Breaking News: In January, 2018, Assist. Sec. of Mental Health Dr. Elinore McCance-Katz thankfully disbanded SAMHSA’s registry of so-called evidenced-based programs. Our op-ed in The Hill explains why we support this decision. Dr. Mcance-Katz statement is here.
SAMHSA Suffers from Mission Creep
Former SAMHSA Chief Medical Officer exposé of SAMHSA
The Substance Abuse and Mental Health Services Administration (SAMHSA) was created by Congress to “reduce the impact of…mental illness on America’s communities.” And Congress directed it “to target … mental health services to the people most in need”. SAMHSA has failed to do either.
SAMHSA does not focus on meaningful metrics like reducing rates of violence, incarceration, hospitalization, homelessness and suicide. Instead, SAMHSA focuses on soft outcomes like ‘feeling of empowerment’ and ‘hopefulness.’
SAMHSA ignores the 4% of adults with serious mental illness. Instead, SAMHSA focuses on “improving mental wellness” for all Americans.
Some Examples of SAMHSA Mismanagement
SAMHSA supports and funds groups that don’t believe mental illness exists.
SAMHSA’s Guide to Mental Illness Awareness Week suggests schools invite the following organizations into classrooms to teach students about mental illness:
- Mindfreedom: “There is not conclusive evidence or consensus that mental illness exists”
- The Icarus Project: Had a statement on their website (recently removed), that “We believe these experiences (commonly diagnosed and labeled as psychiatric conditions) are mad gifts needing cultivation and care, rather than diseases or disorders.”
- National Coalition for Mental Health Recovery: “NCMHR holds that psychiatric labeling is a pseudoscientific practice of limited value in helping people recover.”
SAMHSA certifies programs as being evidence based even when they do not help seriously mentally ill and/or lack evidence.
SAMHSA funds groups lobbying to prevent mentally ill from being treated until after they become ‘danger to self or others’
SAMHSA’s 600 person staff only includes one medical doctor specializing in mental illness.
SAMHSA encourages states to spend a portion of their $2 billion in block grants on preventing mental illness when we do not know how to prevent mental illness.
SAMHSA wastes money on make-work projects and useless publications.
SAMHSA’s Protection and Advocacy for Individuals with Mental Illness program (PAIMI/P&A) lobbies to get mentally ill who need hospital care out of hospitals and treatment.
SAMHSA refuses to support evidence based programs that do reduce violence, incarceration, hospitalization and homelessness like Assisted Outpatient Treatment and hospitals.
The Oversight and Investigations subcommittee of the Energy and Commerce Committee held hearings on SAMHSA and ordered a GAO report that found SAMHSA fails to coordinate activities. The former SAMHSA administrator testified that SAMHSA deserves an “A.”
Congress passed The 21st Century Cures Act creating an Assistant Secretary of Mental Health to oversee SAMHSA. The President should appoint a doctor who wants to focus SAMHSA on serious mental illness or someone from law enforcement like a judge, sheriff or police chief to that position. NIMH had similar mission-creep problems prior to the arrival of Dr. Thomas Insel, but he was able to refocus the agency back to serious mental illness.
If that doesn’t work, Congress should consider eliminating the agency and placing any mental illness programs worth preserving within other agencies with greater dedication to improving the lives of people with serious mental illness. Ex. NIMH, CDC, DOJ, NIDA, etc.
SAMHSA Fact Sheets
Exposé by former Chief Medical Officer
Overview of how SAMHSA fails (PDF)
Created make-work definition of ‘recovery’
Refuses to exercise oversight of PAIMI (P&A)
Diverts mental health block grants
SAMHSA spends $200K on party (Tom Coburn)
SAMHSA Certifies Programs that are Not Evidence Based
1/2018 SAMHSA eliminates unscientific National Registry of Evidence Based Practices and Programs (NREPP) so it can be replaced with science based evaluations
- 1/2018 Our op-ed in The Hill supporting decision to eliminate NREPP
- 1/2018 Asst. Sec. of Mental Health and Substance Use Disorders explains decision
- 1/2018 Journal article explains the lack of science in SAMHSA evaluations
Problems in NREPP prior to it’s elimination:
- SAMHSA does not require programs to be ‘evidence-based’ or to help people with serious mental illness. Less than five are for serious mental illness.
- SAMHSA only measures soft outcomes (‘satisfaction’, ‘feeling of wellness’, ’empowerment’), not meaningful outcomes (reducing violence, arrest, incarceration, suicide, homelessness and hospitalization).
