I’ve long scratched my head at one of the arbitrary political lines drawn in the sand in the world of mental health and mental illness advocacy — “serious mental illness.” (Some people refer to it as “severe mental illness,” but the correct term is “serious.”)
Focusing on this division is a lie. It is a lie told to Congress and to the public with earnest testimonials. But also with little evidence that it represents a valid — or meaningful — scientific distinction.
Ask anyone who’s been living with a mental illness for any length of time — a year or more — and they’ll tell you it can be severe, debilitating, and even life-threatening. I’ve known people who’ve lost their jobs and livelihoods over severe anxiety. Or depression. Or yes, even ADHD. I could tell countless stories of lives ruined, paradise lost, and homes foreclosed upon.
Yet in the upside-down world of mental health — where advocates should largely be on the same page that mental illness can be successfully treated for all — there are those who believe people with mental illness should be divided into two classes. One class of patients — those with serious mental illness (SMI) — should be treated better and with more resources than the other class (those without).
The term appears to originate with the Substance Abuse and Mental Health Services Administration (SAMHSA), based upon the 1992 federal law, the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act. That law requires states to include prevalence rates of serious mental illness in their application for federal funding, so SAMHSA was charged with creating a definition:
“SAMHSA defined SMI as persons aged 18 or older who currently or at any time in the past year have had a diagnosable mental, behavioral, or emotional disorder (excluding developmental and substance use disorders) of sufficient duration to meet diagnostic criteria specified within DSM-IV (APA, 1994) that has resulted in serious functional impairment, which substantially interferes with or limits one or more major life activities.”
Remember, this definition was created in order to serve the purposes of states applying for grant funding — basically, a simple definition meant to fulfill a legal requirement. It was never intended to differentiate between two groups of people with mental illness — those deserving of our attention, and those who are not.
That hasn’t stopped some so-called “experts” and advocacy organizations from trotting out “serious mental illness” to highlight their own political agendas.
All Mental Illness is Serious & Deserves Equal Access to Treatment
I’m sorry, but I don’t fall for these arbitrary distinctions that mean little in the real world. All mental illness — every disorder in the DSM-5 — is “serious” if it’s causing you significant distress and problems in your daily functioning. OCD? Serious. Binge eating? Serious. Depression due to the loss of a loved one? Yes, that too can be serious if it’s been going on for more than a year, and has significantly impaired your life and ability to function.
DJ Jaffe’s latest argument (writing over at the Huffington Post) — that the federal government is diverting millions of treatment dollars into education programs — is patently absurd and easily-proven false. Congress dictates how the public money is divided (mental health treatment, substance abuse treatment, substance abuse prevention) — not non-profit organizations. It’s right there in the law already — a law that Jaffe apparently hopes nobody reads.1
It’s not that we need to stop spending money on education and helping reduce the stigma of mental illness. We simply need more money to replace all of the funding slashed from mental health funding since the 1980s, starting with the Reagan administration. We need someone to bravely step up to the plate and hold states accountable who’ve slashed their own mental health treatment funding (which nearly all states have done in the past 5 years).
What we don’t need are arbitrary distinctions made about those with mental illness, dividing them up like so many cattle. Anyone who’s ever experienced it can tell you: all mental illness is serious business and can significantly impact a person’s life.
We need more mental health treatment funding across the board — not finger-pointing and Balkanization of our mental health advocacy efforts. Sadly HR 3717 does very little to increase funding to states for the treatment of mental illness. It does virtually nothing to increase psychiatric hospital beds in states — one of the primary points DJ Jaffe was making in the opening of his article of what’s needed.2
What’s not needed is scapegoating one set of patients at the expense of another. What’s not needed is cramming forced treatment laws down state’s throats — even if their own citizens don’t want them.
All people with mental illness should be treated equally — as individuals and citizens of these United States, who deserve and should have access to quality treatment, even if they are uninsured.3
Read JD Jaffe’s odd rant about the “nonprofit mental health industry” (whatever that is!): Is the Nonprofit Mental Health Industry Misleading Congress?
- DJ Jaffe is anti-SAMHSA, so it’s no surprise that he supports HR 3717, the bill designed to gut much of SAMHSA and its work with mental illness in America. [↩]
- HR 3717 attempts to address one of the reasons there are so few psychiatric inpatient beds, but I believe largely misses the mark. It may help staunch the decrease in beds, but does little to actually fix the problem of too few beds to begin with. [↩]
- And the right to refuse treatment if they are not a danger to themselves or others. [↩]