Employees at lead U.S. mental health agency critical of leadership

Those who are concerned about how America treats the most seriously mentally ill should pay attention to a new report that shows that Pam Hyde, administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), the lead agency for coordinating America’s mental health efforts lost the confidence of her employees. Other problems at SAMHSA have been well documented and could explain why America has 10 times as many persons with serious mental illness incarcerated as hospitalized, why 165,000 seriously mentally ill are homeless, and why headlines are full of reports of seriously mentally ill who as a result of lack of access to treatment become involved in headline grabbing incidents. The federal agency responsible for helping people with serious mental illness has turned its sights elsewhere—trying to “improve the mental health” of all Americans.  

In the new survey of federal employees conducted by the Partnership for Public Service, SAMHSA employees ranked their leadership team the 266th worst out of 315 government agencies. Compare that to another health agency, the National Institutes of Health, which ranked 80th. When it came to empowering employees, SAMHSA, ranked 298th, showing the problems are coming from the top. The survey also shows that failure pays well. While SAMHSA ranked below the median of other agencies on every measure of leadership, its median pay was higher. If SAMHSA was loaded with doctors, high pay might make sense, but in spite of increasing the number of SAMHSA employees by 18% between 2008 and 2013, the SAMHSA administrator has not a single doctor on her team. The lead agency for mental health policy lacks medical expertise.

A General Accounting Office (GAO) report on SAMHSA programs was requested by Rep. Murphy (R. PA), a psychologist, and Rep. Diane DeGette (D. CO) as part of hearings on how to improve care for the mentally ill. It found SAMHSA fails to coordinate national mental health policy or evaluate results, and that most programs don’t serve the seriously ill. Speaker after speaker told committee members about the refusal of SAMHSA to focus on helping the most seriously mentally ill and diverting its attention elsewhere. Mothers of people with serious mental illness told of their inability to get care for loved ones. Dr. Fuller Torrey told of SAMHSA commissioning a $22,500 painting that sits in SAMHSA’s headquarters. Dr. Sally Satel told the committee of SAMHSA ignoring its own advisory board and refusing to include programs that help the seriously ill in SAMHSA’s registry of effective programs. Mental Illness Policy Org. has documented SAMHSA diverting block grants away from people with serious mental illness and even funding antipsychiatry, thereby making it more difficult for the most seriously ill to get life saving and violence preventing treatments.

In 2013, to fix SAMHSA, and focus the nation’s attention on the most seriously mentally ill, Rep. Murphy, along with 115 bipartisan cosponsors, including Rep. Eddie-Bernice Johnson (D. TX), a former head of psychiatric nursing at a V.A. hospital and member of the Congressional Black Caucus, introduced the Helping Families in Mental Health Crisis Act. It will soon be reintroduced. The bill would remove responsibility for executing mental health policy from SAMHSA and place it with an Assistant Secretary for Mental Health. SAMHSA programs that are ineffective would be eliminated and those worth preserving transferred to more effective and efficient agencies like the National Institute of Mental Health (NIMH), Centers for Disease Control (CDC), Department of Justice (DOJ) and others.

The sole opposition to this reform comes from an expected quarter: those who receive funds from SAMHSA. They want SAMHSA’s budget increased. But this new survey of employees clearly shows lack of money is not the problem at SAMHSA, lack of leadership is. Passing the Helping Families in Mental Health Crisis Act won’t solve every problem in Americas mental health system, but it will go a long way towards fixing SAMHSA.

DJ Jaffe is executive director of Mental Illness Policy Org. and author of the upcoming  book, How the Mental Health Industry Kills the Seriously Mentally Ill: A Handbook for Change.