- SAMHSA uses non-independent data that comes from the the creators of the programs
Because states rely on SAMHSA certifications, they are funding programs that lack of evidence.
- WRAP (Wellness Recovery Action Plan) claims to improve wellness. But SAMHSA relied on studies by those who sell the program.
- Teen Screen There is no evidence it reduces suicides, but as a result of SAMHSA certification, it is used in 47 states.
- Kognito At-Risk for College Students claims to help students identify and refer students in ‘psychological distress.’ There is no evidence it works.
- Mental Health First Aid (MHFA) claims to teach people to identify individuals so asymptomatic, others can not identify them. The program makes those trained feel better, but there is no evidence it helps people with mental illness.
SAMHSA Doesn’t Certify Programs That Do Work
Following are some programs with good results that SAMHSA resists certifying.
- Assisted Outpatient Treatment has had stellar results in helping people with serious mental illness avoid homelessness, violence, arrest, incarceration and hospitalization. DOJ certified AOT as an effective crime prevention program and so has AHRQ. There were numerous attempts by families of people with mental illness to bring AOT to SAMHSA’s attention and SAMHSA’s own stakeholders voted for SAMHSA to evaluate AOT. They ignored it until pressure was too much, and then immediately put it in the bin of ‘legacy’ (old) programs so it would not show up on their website. Congress forced SAMHSA to give AOT grants for it as part of the “DocFix” bill and 21st Century Cures Act.
- SAMHSA hasn’t certified Mental Health Courts as an evidence based program. Mental health courts help the seriously ill avoid incarceration.
- SAMHSA hasn’t certify Crisis Intervention Training (CIT) for police as an evidence based program. CIT Training helps people with serious mental illness avoid arrest or injury in altercations with law enforcement.
Media Reports and op-eds
SAMHSA Needs New Leader (Oklahoman 2/2017)
SAMHSA Strategic Plan Fails Seriously Ill (Summergrad, Psych News)
Chief Medical Officer Quits in Disgust (McCance-Katz Psych Times 4/16)
Drain the Swamp at SAMHSA (Pittsburgh Gazette 12/16)
Stop the Madness (Real Clear Health 12/2016)
Employees Say SAMHSA Failing (National Review 4/15)
Bungling the Job on Mental Illness (WSJ 3/15)
Problems at SAMHSA (WSJ 3/14)
SAMHSA Fails to Lead on Mental Health (National Review)
“Counterproductive Craziness at Federal Agency” (Washington Times 9/11)
“Mental Illness, Homicide & SAMHSA “(National Review)
SAMHSA Slammed by Congress…And for Good Reason (Huffington Post)
SAMHSA is Worst Government Agency (Video)
Supercommittee: Eliminate SAMHSA (Huffington Post)
Let’s Learn from Failure of US Policies (Huffington Post)
More: See Federal Page on Helping Families in MH Crisis Act
The House Subcommittee on Oversight and Investigations of the House Energy and Commerce Committee held hearings on SAMHSA.
Video of Hearing
Rep. Tim Murphy (opening statement)
Dr. Fuller Torrey (testimony on leadership)
Dr. Sally Satel (testimony on NREPP)
Joe Bruce (testimony on PAIMI)
GAO Report: SAMHSA Fails To Coordinate Care
2017 SAMHSA Budget Justification
SAMHSA 2015-2018 Strategic Plan
SAMHSA 2011-2014 Strategic Plan
Specifying Mental Health Block Grants are for “Serious Mental Illness”
SAMHSA “Worst Place to Work” Report (2016)
CMHS make-work Process to Define “Recovery” (2011)
CMHS Revises Definition of Recovery (2012)
National Registry of Evidence Based Programs and Practices (NREPP)
2015 Mental Health Block Grant Application
2013 Mental Health Block Grant Application
- “SAMHSA’s strategic plan entitled “Leading Change” focuses exclusively on “behavioral” and “emotional” health and doesn’t mention schizophrenia or bipolar disorder.
- SAMHSA funds groups working to ensure people with serious mental illness do not receive treatment until after they become danger to self or others.
- SAMHSA won’t exercise oversight of Protection and Advocacy Program. PAIMI lawyers got Joe and Amy Bruce’s son Willy released from the hospital over their objection. Two months later Willy killed Amy with a hatchet.
