The Mental Health Industry

Writing in the City Journal James Panero reviews D. J. Jaffe’s new book: Insane Consequences: How the Mental Health Industry Fails the Mentally Ill. (Via Maggie’s Farm)

Mental health care is being disbursed by an industry that is controlled by lawyers and bureaucrats. The school shooters are only the most obvious sign of a system that does not help people. And that is unlikely to change. After President Trump and others recommended that one of the best approaches to school shooters was through the mental health system, his views have been drowned out by shrieking high school students who blame the NRA.

Panero summarizes Jaffe's view:

As Jaffe makes clear, the headline-making cases involving gun violence and mass murder are only the most atrocious symptoms of a much greater systemic failure, one that leads to the expense of billions a year on mental health yet leaves hundreds of thousands of mentally ill Americans to the cruelties of the streets, the “trans-institutionalization” of the prisons, and the life-threatening dangers of their own diseases.

We have mentioned the anosognosia problem before. People who are mentally ill often do not know that they are mentally ill. An illness that involves brain structure, that many psychiatrists now call a brain disease, does not make an individual fit to evaluate treatment options... or even to understand that he is mentally ill.

The system malfunctions at the most elementary level by allowing people with severe neurological problems to diagnose themselves and to choose whether or not to accept treatment. This is the contribution of the civil liberties lobbyists:

One problem is “anosognosia,” the clinical term for the lack of understanding of one’s own mental fitness. Anosognosia is “present in up to 50 percent of those with untreated schizophrenia and 40 percent of those with untreated bipolar disorder,” writes Jaffe. In a system that relies on patients serving as their own health-care agents and that no longer permits consultation on treatment with parents or loved ones, the consequences of anosognosia mean that the severely mentally ill often go untreated or undertreated. The result: “there are ten times more people with mental illness incarcerated as hospitalized.” Those are just the ones who make it to jail. Thousands die each year by their own hand or are shot by police committing crimes that shouldn’t have happened.

As I have often recommended, Jaffe agrees that involuntary commitment is the most effective way to reduce gun homicides committed by the mentally ill.

Panero explains Jaffe’s viewpoint:

Federal law already bans the sale of firearms to people who have been involuntarily committed. Written into existing policy, institutionalization therefore remains a proven path to reducing gun deaths, if only such intervention were still readily available to the severely mentally ill.