(9-13-16) A gadfly is a person who interferes with the status quo by posing novel, potently upsetting questions, usually directed at authorities. Mental health gadfly D. J. Jaffe, who along with Dr. E. Fuller Torrey frequently stirs up controversy in mental health circles, claims that Democratic presidential hopeful Hillary Clinton’s mental health plan, which I cited in an August blog, isn’t as good as the mental health legislation that could be voted on in the Senate this week. Meanwhile, Clinton’s rival — Republican Donald Trump — has not offered any ideas about fixing our mental health care system.
In addition to attacking Clinton’s plan, Jaffe and John Snook, executive director of the Treatment Advocacy Center (which was founded by Dr. Torrey), have criticized greater federal funding of Mental Health First Aid, an eight hour course that helps ordinary citizens recognize mental illnesses. Some communities are using Mental Health First Aid rather than the 40 hour Crisis Intervention Team training for law enforcement.
Hillary Clinton’s mental health plan doesn’t compare to the bipartisan plan already on the table
by DJ Jaffe
Donald Trump has not introduced a mental health plan, so we can’t evaluate it. But Hillary Clinton did introduce a mental health plan. Unfortunately it is not as good as the bipartisan Helping Families in Mental Health Crisis Act (H. R. 2646), which passed the House by a vote of 422-2, and should be taken up by the Senate this week. It is not even as good a bill as combining Senator Alexander’s Mental Health Reform Act (S2680) with Senator Cornyn’s Mental Health and Safe Communities Act (S2002) would be.
The Clinton plan largely focuses on improving mental wellness in everyone, rather than helping the most seriously mentally ill. There are forty-three million Americans who have a mental health issue, but only ten million, have “serious mental illnesses” including schizophrenia and bipolar disorder. 140,000 of the seriously ill are homeless, 365,000 are incarcerated, and 95,000 who need hospitalization can’t get it. That is the problem we have to focus on.
More money may not be the immediate answer. The federal government already increased mental health spending to $147 billion but at the same time, it made the ability to get care inversely related to the severity of the illness. The easiest to treat go to the head of the line for services and the seriously ill go to jails, shelters and morgues. The Substance Abuse and Mental Health Administration (SAMHSA), encourages spending to go to irrelevant and useless programs and some that are actually harmful. H.R. 2646 puts a doctor at the helm of SAMHSA to try to stop that. The Clinton plan ignores the issue.
People who are psychotic and delusional, those who are hallucinating and “know” they are the Messiah, need hospital beds in order to get better. But there are so few psychiatric beds that a Catch-22 scenario has developed. Anyone with mental illness who is well enough to walk in to a hospital and ask for admission is deemed not sick enough to need it. The Helping Families in Mental Health Crisis Act takes a small step to ameliorate the shortage of hospital beds. The Clinton plan won’t even go that far.
Another problem with the mental health system is that anyone who is so sick they don’t recognize they need hospitalization (“The FBI planted a transmitter in my head”) cannot be treated until after they become “danger to self or others.” The bill that passed the House and the Mental Health and Safe Communities Act both address the inadequacy of our laws, which, as, ludicrous as it sounds, require dangerous behavior rather than prevent it. The Clinton plan does not.
The Clinton plan fails to fix the HIPAA regulations that prevent doctors from telling parents of mentally ill children what their child’s diagnosis is, what medications they should take, and when their next appointments are. These regulations make parents powerless to see prescriptions are filled and appointments kept. Parents who provide housing, case management, and transportation out of love need access to the same information paid providers receive in order to continue providing those services. The bill that passed the House, and can be taken up by the Senate provides a path to do that. The Clinton plan does not.
Ms. Clinton’s plan calls for yet another White House conference on mental illness. Presidents Kennedy, Carter, Clinton, Bush, and Obama have all done that and they all made the problem worse. The seriously ill need services the higher functioning do not, and at these gatherings of the mental health industry, those solutions are never proposed. The mental health industry comes in trotting a laundry list of alleged “risk factors” like bad grades and low self-esteem, and tells the President that if he invests in their social services programs, that they can prevent mental illness. Nonsense. There is no way to prevent serious mental illnesses like schizophrenia or bipolar disorder because we don’t know the cause.
As a result of these conferences, numerous useless and tangential ideas get funded and the seriously ill get shunned. The only way for a White House mental illness conference to succeed would be to gather police and sheriffs rather than mental health industry executives. Law enforcement officers have become the real experts because unlike mental health executives, they can’t refuse to serve the seriously ill.
Instead of coming up with her own tweaks to the existing failure, Clinton, and Trump as well, should urge Senate Majority Leader Mitch McConnell (R., KY) and Democratic Leader Harry Reid (D., NV) to bring Representatives Tim Murphy (R., PA) and Eddie Bernice Johnson’s (D., TX) Helping Families in Mental Health Crisis Act (H. R. 2646) to a vote in the Senate. Or they should urge the Senate to combine the Mental Health Reform Act (S. 2680) with the Mental Health and Safe Communities Act (S. 2002) and pass that. Both paths would help ensure existing spending goes to solving real problems.
I urge those who want to improve the mental health system to call Senate Majority Leader Mitch McConnell at (202) 224-2541 and the Democrat’s Senate Leader, Harry Reid at (202) 224-3542. Ask them to have the Senate pass the bipartisan Helping Families in Mental Health Crisis Act, HR2646 which passed House 422-2. You can also tweet to Senator Mitch McConnell (@SenateMajLdr) and Harry Reid (@SenatorReid)
D. J. Jaffe is executive director of Mental Illness Policy Org., which he created. He’s also author, of the forthcoming book, “Insane Consequences: How the Mental Health Industry Fails the Mentally Ill” (Prometheus Books, April 2017).
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