- SAMHSA spent over a year creating a 1,000 word definition of “recovery” rather than using the three word dictionary definition (‘return to health).
- SAMHSA created an extensive make-work process to define “trauma” rather than using a dictionary.
- SAMHSA wastes money publishing children’s books including A Day in the Park, brochures on Making and Keeping Friends and Building Self-esteem, marketing stickers saying, “I am cool” and “I listen well,” acquiring art-work, producing plays, and creating video games.
- SAMHSA distributes $500 million in mental health block grants to the states and insists states spend some on prevention in spite of the fact there is no known way to prevent serious mental illnesses.
Answers to SAMHSA supported myths
About psychiatry vs. antipsychiatry
About Mental Illness Awareness Week
About P&A (PAMII/PAIMI/Disability Rights) lawyers
About Robert Whitaker and Mad in America
Available in all formats at Amazon and Barnes and Noble
Issues SAMHSA Should Focus On
Implementing Assisted Outpatient Treatment (AOT)
Increasing number of hospital beds
Decreasing reliance on police and sheriffs
Medical model, not recovery model
Mental ‘illness,’ not ‘health’
Freeing parents of HIPAA Handcuffs (PDF)
Media in support of bills to fix SAMHSA
Wall Street Journal
National Review – Jaffe
Observer Reporter (PA)
Daily Journal (CA) – Chip Higgins
Union Trbune (CA) – Jaffe
Timeless Editorials and Opeds
Rational Commitment Laws (DJ Jaffe/Rael Isaac)
Involuntary Treatment Saves Lives (Jaffe)
Huffington Post on Mental Illness
Mental Illness and Violence(DJ Jaffe/Sally Satel)
Huffington Post Blogs(DJ Jaffe)
Not Guilty By Reason of Insanity (DJ Jaffe)
Medicaid Prevents Mental Health Care (Jaffe/Zdanowicz)
Russel Weston & Civil Liberties (Beth Barber)
Unfit to stand trial (Torrey/Zdanowicz)
Beds Deter Dangerousness (Lieberman)
Not everyone recovers (Mary Zdanowicz)
From Asylum to cell (Sally Satel)
- Congressman Tim Murphy on Failures of SAMHSA – Statement | PDF
- Helping Families in Mental Health Crisis Act (Text-2013 Version) | PDF
- House Hearing on SAMHSA – Committee Background Memo | PDF
- Joe Bruce: How Fed. Protection and Advocacy Program Killed My Wife – Testimony | PDF
- Kognito At-Risk for Lacks Evidence SAMHSA Still Certified It
- Mental Health First Aid (MHFA) Liked by Trainers & Trained, but Does NOT Help Mentally Ill.
- NCMHR Position Statement on Alternatives to Force and Coercion in Mental Health Treatment | PDF
- Problems at SAMHSA: Executive Summary | PDF
- SAMHSA “Recovery Model” Drives Services Away From the Most Seriously Mentally Ill
- SAMHSA Diverts Mental Health Block Grants from Seriously Mentally Ill – Documentation | PDF
- SAMHSA Fails the Seriously Mentally Ill – Short Discussion Paper
- SAMHSA Fails to lead National Dialogue on Mental Health – Torrey/Jaffe Oped
- SAMHSA Failure to Help Severely Mentally Ill – Testimony of Dr. E. Fuller Torrey | PDF
- SAMHSA has Unqualified Leadership
- SAMHSA Mental Illness Awareness Week Guide | PDF
- SAMHSA Minimizes role of Serious Mental illness in Causing Violence – Analysis
- SAMHSA minimizes violence in mentally ill | PDF
- SAMHSA Recovery Model Wastes Money and Drives Services From Seriously mentally Ill | PDF
- SAMHSA Response to Congressional Questions | PDF
- SAMHSA Supports Antipsychiatry and Groups that Lobby Against Treatment (Draft Analysis) | PDF
- SAMHSA Undermines Treatment of Mentally Ill – Wall Street Journal Editorial
- SAMHSA Wastes $200,000 on Party
- SAMHSA Wrong on Stigma
- Teen Screen Lacks Evidence, Yet Widely Used and SAMHSA Certified
- Wellness Recovery Action Plan (WRAP) not Independently Proven to Help Mentally Ill, Yet Widely Used and Certified by SAMHSA
- Why SAMHSA Fails Seriously Mentally Ill – Testimony of Dr. Sally Satel | PDF