“It's hard to determine which is more delusional: the mental health system or the people it's intended to treat.”

—Dr. E. Fuller Torrey

America's mental health system is insane, expensive, and ineffective. Under the guise of protecting civil rights, it is killing people. Under the guise of increasing freedom, it is increasing incarceration. Under the guise of facilitating recovery, it ensures that fewer recover. In the name of protecting privacy, it causes suicide. America treats the least seriously ill (“the worried well”) and forces the most seriously ill to fend for themselves. The ability to get help has become inversely related to need. We move sick people from hospitals to jails and label it progress. Government funds those who created the problems rather than those with solutions. The more dysfunctional the system becomes, the more money we throw at it. Our mental health system is not based on science and has nothing to do with compassion. As a result, there are ten times more people with mental illness incarcerated as hospitalized. “Being Mentally Ill” has essentially become a crime.

Our system forces people with serious mental illness to suffer. Your happy, smart, popular child enters his late teens or early twenties, and then slowly schizophrenia strikes. First, he becomes withdrawn, scared, and noncommunicative. Then he becomes imprisoned in a straitjacket of paranoid psychotic thinking that spews forth whenever he talks. My own sister-in-law told me in a single sentence:

The FBI planted a transmitter in my head God is the Messiah did you see Jeopardy! maybe I'm too smart they're after me trying to kill me why is everyone around here so crazy I like the Beatles Johnny is gay Kathy you know what she did I'm gonna be an astronaut that way the beams won't get me. Hahaha.

You attempt to use reason to convince your child that something is wrong and to get help, but he's too sick to know he's sick. He refuses to go to a doctor because “I'm not crazy, and I know you're beaming thoughts into my head.”

You find a social worker who tries to win your son over. He refuses her help too. And because he is over the age of eighteen, or as young as twelve in California, Illinois, and West Virginia, he has the right to refuse all treatment.1 Federally funded lawyers will defend his right to be psychotic. You call the mental health department, so your son starts threatening you: “You want to get rid of me I'm gonna kill you I'm not crazy you're crazy get out of my room! Stop poisoning my food!”

Out of options, you call the police. But they can't help either because he's not dangerous enough yet. Even if you manage to get your son into a hospital, privacy laws will prevent you from learning what's wrong or what's next. He will be discharged to your care without your knowing what the diagnosis is, what medications he should be taking, when the next doctor appointment is, or what to do. Will your son stay on the medications? Will he go off them and become violent to himself, toward you, or maybe toward a bystander? Will that make him a headline? Will you become the headline when the public blames you for being the mom of the next “Psychotic Killer Goes on Rampage”?

There are forty-three million Americans over eighteen affected with “any mental illness” and ten million with “serious mental illness.”² At least 140,000 of these seriously mentally ill are homeless and often can be seen foraging in Dumpsters, engaged in pitched battles with demons only they can see.³ Some 392,037 are in jails and prisons.⁴ An additional 755,360 are on probation or parole, and many of them will return to jail or prison multiple times.⁵ At least 95,000 who need hospitalization can't get a bed because of the deadly shortage.⁶ More than 5,000 kill themselves every year.⁷ Their untreated mental illnesses make them more likely to be murdered and more likely to be victims of violent crime than the mentally healthy.8 They die up to twenty-five years earlier than others. While most people with mental illness do not become violent, those with untreated serious mental illness are more likely than others to become violent. Their victims are most likely to be members of their own families. The public becomes aware of the issue only when strangers are killed en masse:

• Aaron Alexis had untreated mental illness when he shot and killed twelve people in September 2013, thereby becoming the “DC Navy Yard Shooter.”⁹

• One L. Goh shot and killed seven and injured three at Oikos University in California in April 2012. He had schizophrenia.¹⁰

• Seung-Hui Cho had untreated mental illness when he killed thirty-two and wounded seventeen in April 2007 at Virginia Tech.¹¹

Maintaining our failed mental health system is expensive. In 2014, the federal government spent $147 billion in taxpayer funds on mental health.¹² And that doesn't include state spending. The New York State Office of Mental Health alone spends $3.5 billion annually.¹³ Since 2005, California has been investing in excess of $1 billion in public funds annually on mental health and has little to show for it.¹⁴ We are spending more, yet the problems are getting worse.

WE HAVE TO STOP IGNORING THE SERIOUSLY ILL

Mental “health” advocates blame the problem on lack of funding. They are wrong. The mental health advocates themselves are the problem.¹⁵ One hundred percent of adults feel sad at some point and can have their mental health improved. Eighteen percent had some sort of mental illness in the past year. But only four percent had a “serious” mental illness like schizophrenia, bipolar disorder, or severe, major depression.¹⁶ As documented in section seven, the mental health industry persuaded the government to ignore the four percent with a serious mental illness and invest the funds on improving the mental health of all others.

