Response to Dr. E. Fuller Torrey regarding progress in recovery

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Ron Manderscheid, Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors, responds to a recent comment from Dr. E. Fuller Torrey that criticized SAMHSA's National Wellness Week. Dr. Manderscheid does an excellent job of modeling the art of creating bridges to those with vastly divergent views. 

Morning Zen Guest Blog Post ~ Ron Manderscheid ~ 

I write this commentary in response to the recent comment published in National Review from Dr. E. Fuller Torrey. This response is from the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD), the National Association for Rural Mental Health (NARMH), and from me personally.

As my former colleague at the National Institute of Mental Health (NIMH), Dr. Torrey knows that we have been searching for effective interventions and solutions to the problem of serious mental illness for more than six decades. Work in this area extends from NIMH, to the other Institutes in the National Institutes of Health, to the Substance Abuse and Mental Health Services Administration (SAMHSA), and even to the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC).

I am exceptionally pleased to report that significant progress is being made:

Bringing Life: My own research shows that persons with serious mental illness are much more likely to have chronic physical illnesses than other people. Tragically, this research also shows that they die 25 years earlier than others as a result of these chronic illnesses, such as heart disease and diabetes. Wellness initiatives are an exceptionally important effort to confront this issue head-on. Persons with serious mental illness do not want to die in their early 50s; hence, they have embraced wellness efforts with great enthusiasm. National Wellness Week is intended to promote broad national efforts to confront these life threatening diseases. Current national initiatives under the Affordable Care Act to integrate mental health, substance use, and primary care services are another dimension of this ongoing work.

It also is very important to point out that such wellness initiatives are not restricted to the mental health field or to SAMHSA. The US Department of Health and Human Services and CDC endorse and promote wellness efforts. Further, many corporations have undertaken wellness initiatives for their employees and family members. Finally, many individuals engage in wellness activities every day, including running, yoga, and other exercises.

Bringing Recovery:  As Dr. Torrey knows, we did not use the word "recovery" in the mental health field until almost the year 2000. Now, people with schizophrenia and other types of serious mental illness understand that they can engage in an ongoing process of recovery to regain a full life in the community. This is new, very new, and it is exceptionally important. In part, it results from our new understanding that the majority of mental illnesses are due to personal trauma rather than brain disease. SAMHSA has played a very significant role in developing the tools of trauma informed care and recovery. In my own work with the counties, I see the positive effects of this work every day among those with serious mental illness who have been able to regain their lives as productive citizens in the community. 

Bringing Hope: More than a quarter century ago, while Dr. Torrey and I were still at NIMH, a middle age person with serious mental illness once told me, "You people have driven hope out of me." That comment has always stuck with me. Today, I would be delighted to tell that person that we have been able to rekindle hope. As we develop the capacity to prevent early death from chronic disease, and as we develop the capacity to provide help on a long-term trajectory to recovery from serious mental illness, then, indeed, one can have hope. Much of the credit for the rekindling of hope is due to the work of SAMHSA over the past two decades.

As Dr. Torrey also knows, we still have many service issues confronting us. These include the need for a capacity to provide early recognition of signs and symptoms before mental illness becomes severe, reducing the stigma of mental illness so that people are willing to seek care when needed, the development of advance directives for use when a person is incapacitated, reducing the prevalence of persons with mental illness in jails and prisons, among others. Addressing these issues will require the very best efforts of SAMHSA, NIMH, and all of the agencies in the US Department of Health and Human Services.

In all of our work, it seems very clear to me that we definitely do not want to go down legislative paths that will undo the wonderful progress that has been made over the past quarter century. That would be quite tragic. Therefore, we oppose the Mental Health Bill introduced by Representative Tim Murphy (R-PA) in its current form. We support the Mental Health Bill introduced by Representative Ron Barber (D-AZ) because it will advance the work described above. We do hope that Representatives Murphy and Barber will work together collaboratively to produce a single piece of legislation that we all can support.

I encourage Dr. Torrey to work collaboratively with me and others to continue to move our field forward. Much can be done in this era of the Affordable Care Act. We hope that Dr. Torrey will join us.

As full disclosure, neither NACBHDD, nor NARMH, nor I receive any funds from SAMHSA or its components.  

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manderscheidRon Manderscheid, Ph.D., serves as the Executive Director of the National Association of County Behavioral Health and Developmental Disability Directors. The Association represents county and local authorities in Washington, D.C., and provides a national program of technical assistance and support.  Concurrently, he is Adjunct Professor at the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, and Immediate Past President of ACMHA—The College for Behavioral Health Leadership. Dr. Manderscheid serves on the boards of the Employee Assistance Research Foundation, the Danya Institute, the FrameWorks Institute, the Council on Quality and Leadership, the International Credentialing and Reciprocity Consortium, and the National Research Institute. He also serves as the Co-Chair of the Coalition for Whole Health. Previously, he served as the Director of Mental Health and Substance Use Programs at the Global Health Sector of SRA International and in several federal leadership roles in the U.S. Department of Health and Human Services. Throughout his career, he has emphasized and promoted peer and family concerns.   

 This post originally appeared in Behavioral Health Care and is reprinted here with permission of the author.


