On November 1, Psychiatric News published 50 Years After: Will We Realize JFK’s Vision for Mental Health Care? Psychiatric News is an APA publication, and the piece was written by APA’s President, Jeffrey Lieberman, MD.
Dr. Lieberman begins by reminding us that in 1963, President Kennedy signed the Community Mental Health Act (CMHA) into law. Dr. Lieberman points out that the CMHA:
“…was intended to set the foundation for contemporary mental health policy, one premised on the establishment of community-based care as an alternative to institutionalization.”
But, he tell us,
“Adequate funding for treatment and programs never followed, and many people were left without the support they desperately needed. Consequently, many patients wound up homeless or incarcerated.”
Dr. Lieberman tells us that this tragedy persists to this day:
“…20 percent of the inmates of jails and prisons are persons with mental illness, and the penal system is now the nation’s biggest provider of mental health services.”
This notion – that the prisons and jails are being used as mental institutions – is frequently mentioned by psychiatry as evidence for the need for more mental health funding. But the statement warrants further scrutiny.
We are routinely told that at any given time, 20%, or more, of the general population has a “diagnosable mental illness.” So why would it be surprising to find this percentage reflected in our prisons and jails? If anything, we should expect to see higher numbers in the penal system, because criminality itself is a mental illness according to the APA. Both conduct disorder and antisocial personality disorder are simply psychiatric labels for criminal activity.
In addition, the use of the term “penal system” in this context is misleading, in that it contains the implication that all the prisons, jails, juvenile detention centers, etc., constitute a single entity, which is not the case.
According to Wikipedia
“…2,266,800 adults were incarcerated in U.S. federal and state prisons, and county jails at year-end 2011…”
The US Department of Commerce Census Bureau puts the present US population at 317 million people. This means that there are approximately 315 million people who are not incarcerated. If, for the sake of argument, we accept the 20% figure for both populations, we obtain the following:
“mentally ill” incarcerated 453,360
“mentally ill” at large 63 million
Psychiatry claims that only about 40% of those with “mental illness” in the community actually receive “treatment.”
This comes to about 25 million of the 63 million “mentally ill” at large. These people receive treatment from the mental health system, i.e. the entire network of hospitals, (public and private); outpatient clinics (public and private); addiction units (public and private); etc…
Even if we weight the matter in Dr. Lieberman’s favor by assuming that 100% of “mentally ill” prisoners receive services, we still come up with only 453,360 who receive mental health treatment in the penal system, i.e. 1.8% of the 25 million who receive services from the mental health system.
If one compares the number of people “treated” in the penal system with the number “treated” in any given mental health center, then obviously the penal system treats more. But this is apples and oranges. The only valid comparison is between the penal system and the mental health system. And in that comparison, the penal system doesn’t even come close.
The statement that “…the penal system is now the nation’s biggest provider of mental health services,” has shock value, but is simply false. It is just one more example of psychiatric spin. In addition, it needs to be stated that if people meet the legal criteria for insanity, they don’t go to prison. But the vast majority of people who meet the APA’s increasingly inclusive criteria for mental illness don’t come even close to the criteria for legal insanity.
PARITY ACT AND AFFORDABLE CARE ACT
The rest of Dr. Lieberman’s article is devoted to the issue of parity, i.e. that insurance coverage for “mental illness treatment” is legally required to be basically on a par with coverage for physical illness. He complains that:
“… key provisions of the act’s implementation have been twisted and manipulated by insurers to restrict coverage. This abuse has endangered lives by denying mental health patients the care they need and are entitled to legally.”
This is standard Dr. Lieberman stuff. He sees the implementation of the final parity regulations and the implementation of Obamacare as a potential bonanza for psychiatry, and he wants to make sure that they don’t miss out. Psychiatrists get a lot of things wrong, but they have an unerring sense of accuracy and dedication in matters relating to their own remuneration and status.
Then Dr. Lieberman treats us to this gem:
“We cannot ignore the mistakes and shortcomings of deinstitutionalization, but we should mark the extraordinary progress made since 1963—in the public’s understanding of mental illness, in our capacity to treat it and the breadth of services now offered in communities, and in the effective advocacy by people with firsthand experience of problems like depression and schizophrenia.”
Let’s examine this statement.
“… the mistakes and shortcomings of deinstitutionalization…” Is there a suggestion here that we need to revert to a higher level of custodial care?
“… the extraordinary progress made since 1963…” presumably he means the relentless expansion of the “diagnostic” net, where we have reached the point where it is confidently asserted that the lifetime prevalence of “mental illness” is higher than 50%; or perhaps he means that neuroleptics are being given to two-year-olds for temper tantrums; an unprecedented breakthrough!
“…the public’s understanding of mental illness…” What he means here is that pharma-psychiatry has poured millions of dollars into promoting the falsehood that all problems of thinking, feeling, and/or behaving are brain illnesses, and that a large proportion of the population has bought it.
“… our capacity to treat it…”: i.e. toxic drugs, shock “treatment” and lately, little gizmos implanted in the brain to keep us on the straight and narrow.
“… breadth of services now offered in communities…” i.e. drugs, ECT, and little gizmos.
“… the effective advocacy by people with firsthand experience of problems like depression and schizophrenia.” I think he means groups like NAMI, DBSA (Depression and Bipolar Support Alliance), and FFDA (Families for Depression Awareness). I’m sure he doesn’t mean the survivors’ movement, though he might get a more accurate picture from them.
And Dr. Lieberman is very clear as to what we must do:
“Now is the time to build on this progress by addressing the continuing challenges to quality mental health care. One of the most daunting is the shortage of mental health professionals in many areas, and efforts to integrate psychiatric care into primary care practice deserve increased support.”
In other words, give us more money and we’ll put psychiatric service into every GP’s office. We’ll get the prevalence rate up to 100%, and everybody will be taking our drugs. Everybody has a mental illness anyway; we just want to help them recognize this and get the treatment that they need and deserve.
All of Dr. Lieberman’s writings have the same basic message:
- We psychiatrists are real doctors.
- We do fabulous work – at the cutting edge of neuropsychopharmacology.
- All those mean things that people say about us are false and malicious.
- Brain illnesses have reached epidemic proportions, but luckily we have lots of drugs that treat these illnesses.
- All that we need right now is more money so that we can spread our net wider and bring help to more people.
- Etc., etc…
And remember, readers, Dr. Lieberman is the President of the APA, and is presumably speaking for the membership.