The mental health industry cherry-picks the most compliant and least symptomatic. It labels all other patients “high-needs” and claims it is not set up to help them. A psychiatric social worker admitted to me, “A rampant problem with not only the mental health system but the entire healthcare system is it discriminates against potential clients it perceives as being too difficult to handle.”

While ignoring those with serious illnesses, the mental health industry expands the number of people entitled to services by inventing new illnesses like bullying and cyberbullying. It declares poverty, bad grades, divorce, sexual dysfunction, and unemployment to be mental illnesses and diverts mental health funding to them. It even persuaded the Substance Abuse and Mental Health Services Administration (SAMHSA), which develops the nation's mental health policy, and state mental health authorities to ignore science and fund politically correct pop psychology that improves nothing but the industry's own coffers. The industry convinced the states to shutter psychiatric hospitals that serve the seriously ill and enact laws that prevent the seriously ill from being helped until after they become “a danger to self or others.”

Until the 1940s, public funds were used to treat the “insane.” Then we moved to helping the “mentally ill,” then to the even broader mission of “improving mental health,” then to the broader mission of addressing “behavioral health,” and today we've arrived at denying that the seriously ill exist and divert the funds to “wellness services” for everyone.

The industry is “medicalizing ever larger swaths of human experience.”17 The American Psychiatric Association fuels this trend with each new edition of the Diagnostic and Statistical Manual (DSM), which defines ever greater numbers of normal emotional reactions, such as grief over losing a parent, as mental disorders.¹⁸ Outreach workers pour into elementary schools looking for barely symptomatic children to engorge the mental health system.

Meanwhile, everyone ignores the seriously mentally ill in plain sight. No one stands outside homeless shelters or prison doors to help those who really have serious mental illnesses stay in treatment. It's become harder to get into Bellevue than Harvard. And if the most seriously ill can find a hospital to admit them, they will be discharged “sicker and quicker.” They wind up in jails, prisons, shelters, and nursing homes, moving from an institution that was appropriate to others that are not.

The solution is to replace mission creep with mission control. We have to stop ignoring the most seriously ill. We have to spend less on mental health and more on serious mental illness. And we have to base our policies on science.

Insane Consequences will show how the mental health industry wrested control of mental illness policy and spending from the government. The industry focuses on improving the mental health of everyone rather than delivering treatment to the 4 percent with serious mental illness. Their “three main strategies when discussing schizophrenia and other forms of psychotic illness is to deny it, romanticize it, or trivialize it.”19 This book argues that the government has to recognize certain unpleasant truths about the most seriously mentally ill that the mental health industry convinced it to ignore: not everyone recovers, sometimes hospitals are necessary, involuntary treatment is preferable to incarceration, and there is a group of the most seriously ill who—left untreated—become suicidal, homeless, criminal, incarcerated, and, yes, sometimes violent. To solve these problems, we should focus our resources on science-based treatments for those who need help the most rather than on those who need help the least. We should move away from a system that requires tragedy before treatment to one that offers treatment before tragedy. Pretending the seriously mentally ill don't exist is no solution.

Section 1 describes the Insane Consequences of ignoring the most seriously ill: increased homelessness, suicide, victimization, perpetration, arrest, violence, imprisonment, and suffering. It documents the drain on the criminal justice system, the danger to the public and patients, and the cost to taxpayers.

Section 2 details the difference between poor mental health and serious mental illness for those new to the subject. While the boundary between the two is debatable, the extremities are clear. It describes the science of serious mental illness because policy should be driven by that science.

Section 3 introduces the major mental health organizations that fail the most seriously ill, with particular attention to the Substance Abuse and Mental Health Services Administration (SAMHSA), the Center for Mental Health Services (CMHS), and the nonprofits they fund. It also identifies the good guys who are trying to convince the government to treat the most seriously ill.

Sections 4 and 5 document exactly how SAMHSA and the mental health industry prevent help from reaching the seriously mentally ill and encourage the government to waste money on programs that don't help.

Section 6 identifies the major federal actions and US Supreme Court decisions that fail the seriously ill.

Section 7 lays out a road map for reform. It proposes ways to eliminate wasteful mental health spending and increase the efficacy of existing spending.

After reading this book, I hope you will conclude that lack of money is not as big a problem as lack of leadership. We have to narrowly focus our resources on delivering actual treatment to those known to be the most seriously mentally ill rather than on all the softer sideshows that receive funding now. We have to adopt policies grounded in science. That path will improve the lives of people with the most serious mental illnesses, save money, keep the public, police, and patients safer, and make us a better country.