During the new session of the U.S. Congress, legislators will be considering the proposed "Helping Families in Mental Health Crisis Act." The decisions they make can have a big impact on mental health care in Canada.
If the bill passes, the U.S. Substance Abuse and Mental Health Services Administration will be forced to fulfill its original mandate which was to meet the needs of people living with the most severe mental illnesses. Instead of serving this population, SAMHSA, with its billion-dollar-a-year budget, has promoted a de-medicalized approach to psychotic disorders that has been disastrous for this population. There are now 10 times as many people with mental illness who are incarcerated as there are in hospital beds.
The proposals in the "Mental Health Crisis Act" grew out of an extensive examination of SAMHSA by a U.S. Congressional subcommittee. The chair of this committee and key sponsor of this bill, Pennsylvania Representative Dr. Tim Murphy, eventually determined that SAMHSA "has behaved as if schizophrenia and bipolar disorder don't exist."
While SAMHSA's policies have led to poorer care for people with the most severe illnesses, they have poured money into developing a powerful alternative mental health care system; this system operates on the assumption that schizophrenia and bipolar disorder are not actually illnesses and ignores the contemporary neuroscience and psychiatric view that these are disorders of neural circuitry. Instead, SAMHSA and the psychiatric survivor groups it funds, highlight social adversity and psychological trauma, usually delivered by neglectful and abusive parents, as the causes of the mental distress they focus on.
Murphy's bill seeks to redirect mental health care in many significant ways. These changes include:
1. Increasing inpatient and outpatient care for people with the most severe illnesses
The Murphy bill calls for increases in the number of inpatient psychiatric beds. Not only have there been too few inpatient beds, but the bed shortage has resulted in hospital stays that are too short for people to become stabilized.
A heated controversy in the U.S. and Canada focuses on the need, at times, for involuntary treatment. International research consistently demonstrates that many people experiencing psychosis have a brain based inability (anosognosia) to understand that they are ill. There is no reason for them to seek or agree to treatment.
Many people with untreated psychotic disorders shuffle between homelessness, trips to emergency rooms, and incarceration in jails and prisons. The Murphy bill encourages the use of Assisted Outpatient Treatment programs to help people get back control of their lives. This evidence-based treatment has been shown to reduce homelessness among people with mental illnesses, as well as reduce rates of victimization, crime, violence, arrests and incarceration.
Please let me know if you can find any references on SAMHSA's website to the inability of many psychotic people to understand that they are ill.
2. Improving communication with caring families
SAMHSA has trained and empowered psychiatric survivor groups to speak for all people with mental illnesses. Often led by people whose mental health problems stem from abusive parents, these groups consistently argue that sharing information with family caregivers of ill people violates their human rights. The Murphy bill works to ensure that caring families aren't blocked from receiving the information they need to help ill family members.
By insisting on evidence-based care, the mental health system can finally start to address the many unmet needs of families coping with psychotic disorders. These include much-needed science-based public education about psychotic disorders; this will help get ill people into treatment and create the informed communities that can offer the appropriate support they will continue to need. People with illnesses can receive the comprehensive education about their illnesses they need in order to accept and manage them. And mental health clinicians can start to receive the education about psychotic disorders that too many are not receiving; they can finally replace their muddled sociological and psychological theories with knowledge that lets them partner with family caregivers.
3. Forbidding federally funded agencies from working to prevent treatment of ill people
SAMHSA funds the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program. Murphy's congressional subcommittee documented the damage this group does across the U.S. in lobbying against any involuntary inpatient or outpatient treatments. As well, its 'patient advocates' routinely encourage very ill people who have been hospitalized on how to avoid treatment and leave the hospital.
I urge readers to watch at least 10 minutes of this three-hour, highly informative footage of one of the hearings investigating SAMHSA. In this session (at 2:06), Joe Bruce describes the role that PAIMI played in getting his very psychotic son out of the Maine hospital where his family was trying to get him treated.
PAIMI employees coached the son on everything he needed to say in order to get released from the hospital and avoid taking any anti-psychotic medications. In a delusional state, the son murdered his mother with an axe. The murder led to the son's commitment to a forensic institution where he finally received the treatment he needed. Joe Bruce quotes from the Wall Street Journal article in which his son, now doing well, says, "The advocates didn't protect me from myself. None of this would have happened if I had been medicated."
4. Increased funding for the U.S. National Institute of Mental Health (NIMH)
NIMH is the world's largest government funded organization doing science based research on mental illnesses.
It has only been through NIMH research that I began to learn about the predictable cognitive losses that often accompany schizophrenia and that impact my daughter. NIMH makes clear that these cognitive losses are the biggest factor in the ongoing disability of most people with schizophrenia. NIMH promotes research about these disorders and about the cognitive remediation programs needed to restore the ability to handle the tasks of daily living. Meanwhile, try finding even a description of these cognitive losses on SAMHSA's website.
SAMHSA's ideas are influential in Canada. Just google "SAMHSA" and "Canada." Even the first few pages of the over 300,000 results reveal the breadth of their impact.
Denying the reality of psychotic disorders, as SAMHSA has done, has led to disaster. We in Canada need to hope that the U.S. Congress will take the steps necessary to fix its broken system so that we can fix ours.