national demonstration project of Assisted Outpatient Treatment (AOT). AOT allows judges to order highly symptomatic and problematic individuals with serious mental illness to accept treatment as a condition of living in the community. Even more important, it allows judges to order the mental-health system to do what it won't do voluntarily: accept the most seriously ill into their programs. AOT is only for those who have a past history of needless arrests, incarcerations, and hospitalizations. In New York, Kendra's Law reduced homelessness (74 percent), suicide attempts (55 percent), substance abuse (48 percent), hospitalization (77 percent), arrests (83 percent), physical harm to others (47 percent), destruction of property (46 percent), and incarceration (87 percent ) among those enrolled. Similar results occurred in California.

While SAMHSA administrator Pamela Hyde continues fighting AOT and funding anti-AOT groups, the Department of Justice certified AOT as an effective crime-prevention program; the National Sheriffs' Association is asking every state to adopt it; and the New York State Association of Chiefs of Police made it a top priority. Obama should listen to them.

Obama can also get good advice from Representative Tim Murphy of Pennsylvania. Yes, Murphy is a Republican, but as a psychologist who has worked in the mental-health system he knows what its tricks are.

I do believe President Obama wants to help and here are five steps that would make a real difference. But unfortunately, like the mentally ill people he's trying to help, Obama is hearing voices in his head. They are the voices of those who created the problem. And those voices are telling him dangerous things.

D. J. Jaffe is executive director of Mental Illness Policy Org., and worked on the Obama campaign.

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