The demise of the mental health system is not the result of SAMSHA

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The following is a response to commentary made on the Morning Zen post - SAMHSA is under attack - and the rank and file are paying the price.

Morning Zen Guest Blog Post ~ Dennis Embry

Thank you, Scott for noticing the bigger problem.

The demise of the mental health system is not the result of SAMSHA, though the demise is a casualty of the broad dismantling of mental health systems of care that has been happening since the bloom and bust of the private psychiatric hospital wars in the late 1980s and early 1990s. Most states have systematically defunded their mental health treatment services that include both medication and all of the ancillary services required to help people with serious mental illnesses. I've watched this in Arizona where I have worked as a clinician with adults and children with very serious mental illnesses. I have witnessed the absolute destruction of such systems in Kansas in a decade where I grew up and was at the epicenter of this destructive dismantling. How big is the defunding by states? At least $5 billion, just in the last few years. If you are ticked about this, vote for new state legislators.

SAMSHA did not cause the decline in funding for the seriously mentally ill, nor did its many fine and dedicated civil servants. SAMSHA’s core funding priorities are decided by Congress, which funds about $1.8 billion for substance abuse treatment and prevention by SAMHSA and only about $450 million for mental illness. The latter is about $9 million per state provided by Congress, which can accurately be described as “budget dust.” How infinitesimal is that by comparison to New York State’s special appropriation to support high-quality services for seriously mentally ill in its Assisted Outpatient Treatment effort?  Well, New York state spent an extra $160 million dollars, which adjusted per capita for the rest of the United States is about $3.9 billion extra dollars for high-quality mental health treatment.

Let’s wave a magic wand. Every single penny of the $450 million Congress appropriates to SAMHSA for mental illness is overnight spent on the most seriously mentally ill. That sounds like a cure for cancer or more, unless you have a 4-function calculator. If you hypothesize that high-quality treatment costs about $15K per year, only 30,000 people could be helped by those federal funds. Now, frame that in context of Dr. Thomas Insel’s blog (the director of the National Institute of Mental Health) who noted that 500,000 people have a first-episode psychosis each year in the U.S.  Let’s say Tim Murphy’s committee has its way and mandates SAMHSA spend its mental health funding on really, really serious mental illness like those 500,000 people with first episode psychosis. What an admirable priority!  Nobody could disagree that such folks with first episode psychosis need treatment, and such folks are responsible for the bad things that happened Tucson (my home), the Aurora Colorado movie theatre, and Sandy Hook Elementary. What a great idea! Each state can spend $900 for their treatment.

Now, most states have voluntary commitment procedures. It’s not pleasant to do, and its agony for us a family members. I had to do this with my parents, and it did not work because the “treatments” were actually iatrogenic. Such coerced treatment in no way guarantees effective results. Please read the Cochrane Review (the august impartial, non-political review of such matters) here: http://bit.ly/compulsoryRx.

As a well-respected scientist, I don’t believe ANY member of Congress regardless of their political leanings about their reports of science nor the witnesses they call. There is just way too much psychotropic money greasing political campaigns, even in state elections. I go read the bloody science myself, which any reader of the Children’s Mental Health Network can and should do. The best source is the National Library of Medicine, www.pubmed.gov, which you may conveniently read for a search on “compulsory treatment.” I urge both the advocates and the doubters to read through these abstracts, and if you believe the political stances and hyperbole on either side of the AOT…well, that is a completely different diagnosis called, “thought gullibility”.

The insistence that mental illnesses—even serious ones have nothing to do with behavior and are purely “brain diseases” is so far off the mark of what we know scientifically. That is a long lecture, and not possible to communicate in sound-bytes. The “brain disease” sound byte creates the false belief that these problems are inevitable genetic, biochemical disease. Perhaps the most cited person for the concept of “brain disease”, Dr. E. Fuller Torrey, is the very guy who proved that some cases of schizophrenia could be the result of an infectious disease passed on by cat poop. Dr. Torrey’s group also funded the first randomized trial in the world to prevent first episode psychosis, using nothing more than 1.3 grams of high-quality omega-3 (fish oil).  More detail can be read at www.pubmed.gov.

But consider an analogy that puts it into a layperson’s experience. Almost everyone reading this post knows that we have an epidemic of diabetes. Clearly diabetes involves elaborate biochemistry with one major organ. So should we now call diabetes just a “pancreas disease?” Hardly. There are many environmental, social, epigenetic, and behavioral predictors and levers to move to help a person afflicted with diabetes live a healthier life than just taking insulin. And, this is just so about mental illnesses from V-codes to major, serious mental illnesses.

The rank and file SAMSHSA employees are pawns in a really bad movie. I know many of them. They have been given a job to prevent, treat and cure the most costly and difficult illness in America on a peanut butter budget. It’s a time for SAMSHA leadership to stop defending an impossible task to stem and epidemic of mental illness in America, and it’s time for us to call out politicians and others for engaging in Kabuki theatre for 10-seconds of fame.

Dear readers, we have an epidemic of mental illnesses that dwarfs the polio epidemic. That requires a wholly different discussion than current posturing, deflection and blaming.

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enbry

Dennis Embry, President/Senior Scientist at PAXIS Institute – Dennis D. Embry is a prominent prevention scientist in the United States and Canada, trained as clinician and developmental and child psychologist. He is president/senior scientist at PAXIS Institute in Tucson and co-investigator at Johns Hopkins University and the Manitoba Centre for Health Policy. His work and that of colleagues cited in 2009 the Institute of Medicine Report on The Prevention of Mental, Emotional, and Behavioral Disorders Among Young People. Clinically his work has focused on children and adults with serious mental illnesses. He was responsible for drafting of the letter signed by  23 scientists, who collectively represent scores of randomized prevention trials of mental illnesses published in leading scientific journals. In March 2014, his work and the work of several signatories was featured in a Prime-TV special on the Canadian Broadcast Corporation on the prevention of mental illnesses among children—which have become epidemic in North America. Dr. Embry serves on the Children's Mental Health Network Advisory Council.  

Comments

  1. George Patrin, MD/MHA, San Antonio, TX's avatar
    George Patrin, MD/MHA, San Antonio, TX
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    Well said. Thanks for "calling it what it is," Dennis. I must get with the TX politicians in this state where I have decided to retire and can't locate effective mental healthcare for my nephew. We have lots to talk about, being the 50th out of 51 States for per capita spending for mental healthcare (UP ONE from the last review, actually). Is the USA the only country demonstrating its ignorance regarding need for mental and spiritual healthcare? (Of course not.)
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