Federal Oversight of Mental Health Programs a 'Disaster'

Alicia Ault

February 11, 2015

Washington, DC — A congressional committee took the Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) to task for a failure to effectively coordinate programs for the seriously mentally ill and demanded more accountability.

There was bipartisan agreement today among the members of the House Energy and Commerce Oversight and Investigations Subcommittee that a recent Government Accountability Office (GAO) report exposed a teetering bureaucracy that was not getting help to where it was needed.

The report, issued February 5, "produced unassailable evidence that our mental health system is dysfunctional, disjointed, and a disaster," said subcommittee Chairman Rep. Tim Murphy (R-Penn.). Murphy, a psychologist, requested the report, along with Rep. Diana DeGette (D-Col.).

Murphy also has introduced legislation in previous congressional sessions to essentially dismantle SAMHSA and create a new assistant secretary of substance abuse and mental health within HHS.

"Action Is Needed"

At today's hearing, both Murphy and DeGette, along with other lawmakers, said the findings of the GAO report were concerning.

Linda T. Kohn, director of healthcare at the GAO, said the organization had identified 112 federal programs that supported people with serious mental illness in some way, but that only about 30 specifically targeted those individuals. Those 30 programs are run by five federal agencies: the Department of Defense, the Department of Justice, HHS, the Social Security Administration, and the Veterans Administration.

SAMHSA is required by law to promote coordination of those programs, but the GAO found the agency's efforts lacking. The GAO also reported that reviews of the effectiveness of federal mental health programs are inconsistent, and in some cases they are not being done at all.

The GAO recommended that the agencies determine which programs need to be evaluated, and how often. All the agencies except HHS agreed with the GAO's recommendations.

Richard G. Frank, PhD, assistant secretary for planning and evaluation at HHS, told the committee that HHS felt that the GAO report "fell short" of describing the department's efforts to help the mentally ill.

"This administration has shown a deep commitment to addressing mental health care, and serious mental illness specifically," said Dr Frank. But, he added, "I know we can do more."

"We continue to believe that action is needed," countered the GAO's Kohn.

Rising Death Rates From Suicide

Murphy said that refusal by HHS to accept the GAO recommendations "is a clear example of unaccountable government." He added that it was not just about "wasted dollars or lost program efficiencies. We are talking about lives ruined, dreams shattered, and preventable tragedies."

He noted that mortality rates for many major illnesses, such as stroke, heart disease, and cancer, for instance, had declined, but suicide deaths had continued to climb.

Pamela Hyde, JD, the SAMHSA administrator, said that the agency had "taken significant action on suicide." She added, "We are concerned about those numbers."

Rep. Joseph P. Kennedy, III (D-Mass.) said the GAO report could be seen as a starting point. "Instead of throwing in the towel, we should see this report as a rallying cry," he said.

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