Now that someone with mental illness has shot one of Washington's own, maybe Congress will start to pay attention to its abysmal failure to provide care for the most seriously mentally-ill Americans.
We'll see. Lawmakers took a brief lunge in that direction after mentally-ill John Hinckley shot Ronald Reagan in 1981, and an even smaller step in 1988 when Russel Weston, another mentally-ill man, entered the Capitol and shot two police officers. But most mentally-ill people are not violent -- and Congress seems content with ignoring those who are.
I fear legislators will react to Rep. Gabrielle Giffords' shooting by giving themselves added police protection -- that is, covering their own butts while leaving everyone else's exposed.
When you read Jared Loughner's rantings on YouTube, you're instantly transported back to the 1980s, when mentally-ill Ted Kaczynski -- the Unabomber -- started a 20-year career of sending bombs through the mail. He was caught only in 1995 -- after family members who read the Unabomber's 35,000-word psychotic manifesto, said, "That sounds like Ted," and told the police.
The family had tried to get help for Kaczynski before then -- but, like most families of people with serious mental illness, faced a Catch-22. They are powerless to do anything other than say, "Why don't you go to a doctor" until after the mentally ill person becomes dangerous.
Here's what Congress should do to save money, improve care and prevent violence:
1) Prioritize the seriously mentally ill. Federal mental-health dollars now go to an astonishing variety of social programs for the worried-well, with little left for the seriously ill. Congress should establish a federal definition of "serious mental illness" that covers no more than 5 percent of the population and require all programs that get federal mental-health funds to use at least 60 percent of those funds for the seriously mentally ill.
2) Eliminate the Substance Abuse and Mental Health Services Administration. This federal agency wastes its funds on everything but serious mental illness.
SAMHSA just e-mailed to alert me that its children's book, "Play Day in the Park," which "reinforces positive, healthy choices for children ages 3 to 4," is back in print. This, when seriously mentally-ill people are going homeless and untreated. But it's far worse; SAMHSA actually funded a conference in California where a speaker taught participants how to go off their antipsychotic medicines.
3) End or greatly restructure the Federal Protection and Advocacy for Mentally Ill Individuals Program (PAMII). The lawyers in this program occasionally do good work -- but more often, they defend the right of people with mental illness to go off treatment and be psychotic. They are the major impediment to reforming involuntary-treatment laws.
Congress should ban the use of any PAMII funds for lobbying against reform of involuntary-treatment laws or working to prevent family members from helping their loved ones, an especially big problem here in New York.
4) Provide seed money to states that want to make use of Involuntary Outpatient Commitment Laws. These laws allow courts to order someone with mental illness and a history of violence to stay in treatment if he wants to stay in the community. By cutting down on arrests, incarcerations and hospitalizations (not to mention dangerous), these laws save money and lives while helping the mentally ill live successfully in the community.
5) End the Institutions for Mental Disease Exclusion in Medicaid law. This prevents states from providing long-term care for people with mental illness.
If you need long-term care for a disease that resides in any organ other than the brain, Medicaid reimburses states for half the cost. But not if the disease is in the brain. So states lock the front door and open the back -- patients wind up in jail after committing some vile act only because they were left untreated.
There are mental-health groups that will oppose these changes -- they're feeding nicely off the status quo.
If there is any sanity needed, it's in how Washington addresses mental illness.
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