It’s a shame that Sen. Kamala Harris (D-Calif.) dropped out of the Democratic presidential primary. Her mental health plan demonstrated the triumph of science and compassion over political correctness and wishful thinking. If adopted it could improve the quality of life for the seriously mentally ill and the communities in which they live. The remaining candidates and the Democratic National Committee (DNC) should include Harris’s proposals in their 2020 platforms.
In spite of the federal government spending $150 billion to address mental health, rising numbers of mentally ill people are going homeless and being incarcerated. This is largely because of a multi-year trend: Parts of the mental health industry convinced legislators to move spending away from hospitals and programs that serve the most seriously mentally ill and fund instead soft programs designed to improve “mental wellness” in the masses.
California and New York City have massively increased mental health spending. But because they fail to focus the spending on the seriously ill, both are experiencing increases in homelessness and incarcerations. The resultant community outrage is making the siting of facilities more difficult, further compounding the problem.
Harris’s plan — and that of former candidate, Montana Gov. Steve Bullock — included the four most important reforms the federal government can make to help the most seriously mentally ill. They are expanding the number of psychiatric hospital beds, reducing the use of involuntary inpatient commitment by supporting outpatient versions, freeing families of HIPAA handcuffs, and evaluating programs based on the most important outcomes. Those same reforms seem to be supported by President Trump, meaning they perhaps could become law.
In spite of advances in medications and other treatments, some seriously mentally ill do not get better. This is a sad, politically incorrect reality. Even with perfect community services, the country still would be short 95,000 hospital beds to serve those not yet ready to live in the community. Many likely are among the 400,000 who are incarcerated or 140,000 who are homeless.
Like candidates Pete Buttigieg, the South Bend, Ind., mayor, and Sen. Amy Klobuchar (D-Minn.), Harris acknowledged that we must fix the bed shortage by eliminating Medicaid’s Institutes for Mental Disease (IMD) Exclusion. This exclusion prevents states from accessing Medicaid funds to hospitalize adults with serious mental illness. If Democrats are for “parity,” they must support eliminating this federally mandated discrimination. The IMD exclusion is what causes states to kick the mentally ill out of hospitals, thereby increasing homelessness and incarceration. Ending the exclusion could improve those metrics and give hospitals enough funding to offer care that is truly therapeutic.
Harris also laid out a way to reduce inpatient commitment and incarceration by expanding the use of Assisted Outpatient Treatment (AOT) for a tiny subset of the most seriously ill who do well in treatment but deteriorate because they refuse to stay in it. With due process protections, AOT allows judges to order them to stay in mandated, monitored treatment for up to one year without giving up their rights or their homes.
The results have been extraordinary. AOT reduces homelessness, needless hospitalizations and incarcerations by approximately 70 percent, saving taxpayers 50 percent of the cost of care. AOT is endorsed by groups as diverse as the Treatment Advocacy Center, National Alliance on Mental Illness, the National Sheriffs Association and the U.S. Conference of Catholic Bishops. Seventy percent of those in AOT say it helps them get well.
Harris called for tweaking HIPAA, the Health Insurance Portability and Accountability Act. The privacy law already allows limited information to be disclosed to companies that provide case management, transportation and housing to the seriously mentally ill for money. She proposed giving families who provide those services, for free, the same access to limited information that paid providers receive. Without that information, parents are prevented from knowing the diagnosis, medications, appointments and rehabilitation needs of mentally ill loved ones. They can’t get prescriptions filled, arrange transportation, or see that appointments are kept. These HIPAA restrictions can turn patients with loving families into wards of the state.
Finally, Harris’s plan requires the National Institute of Mental Health to focus its research on medications and other interventions that reduce the most important metrics: the number of seriously mentally ill who are homeless, arrested, incarcerated, violent and needlessly hospitalized. She would require the government to use existing funds to collect and publish those metrics. That would encourage government to send the most seriously mentally ill to the head of the line for services, rather than to jails, shelters, prisons and morgues.
All campaigns should adopt Harris’s proposals and the Democratic National Committee should make them part of the party platform. Sen. Bernie Sanders (I-Vt.) has said his “Medicare for All” plan will solve the problem, but it doesn’t address what to do about people with serious mental illness who don’t know they are ill — a condition called “anosognosia” that affects 40 percent of the seriously mentally ill. Having insurance doesn’t mean they will access it.
Sens. Cory Booker (D-N.J.) and Elizabeth Warren (D-Mass.) have yet to issue plans to address serious mental illness. Will they let political correctness triumph over science, or will they support AOT, repeal of the IMD exclusion, and freeing parents of HIPAA handcuffs and reporting on important metrics?
It is true that some believe that being psychotic and delusional is a right to be protected, rather than an illness to be treated. Others believe it doesn’t exist at all. But we are no longer in the Stone Age, and it’s time our policies reflect that.
DJ Jaffe is an adjunct fellow at the Manhattan Institute and executive director of Mental Illness Policy Org. He is the author of “Insane Consequences: How the Mental Health Industry Fails the Mentally Ill.” Follow him on Twitter @MentalIllPolicy.