By E. Fuller Torrey and Doris A. Fuller
February 6, 2015
The nonpartisan Government Accountability Office this week released a scathing report on the lack of leadership in the Department of Health and Human Services for coordinating federal efforts related to serious mental illness. It described 112 separate programs in eight federal agencies with little coordination. “The absence of high-level coordination,” the GAO concluded, “hinders the federal government’s ability to develop an overarching perspective of its programs supporting and targeting individuals with serious mental illness.” The report was especially critical of the lack of any formal evaluation mechanism for the majority of the programs, so there is no way to tell whether they are working.
The main target of the report was the Substance Abuse and Mental Health Services Administration, or Samhsa, an HHS agency that is required by its enabling legislation “to promote coordination of programs relating to mental illness throughout the federal government.” In 2003 President George W. Bush’s Commission on Mental Health noted the lack of coordination among federal programs. In response, a Federal Executive Steering Committee for Mental Health, led by HHS, was formed. This produced some improvement in program coordination, as noted by the GAO in 2008. But, astonishingly, the Steering Committee hasn’t met since 2009.
Not coincidentally, the new director of Samhsa, Pam Hyde, assumed her position in November 2009. A lawyer by training, Ms. Hyde has made clear that Samhsa’s mission is to be mental health, not mental illness. Incredibly, “Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014” didn’t include a single mention of schizophrenia or bipolar disorder, despite running more than 41,800 words.
Ms. Hyde promoted a social worker to be the director of the agency’s Center for Mental Health Services, a center that doesn’t include a single psychiatrist. There is only one psychiatrist among all of Samhsa’s 570 employees and her expertise is in substance abuse, not serious mental illness. Thus it is not surprising that the GAO notes that “coordination related to serious mental illness has been largely absent across the federal government.”
Meanwhile, problems related to serious mental illness have continued to get worse. Such individuals comprise at least one-third of the homeless population. And according to our analysis of data from the Justice Department, American Correctional Association and the American Jail Association, there are now 10 times more people with serious mental illness in U.S. jails and prisons than in state mental hospitals. Individuals with untreated serious mental illness are responsible for 10% of all homicides in the U.S. and approximately half of all mass killings.
And what has been Samhsa’s response? In September the agency sponsored a “National Wellness Week” during which it suggested that drinking fruit smoothies and line dancing would achieve wellness. And during last month’s “historic” East Coast snowstorm, Samhsa opened four hotlines for individuals worried about the storm.
The GAO report was prepared after congressional hearings that culminated with Pennsylvania Rep. Tim Murphy’s Helping Families in Mental Health Crisis Act of 2013, which gained wide bipartisan support before being killed by the Democratic leadership of the last Congress. That desperately needed legislation included proposals to reform Samhsa and create a leadership position to coordinate federal programs for mental illness. The GAO report strongly supports such a position. Its title says it all: “HHS Leadership Needed to Coordinate Federal Efforts Related to Serious Mental Illness.” The current absence of such leadership is shocking.
Dr. Torrey is founder and Ms. Fuller executive director of the Treatment Advocacy Center, a nonprofit working to eliminate barriers to treatment for people with severe mental illnesses.