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Broken minds, broken lives

"Broken minds, broken lives" Continued...

Issue: "Getting paid not aid," Feb. 22, 2014

WHILE SYLVIA and millions of others despair, Americans spend billions on mental health: $135 billion in 2010, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). The money comes from state and county funds, Medicaid and Medicare, private insurance, various other private and nonprofit programs, and individual out-of-pocket payments. But D.J. Jaffe, executive director of Mental Illness Policy Org., says money often goes to programs under the elastic scope of “mental health” that includes yoga classes, basic computer skills tutoring, counseling for bullied kids, and anti-stigma campaigns. The most severely ill—those with schizophrenia, bipolar disorder, and severe depression— are often left out.

FOLLOWING THE MONEY: Murphy in the basement of the Capitol.
Bill Clark/Roll Call/Getty Images
FOLLOWING THE MONEY: Murphy in the basement of the Capitol.
SAMHSA and the Center for Mental Health Services (CMHS) are major culprits, many caregivers believe. Each year, SAMHSA shifts about $460 million in block grants to CMHS, but when Rep. Tim Murphy (R-Pa.), also a psychologist, spent a year with his Subcommittee on Oversight and Investigations to follow the money and examine the actual spending, he concluded: “[T]oo many of these grants are directed to advancing services rooted in unproven social theory and feel-good fads, rather than science.” 

At a hearing last year psychiatrist Sally Satel, a former member of the CMHS National Advisory Council, testified that SAMHSA and CMHS follow a misguided ideology that “supports activities that actively sabotage [the seriously mentally ill’s] welfare.” Their practices, she said, “either condemn the use of medications or are hostile to formal psychiatric care.”

Two days before the first anniversary of the Newtown shooting in December, Murphy unveiled legislation he says will fix the “broken” mental health system. The Helping Families in Mental Health Crisis Act, if passed, will appoint a new assistant secretary for mental health and substance abuse disorders. The appointee must be a medical professional who will advocate research and evidence-based models of care on a federal level.

The bill also aims to facilitate access to direct, primary treatment. It proposes modernizing laws that prevent mental health professionals from sharing vital information with parents and caregivers of mentally ill patients. It allows grants only to centers in states that allow involuntary treatment and assisted-outpatient treatment, and also cuts off taxpayer dollars that previously funded anti-psychiatry, anti-treatment organizations. 

The Affordable Care Act (Obamacare) will bring more patients into the already strained mental health system, and Vice President Joe Biden recently announced that the federal government will send $100 million more to existing mental health facilities and mental health services at community health centers. But how does more money help, when the existing mental health system is a failure?

Jaffe, who calls himself “a superliberal—as liberal as you can get,” said when it comes to mental illness, “the conservatives seem to understand mental illness better.” He says that, other than Tim Murphy, “most politicians don’t understand the difference between improving mental health and treating mental illness.” His bottom line: “Nobody really cares about the serious mentally ill. And I don’t see that changing.”

HAVE CHURCHES SHOWN they really care? Not according to research by Baylor University professor Matthew Stanford. His 2007 survey of 293 Christians who approached their local church for assistance on personal or a family member’s mental illness found that 60 percent of participants felt abandoned by the church, 19 percent were told mental illness is due to personal sin or a lack of faith, and 21 percent were told that it’s demonic.

The relationship between serious mental illness and sin is complicated. Mental illness has a physical component, but since it afflicts human beings it also has spiritual dimensions. Christians often deny the physical aspect. Stanford said “a majority of churches are denying” mental illness and sometimes covering it with an “ugly spiritual crust” by attributing everything to spiritual issues and refusing to take into account physical factors.

A Baylor survey in 2008 of church members with mental illness in their families showed about three in five saying their church was not involved at all in the problem. The other two-fifths said their church is “a little” (18.8 percent) or “somewhat” (17.6 percent) or “a great deal” (5.9 percent) involved, but many said the church only made matters worse. 

That’s a tragedy, Stanford said, because those dealing with mental health issues usually turn to the clergy first: “Even the very ill, the very psychotic individuals, while they are certainly distracted from their faith, they are really asking the big questions: ‘Where is God in this? Do I have hope? Is God punishing me?’ They are often crying out to God.”

Esther Park, a private-practice psychiatrist in Southern California, told me that many churches are oblivious or ignorant about mental illness because many Christians “judge the level of faith by their outcome” and aren’t open about their uglier struggles. If more pastors became educated on the illness, they could foster an environment in which people feel more confident to ask for help and discover, “What’s God’s will in this?” She recently started a community service Bible group for those with mental illness in her clinic, because she saw a gaping need within the Christian community.

—Part 2 of a two-part series on mental illness (see “Saving Seth,” Feb. 8)

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