Tuesday, February 5, 2013


By E. Fuller Torrey, MD, for the Wall Street Journal

"The evidence is overwhelming that this federal experiment has failed, as seen most recently in the mass shootings by mentally ill individuals in Newtown, Conn., Aurora, Colo., and Tucson, Ariz. It is time for the federal government to get out of this business and return the responsibility, and funds, to the states.

Altogether, the annual total public funds for the support and treatment of mentally ill individuals is now more than $140 billion. The equivalent expenditure in 1963 when Kennedy proposed the CMHC program was $1 billion, or about $10 billion in today's dollars. Even allowing for the increase in U.S. population, what we are getting for this 14-fold increase in spending is a disgrace.
Including President Kennedy, five Democratic and five Republican presidents have presided over the 50-year federal experiment. Jimmy Carter and George H.W. Bush appointed presidential commissions to examine the failed programs, but nothing useful came from either. 
Nor is President Obama likely to do anything, since his lead agency, the Substance Abuse and Mental Health Services Administration, has essentially denied that a problem exists. Its contribution to the president's response to the Dec. 14 Newtown tragedy focused only on school children and insurance coverage. And its current plan of action for 2011-14, a 41,000-word document, includes no mention of schizophrenia, bipolar disorder or outpatient commitment, all essential elements in an effective plan for corrective action.
On Feb. 5, 1963, 50 years ago this week, President John F. Kennedy addressed Congress on "Mental Illness and Mental Retardation." He proposed a new program under which the federal government would fund community mental-health centers, or CMHCs, to take the place of state mental hospitals. As Kennedy envisioned it, "reliance on the cold mercy of custodial isolations will be supplanted by the open warmth of community concern and capability."

President Kennedy's proposal was historic because the public care of mentally ill individuals had been exclusively a state responsibility for more than a century. The federal initiative encouraged the closing of state hospitals and aborted the development of state-funded outpatient clinics in process at that time.

Over the following 17 years, the feds funded 789 CMHCs with a total of $2.7 billion ($20.3 billion in today's dollars). During those same years, the number of patients in state mental hospitals fell by three quarters"”to 132,164 from 504,604"”and those beds were closed down.

From the beginning, it was clear that CMHCs were not interested in taking care of the patients being discharged from the state hospitals. Instead, they focused on individuals with less severe problems sometimes called "the worried well." Federal studies reported individuals discharged from state hospitals initially made up between 4% and 7% of the CMHCs patient load, and the longer the CMHC was in existence the lower this percentage became.

It has now become politically correct to claim that this federal program failed because not enough centers were funded and not enough money was spent. In fact, it failed because it did not provide care for the sickest patients released from the state hospitals. When President Ronald Reagan finally block-granted federal CMHC funds to the states in 1981, he was not killing the program. He was disposing of the corpse.

Fifty years later, we can see the results of "the open warmth of community concern and capability." Approximately half of the mentally ill individuals discharged from state mental hospitals, many of whom had family support, sought outpatient treatment and have done well. The other half, many of whom lack family support and suffer from the most severe illnesses such as schizophrenia and bipolar disorder, have done poorly.
Read the full article by Dr. E. Fuller Torrey, founder of Treatment Advocacy Center, in the Wall Street Journal.

1 comment:

  1. The Community Mental Health Act of 1964 and the Medicaid IMD Exclusion, enacted with Medcaid shortly after, were just the beginning. The Olmstead decision was the icing on the cake that allowed my brother Paul to be released to independent living conditions he could not handle.

    Paul's treatment after his release in 1996 - or I should say the lack of adequate support he received - is case in point to this article.

    My brother was treated as is if he was a fully functional, fully recovered adult, when he wasn't. That was the sad truth. Paul would never recover to the point where he could have lived in his own apartment and manage his own treatment, but that is not only what was expected of him from the minute he was transitioned from the hospital to a transitional group home - there were also time limits at each step down level - he was pushed out certain intervals whether he could handle it or not. It almost killed him outright, But he road that roller coaster to hell and back for almost a decade first. And Paul was one of the lucky ones. Although he died young at 48, he was never homeless or incarcerated. That is a sad testament to the mental health care system in this country.

    I commend Dr. Torrey for continuing to speak out for the forgotten population...the Paul's of this country.

    The problem is that we look at how MOST people can recover and forget that a FEW don't recover at all and MANY only recover moderately - and MANY need intense supports in order to "handle and benefit from living in the least-restrictive setting possible".

    The phrase quoted is really paraphrased from the 1999 Olmstead decision - look it up. It is being taken way too far.