Mental illness and homicides
A federal agency tasked with mental-health treatment makes the system worse.

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Article Highlights

  • The Substance Abuse and Mental Health Services administration often flies under the radar and is rarely in the news.

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  • The mission of SAMHSA is important: To reduce "the impact of substance abuse and mental illness on America's communities"

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  • SAMHSA represents a failure of federal leadership on the care of people with severe mental illness.

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‘My son was only able to get treatment by killing his mother." This was the testimony of Joe Bruce at congressional hearings on May 22. In 2006, Will Bruce, then 24 and suffering from schizophrenia, killed his mother, Amy, with a hatchet. "But an unbearable aspect of Amy's death," Bruce told members, "is that my own tax dollars helped make it possible."

Bruce was referring to the federally funded Disability Rights Center of Maine, whose employees coached Will on how to get out of the psychiatric hospital and avoid being treated. As a result, Will returned home. Two months later and still psychotic, he killed his mother.

Today, Will Bruce is being properly treated. The young man, who was eventually deemed not guilty by reason of insanity and now resides indefinitely in a forensic institution, acknowledged to his dad that "none of this would have happened if I had been medicated."

In a steady voice, Joe Bruce delivered his jaw-dropping testimony before the House Energy and Commerce's Subcommittee on Oversight and Investigations, chaired by Representative Tim Murphy (R., Pa.), a psychologist. The subcommittee is especially well suited for medically related investigations, as it also includes two physicians (Michael Burgess from Texas, and Bill Cassidy from Louisiana) and a nurse (Renee Ellmers from North Carolina).

The hearings were the third forum held by this subcommittee to investigate psychiatric aspects of the mass killings at such now-infamous places as Newtown, Conn.; Littleton and Aurora, Colo.; Tucson; and Virginia Tech. While almost everyone else has stressed the gun issues, the subcommittee has focused on the role played by untreated severe mental illness.

The hearing examined the role of the Substance Abuse and Mental Health Services Administration (SAMHSA), a little-known component of the Department of Health and Human Services. The size of the agency, which has 600 employees and a budget of $3.5 billion, pales in comparison with that of other federal health programs such as Medicare and Medicaid. This makes it one of Washington's stealth agencies flying under the radar and rarely in the news.

Yet SAMHSA's core mission is important: to reduce "the impact of substance abuse and mental illness on America's communities." The subcommittee wanted to know how well SAMHSA was meeting its obligation to deliver services to the severely mentally ill.

SAMHSA administrator Pamela S. Hyde was questioned for two hours by subcommittee members. They asked her multiple times why SAMHSA's detailed three-year planning document contained no mention of schizophrenia or bipolar disorder, and why SAMHSA employs not even one psychiatrist in its Center for Mental Health Services, the entity responsible for services for mentally ill people.

No satisfying answers from Hyde were forthcoming, confirming what Murphy observed in his opening statement: "It's as if SAMHSA doesn't believe that serious mental illness exists."

Members also asked her why SAMHSA does not include assisted outpatient treatment (AOT) - a form of mandatory care outside an institution - among its list of 288 approved treatments. It's a glaring omission, indeed. Studies have shown that AOT decreases arrests and violence for individuals with severe mental illnesses. It also saves money. Murphy noted that "too many of [SAMHSA's] grants are directed to advancing services rooted in unproven social theory and feel-good fads, rather than science. . . . We expect SAMHSA's work to be firmly rooted in evidence-based practices . . . but much of it appears to fall far short of such standards."

But the most disturbing testimony of the day concerned the wrenching tragedy that befell Joe Bruce and his family. According to the Treatment Advocacy Center, a nonprofit watchdog, Maine is one of at least 14 states in which SAMHSA-funded programs - such as the Disability Rights Center of Maine, which helped Will Bruce slip from the psychiatric hospital - have impeded efforts to improve the treatment of individuals with severe mental illnesses.

Not only, then, do SAMHSA's programs fail to improve the mental-illness-treatment system. They make it worse. This may be a new low-water mark for a federal agency.

When it came to the question of how SAMHSA actually spends some of its money, testimony included a dreary list, including a painting commissioned for $22,500; a SAMHSA staff musical costing at least $80,000, and an annual anti-psychiatry, anti-treatment conference costing $500,000. Such waste is, of course, not unique to SAMHSA, but it bolstered evidence of the agency's neglect of its mission. Murphy noted, for example, that "in at least 38 of the last 62 mass killings, the perpetrator displayed signs of possible mental-health problems."

These catastrophes were not merely gun-control problems. They are failures of federal leadership on the care of people with severe mental illness. The Subcommittee on Oversight and Investigation should be commended for exposing the sorry state of affairs at SAMHSA.

- E. Fuller Torrey, M.D., and Sally Satel, M.D., are psychiatrists who both testified at these hearings. He is the founder of the Treatment Advocacy Center; she is a resident scholar at the American Enterprise Institute.

 

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