Bureaucratic Insanity

[Geee]

National Review:


Some federal-budget cutters claim that we have already picked all the low-hanging fruit. Those of us who work in Washington know better, although it is not considered polite to say so. One counterexample is SAMHSA, a federal health agency distinguished by the fact that the health of its clients would improve if it went out of business.

The acronym stands for the Substance Abuse and Mental Health Services Administration, a $3.6 billion component of the Department of Health and Human Services. It employs 537 people, who have an average salary of $107,760; almost three-quarters have jobs rated a 13 or higher on the General Schedule, meaning their salaries start above $70,000. Its official mission is to reduce “the impact of substance abuse and mental illness on America’s communities” and increase access to treatment services.

Given this mission, one might think that SAMHSA would have a major interest in the two most serious mental illnesses — schizophrenia and bipolar disorder — which together affect 7.7 million Americans, according to the National Institute of Mental Health.

An increasing percentage of homeless persons, as well as individuals in jails and prisons, are diagnosed with serious mental illnesses. This is a direct consequence of the continuing decline in the number of state mental-hospital beds, combined with our failure to provide treatment once these patients return to the community. However, judging by the just-released document “Leading Change: A Plan for SAMHSA’s Roles and Actions 2011–2014,” such individuals not only are not a priority for the organization, they do not even exist. Not once in the 41,804-word text of this three-year plan is either schizophrenia or bipolar disorder even mentioned. Instead, the nation’s mental-health ills are all subsumed under a vague category called “behavioral health problems.” Assuming this broad mandate has allowed SAMHSA to dabble widely and ignore the most serious disorders.

One might also think that SAMHSA would be concerned that 4.7 million individuals receive Supplemental Security Income (SSI) and Social Security Disability Income (SSDI) because they suffer from “mental disorders, other” (as the category is named). The total federal cost for such support for these mentally ill individuals in 2009 was $45.7 billion. When I recently queried SAMHSA about what it knows about these 4.7 million people and why some states have three times as many mentally ill individuals per capita on SSI and SSDI as other states, the agency replied, “SAMHSA does not collect this information. . . . We have no data.”