  1. Mary Murphy's avatar
    Mary Murphy
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    A very good read on "recovery":
  2. Mary Murphy's avatar
    Mary Murphy
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    Ron Manderscheid, my son suffers from schizo-affective/bipolar, which is a brain disease. Schizo-affective/bipolar is a severe mental illness that is not brought on by personal trauma. He has total lack of insight into his illness, anosognosia. Because he was denied help and treatment until he met the bar of danger to himself (attempting suicide) or danger to others (attacking someone), he now sits in jail. After being off his medications for six months, his voices and delusions told him two people walking past my house were going to harm him and he had to drive them off the street. Because the bar was set so high, I could not obtain treatment before tragedy, all I could do was wait until tragedy struck. The "help" he got, after meeting the bar, is possible time in prison, even tho he was declared incompetent to stand trial. Your "wellness" week should have included how to keep those with the severest forms of mental illness from very real death and destruction, treatment before tragedy, and acknowledge that the condition of anosognosia exists. I can only think you are not supporting HR 3717 because you have not been listening to the many, many families that are in the same situation, who know tragedy will strike if they cannot obtain timely, mandated treatment for their very sick loved one. Asking someone to make rational decisions about their care when they are sending letters to the CIA asking for 25 sturdy men and women to help with their "mission" is not going to work out very well. You are ignoring those with the most devastating illnesses, the most difficult to treat, and the horrendous results are prisons now being the new mental institutions. Why?
  3. Mary Murphy's avatar
    Mary Murphy
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    Susan, if it was your loved one that suffered from a severe mental illness, schizophrenia, bi-polar, schizo-affective, you would not be thinking, well, he/she is just a small percentage of the population. It would be your whole world. SMI is not due to past trauma, it is a devastating brain disease. It would be just as easy to say that those who receive SAMSHA funding are lining their own pockets with bloated, ineffective program dollars. What I am "hearing" from the above comments is that those with SMI are so few in number that they are not worth the time and effort, so by all means, let them continue to be hidden away in jails and prisons, which now house more severely mentally ill people than are receiving care thru mental health systems. Untreated severe mental illness kills long before any possible side-effects of medication - or are you not aware of the almost daily stories of no treatment before tragedy?
  4. Susan McGilloway's avatar
    Susan McGilloway
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    Perhaps it would behoove Drs. Jaffe and Torrey to recognize that serious mental illness impacts a relatively small percentage of the general population. It is SAMSHA's responsibility to engage in activities aimed at the entire population. The entire population is in need of wellness services to aid in avoiding anxiety, depression, stress related trauma, substance abuse, and physical maladies associated with the above. Perhaps the fear within the psychiatric community is that individuals will avoid dependence on psychopharmaceutica therapies that are the financial lifeblood of psychiatrists' practices. Much of the mental illness impacting the general public is treated by the psychiatric community with drugs from the very pharmaceutical companies that pay for lavish vacations, conferences, dinners, and additonal perks that are so near and dear to psychiatrists. Materials from SAMSHA are a major medium of psychoeducation for the public and address mental wellness as a prevention rather than pharmaceutical intervention focus.

    It is vital to understand the difference between therapies focused on psychopharmaceutical intervention with medications that have serious and long term damage particular for children. The American Psychiatric Association (AMA) supports primarily pharmaceutical interventions that are, in many cases, not necessary in addressing issues within the general population that has become dependent on such interventions to the expense of their general health. These medications cause serious physical symptoms that are detrimental to normal physical digestive and neurological functioning that have long term implications for individuals.

    It is financially profitable for Drs. Jaffe and Torrey to focus on pharmaceutical intervention rather than prevention. It is worth mentioning that Drs. Torrey and Jaffe have been engaged in this crusade well before the Obama and current SAMSHA administration in an effort to foster programs that line the pockets of AMA members and pharmaceutical companies - programs including pharmaceuticals that are costly to the individuals for whom they are prescribed. It advances the AMA to focus on the disease model rather a wellness model as treating disease is more profitable than preventing it.
  5. DJ Jaffe's avatar
    DJ Jaffe
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    Mr. Manderscheid disclosure that NACBHDD receives no money from SAMHSA may be technically accurate but the county agencies his members run are THE major recipient of SAMHSA funds since they receive the Mental Health Block Grants SAMHSA distributes. Readers may want to consider that when considering his defense of SAMHSA. l
  6. DJ Jaffe's avatar
    DJ Jaffe
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    Dr. Torrey and I have been criticizing SAMHSA for ignoring seriously mentally ill for years and have been criticized by writers like Mr. Manderscheid. With that in mind it is delightful to see the American Psychiatric Association join us in the criticism. We hope Childrens Mental Health Network will also say 'enough!' and encourage the Substance Abuse and Mental Health Services Administration to start helping the most seriously ill.
    Here's part of what APA President Paul Summergrad wrote about SAMHSA:
    "However, for an agency with such a broad responsibility, the proposed (2014 Strategic) plan is striking for what it leaves out: a focus on the appropriate medical care of patients with serious mental illness and the development of a physician workforce that is essential for their care. In APA’s letter to SAMHSA Administrator Pamela Hyde, J.D., responding to the draft strategic plan, our CEO and medical director, Saul Levin, M.D., M.P.A., noted, “APA is strongly concerned about the lack of explicit recognition of the psychiatric treatment needs for Americans suffering from mental illness and substance use disorders, and in particular for the 13 million Americans who suffer from debilitating serious mental illnesses (SMI).” In addition, we urged SAMHSA to develop explicit goals for evidence-based medical care for serious psychiatric illnesses."
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