Help for the Mentally Ill

"Leaving the Mentally Ill Out in the Cold" by E. Fuller Torrey, in City Journal (Autumn 2003), Manhattan Institute, 52 Vanderbilt Ave., New York, N.Y. 10017.

When President George W. Bush’s platitudes that filled the report, suggests Torrey, Commission on Mental Health issued its re-a physician and coauthor of The Invisible port this past July, hardly anybody seemed to Plague: The Rise of Mental Illness from 1750 notice. Maybe that was because of the endless to the Present (2002). Or maybe the report’s political correctness put people off. But the study was at least partly redeemed by offering "a hint" of how to make progress.

The Bush commission’s "aversion to unpleasant truths," Torrey says, was frequently on display. While calling for a campaign to "‘reduce the stigma’ " of mental illness, the commission made no mention of that stigma’s chief cause: "untreated mentally ill individuals committing acts of violence," including 1,000 homicides annually, or more than four percent of the national total. Some 35 percent of the nation’s homeless people and 16 percent of the inmates in prisons and jails are mentally ill.

The commission likewise emphasized the need for mental health "consumers" to choose their own treatments, ignoring the fact that 50 percent of all schizophrenics and manic depressives aren’t even aware that they are sick. The commission also ignored the "proven effectiveness" of mandatory-treatment laws. Arrests of mentally ill individuals in New York state have declined by 85 percent since such legislation was enacted in 1999.

The nation’s mental health system is "fragmented, disconnected and often inadequate," the commission noted, much as the first presidential commission on mental illness did in 1961. Yet in 1997 alone, the nation spent $71 billion on treatment, about two-thirds of it through the federal Medicare and Medicaid programs whose administrators , according to Torrey, lack adequate knowledge of which local programs work well enough to deserve funding.

But almost in passing, the commission pointed the way forward, says Torrey, in urging that Washington give the states more flexibility in spending federal aid money for people with mental illness while seeking improved accountability and results. Yes, the states performed abysmally in this field in the past, but that was because federal programs beginning in the 1960s unwittingly created massive incentives to "deinstitutionalize" the mentally ill. Experimental programs in a half-dozen states could serve as a first step. That approach set the stage for welfare reform, Torrey says, and it would do the same for repair of the mental health care system.