A Psychiatric Trick or Treat

November 1, 2013

Fifty years ago this week, President John F. Kennedy signed legislation creating a federally funded Community Mental Health Centers (CMHC) program. The CMHC program was the last piece of major legislation signed by Kennedy and thus became a symbol of his legacy, says E. Fuller Torrey, M.D., founder of the Treatment Advocacy Center, writing for the National Review.

The legislation and subsequent additions authorized the use of federal funds to construct and staff CMHCs to "provide comprehensive mental health services" to local communities. Kennedy had high hopes for the program, claiming that it would replace "the shabby treatment of the many millions of the mentally disabled in custodial institutions." Sadly, JFK's dream of federalizing public services for mentally ill persons was subverted by the law of unintended consequences. The program has been an unmitigated disaster, both for those who suffer from severe mental illnesses such as schizophrenia and bipolar disorder and for the communities in which they live

  • Untreated mentally ill individuals are now responsible for at least 10 percent of all homicides and half of the mass killings such as those at Virginia Tech, Tucson, Aurora, Newtown, and the Washington Navy Yard.

Skeptical voices were raised during the 1963 congressional hearings on the proposed CMHCs.

  • The New York state commissioner of mental hygiene said flatly that the CMHC program would be ineffective for the sickest mentally ill individuals.
  • In fact, in 1963, at the time of the proposed federal legislation, most states had already begun making provisions for community psychiatric services for patients being deinstitutionalized from state hospitals.

Twenty states had passed or proposed state mental-health legislation, and 234 mostly state-funded programs were operational. Following the implementation of the federal CMHC program, state efforts gradually ceased.

With the subsequent passage of the Medicare, Medicaid, Supplemental Security Income, and Social Security Disability Insurance programs, the financing of mental-health services effectively shifted from the states to the federal government.

The saddest part of JFK's legacy is that we now have much better treatment and rehabilitation programs than we had in 1963, but they are unused for the majority of the sickest individuals. Reversing JFK's shift toward federalization and holding states accountable is, ironically, our best hope for fulfilling his original dream.

Source: E. Fuller Torrey, "A Psychiatric Trick or Treat," National Review, October 31, 2013.

 

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