How Public Policy Is Failing the Severely Mentally Ill

By Meridian M. Paulton, Research Assistant in Domestic Policy Studies, Institute for Family, Community, and Opportunity at The Heritage Foundation.

Severe mental illness has received considerable attention lately, owing largely to recent tragedies, including mass shootings involving the mentally ill.

The issue also has emerged in discussions about fighting poverty, because an estimated 1 in 5 homeless people suffer from severe mental illness. It also has arisen in the context of criminal justice and prison reform, since some 20 percent of the incarcerated are thought to be seriously mentally ill.

In 2016, an estimated 10.4 million adults in the United States suffered from serious mental illnesses.

The issue of how best to treat these people is a complex matter, as experts in psychiatry, law, and public policy noted last week in a panel discussion at The Heritage Foundation on severe mental illness.

The discussion began with an opening statement from Dr. Sally Satel, resident scholar at the American Enterprise Institute and a Washington, D.C.-based psychiatrist, who emphasized that there’s a clear distinction between a severe “mental illness” and a “mental health” concern.

She said, for example, that someone who has “mood swings” often does not pose the same potential dangers as a manic person whose delusions could lead to violent and erratic behavior.

Severe mental illness is most typically schizophrenia or bipolar disorder, Satel noted, but can include severe instances of other diseases and behaviors.

D.J. Jaffe—executive director of Mental Illness Policy Org and a longtime advocate for the seriously mentally ill—said there’s a noticeable shift among mental health activists that homes in on particular agendas, such as destigmatization of mentally ill patients, and a focus on mental wellness.

That has distracted much-needed policy attention from those with severe mental illness, he argued, adding that 35 percent of the most seriously mentally ill never receive treatment. That includes the 40,000 incarcerated people and 140,000 homeless people with a serious mental illness.

Efforts that do exist are poorly targeted, too: Though suicide-prevention programs typically target young people, Jaffe says that 90 percent of those who take their own lives are adults.

Andrew Sperling, director of legislative and policy advocacy at the National Alliance on Mental Illness, emphasized the need for more research in mental illness treatments. There is currently no cure for mental illness, so “treatments are palliative,” he said.

But Sperling said that many pharmaceutical companies, unfortunately, have abandoned efforts in this field, owing largely to the difficulty of conducting such research. While HIV researchers discovered a biomarker in developing treatment, no equivalent discovery has yet been made in the mental illness arena.

Sperling is hopeful research efforts will continue and that companies would return to develop long-term treatments and possible cures.

John Malcolm, vice president of the Institute for Constitutional Governmentand director of the Meese Center for Legal and Judicial Studies at The Heritage Foundation, reminded the audience that there are times when someone with severe mental illness is truly a danger to themselves or others.

“Two-thirds of all gun-related deaths are people who commit suicide,” Malcolm said. “And it’s been estimated that 10 percent of gun-related violence and 60 percent or more of mass shooters are suffering from a severe mental illness.”

What’s more, these individuals often self-medicate with alcohol or illegal substances, he said, and that dramatically increases the risk of violence.

Malcolm expressed concern over the high standard of evidence required to commit a severely mentally ill person to a mental hospital. That has often landed these individuals in jail cells, rather than hospital beds.

The panelists concluded the discussion by stressing the importance of broadening awareness of serious mental illness and understanding of how public policies affect those suffering from it.

This piece originally appeared in The Daily Signal

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