In the past three months, a Brooklyn woman beat her four-year-old son to death with a broomstick, an Indiana man was fatally shot by police, and a gunman in Texas opened fire on parishioners at Sunday mass. All of these people suffered from serious mental illness. And all of these tragedies were preventable had there been better access to treatment. Thankfully, the Trump administration is starting to address the broken mental health system that currently fails our most seriously mentally ill.
In this same three month timespan, the federal Interdepartmental Serious Mental Illness Coordinating Committee has been preparing the first of two reports to Congress describing how to improve services for those with serious mental illnesses, including schizophrenia, bipolar disorder, and major depressive disorder. The committee is made up of leaders from multiple federal agencies and select members of the public, and was established in December 2016 through bipartisan health care reform. The assistant secretary for mental health and substance use in the Department of Health and Human Services, Dr. Elinore McCance-Katz, leads the committee and released the first report to Congress on Wednesday.
In previous years, lack of leadership at the federal level has prevented substantive change in mental health policy on a national scale and driven resources away from the seriously ill and towards the higher functioning. Although many decisions regarding the treatment and care of those with serious mental illness are made at the state and local level, federal agencies can work together to create a blueprint of best practices and also help set the standard for better “evidence-based” treatments.
{mosads}The report presented by Dr. McCance-Katz and the committee this month should be applauded for including a comprehensive overview of what we currently know about serious mental illness, research advances, and an inclusive survey of federal programs in place right now. The first portion of the report was compiled by members of the committee representing federal agencies, and demonstrates a constructive effort by multiple agencies to identify gaps in the system where coordination could be improved.
As an example, a presentation by Ruby Qazilbash, Associate Deputy Director of the Bureau of Justice Assistance at DOJ, describes positive research findings that “by providing connections to community-based services, particularly case management services, increases length of time in the community” after those involved in the criminal justice system are released from jail. “Yet only a fraction of people — at the point of court, jail diversion, or reentry from the jail or prison back into the community — are getting connected to that care.”
A section from the non-federal members of the committee outlines an agenda of solutions grouped by rough categories on what can be done to help those with serious mental illness, such as improving coordination between federal committees, diverting those with serious mental illness from the criminal justice system, and increasing access and affordability to a provided “comprehensive continuum of care.”
Next steps for the committee, which is established to meet over the span of five years, should be to prioritize the federal programs that are “most likely to reduce homelessness, arrest, incarceration, violence, and needless hospitalization over ideas that are politically correct, but don’t improve those metrics” says DJ Jaffe, executive director of Mental Illness Policy Org, a non-partisan think-tank focused on serious mental illness policy. A high proportion of programs, many of which are included in this report, bill themselves as “evidence-based” without improving these meaningful metrics.
One worthy evidence-based treatment included in the report that has been shown to reduce homelessness, incarceration, and hospitalization is Assisted Outpatient Treatment. AOT is court-mandated treatment, which can include medication and therapy, for those who fit strict criteria of having a history of non-compliance to medication and a high number of arrests or hospitalizations within a certain timeframe. The first major study of AOT in New York State, by the Office of Mental Health in 2005, found that participants experienced a 74 percent reduction in homelessness, 87 percent reduction in incarceration, and 77 percent reduction in psychiatric hospitalization. Consequent research has seen similar positive findings. Yet while 46 states have AOT statutes and the 21st Century Cures Act funded pilot programs, it is still not widely used.
The interdepartmental committee report makes clear what the range of options are to fix the programs currently in place, create new programs, and what the non-federal committee members — at least one of whom is a parent of seriously mentally ill adult child — would like to see done.
As noted in the report, the interdepartmental committee is “a historic chance to address SMI and SED across federal departments and the systems that they represent.” While we may be distracted on a daily basis by the noise and negativity surrounding the current political climate, this report and the leadership put in place by the Trump administration is a clear indication that actual, bipartisan, policy change is not only attainable but moving forward.
Carolyn Gorman is the project manager of Education Policy and Mental Illness Policy at the nonprofit Manhattan Institute.