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Hippie Healthcare Policy

While one government agency searches for the cure to mental diseases, another clings to the 60's notion that they don't exist.

By E. FULLER TORREY, M.D.

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In 1998, the primary federal agency devoted to improving mental health services, the Center for Mental Health Services (CMHS), awarded $200,000 to a group of former mental patients in California whose nonprofit organization is committed to vigorously opposing laws that would make it easier to forcibly treat and commit people like Julie Rodriguez. Strengthened by its federal grant, the California Network of Mental Health Clients organized rallies, hired vans to bring people to Sacramento, distributed T-shirts, and created the erroneous impression that there was widespread opposition to the commitment bill.

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Among most professionals who are aware of its existence, CMHS is ridiculed as an agency and widely regarded as more dysfunctional than the individuals it is supposed to serve. Not only is CMHS the major funder of groups opposed to involuntary treatment, it spends millions on programs of dubious merit that offer little help to the crit ically ill.

For instance, in 1998, CMHS awarded $13 million over three years to the National Empowerment Center (NEC) in Lawrence, Massachusetts, for a "National Consumer Technical Assistance Project."

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The largest portion of CMHS funds given to anti psychiatric groups and those opposed to assisted treatment is the $30 million per year allotted through the Protection and Advocacy program. Although the Protection and Advocacy program began in 1986 as a well- meaning attempt to prevent abuse of patients in psychiatric hospitals, many of its state programs quickly evolved into being "playgrounds for anti-psychiatric activists," according to Rael Jean Isaac and Virginia Armat in their 1990 book Mildness in the Streets. In 1999, for example, the Vermont Protection and Advocacy organization changed a state law, thus making it more difficult to medicate seriously mentally ill individuals.

And currently in Wisconsin, that state's Protection and Advocacy organization has filed an amicus curiae brief to change the state's commitment law. The current law, the brief argues, is deficient, because it does not require a person's dangerousness to be "imminent," and allows people to be treated to avoid psychiatric deterioration. Furthermore, the brief says that psychiatric treatment is "of questionable benefit."

Although civil rights is a dominant theme in the distribution of CMHS funds, minorities and women's issues are also prominent. Blacks, Hispanics, Asian Americans, and Native Americans are so predominant among recipients of CMHS largesse that the program might easily be mistaken for one specifically directed to these groups. For example, among 35 Community Action grants awarded by CMHS in 2001, seven (20 percent) were given to Native-American groups, despite the fact that Native Americans constitute only 15 percent of the population. One CMHS program specifically aimed at Native Americans is called "Circles of Care"; this program, which spends $3 million of CMHS funds annually, is intended to promote "culturally appropriate mental health services" for Native-American children.

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Among the more prominent CMHS recipients of funds are the National Mental Health Association (NMHA); and The Bazelon Center for Mental Health Law. In 1998, NMHA received a three-year grant for $820,000 entitled "Consumer Supporter Technical Assistance Center." The purpose of the center was to create "coalitions of community care" to "build bridges-create respect, trust and working relationships between consumer supporters, consumers and professionals.

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It is understandable why CHMS showers fiscal favors on the Bazelon Center; the center, like CMHS, is caught in a time-warp. Its origin as an ACLU-led attempt to prevent all involuntary hospitalization and involuntary treatment of individuals with psychiatric disorders is right out of Cuckoo's nest.

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What should happen? CMHS is probably one of the few federal agencies that could be abolished and virtually nobody would notice. A better plan would be to ask CMHS to do what it was originally intended to do - provide national leadership to improve services for individuals with severe mental illnesses rather than focusing on social problems. The pending Presidential Commission on Mental Health presents an excellent opportunity to reassess services. Block granting mental health-related Medicaid funds to the states and then holding the states responsible for services by rigorously measuring the outcomes deserves consideration. The criteria used to judge CMHS as an agency should include a measurable decrease in the number of severely mentally ill persons who are homeless, in jails and prisons, and responsible for acts of violence.