Mental Health or Mental Illness: A Policy Concern
In December of 2013, Congressman Timothy Murphy proposed the “Helping Families in Mental Health Crisis Act” (HR 3717). The bill proposes an inherent distinction between “mental health” and “mental illness”. In essence, the bill proposes broad changes to the current mental health system. According to the Huffington Post, Congressman Murphy proposes to initiate an Assistant Secretary for Mental Health. The primary task of the Assistant Secretary is “to reorient the mental health system away from its focus on serving the largest numbers of the highest functioning and back towards providing treatment for the most seriously mentally ill”. Among other changes, the bill proposes to establish block grants for special programs that will target individuals with “serious mental illness” while decreasing funding for “mental health” programs.
While I cannot contend that the current system is optimal, I must bring into question this distinction between “mental health” and “mental illness”. It is unclear where or how this distinction derives. According to HR 3717, an ‘‘individual with a serious mental illness’’ is defined as ‘‘[I]ndividual with a serious mental illness’’ means, with respect to the disclosure to a caregiver of protected health information of an individual, an individual who—
(i) is 18 years of age or older; and
(ii) has, within one year before the date of the disclosure, been evaluated, diagnosed, or treated for a mental, behavioral, or emotional disorder that—
(I) is determined by a physician to be of sufficient duration to meet diagnostic criteria specified within the Diagnostic and Statistical Manual of Mental Disorders; and
(II) Results in functional impairment of the individual that substantially interferes with or limits one or more major life activities of the individual (HR 3717)”.
The concept of “serious mental illness” was introduced by Congressman Murphy in response to the Sandy Hook tragedy. Since the tragedy, political leaders have rumbled about the need for “Gun Control” and sanctions on “Individuals with Serious Mental Illness”. Not long after the rhetoric began, Wayne LaPierre offered some advice, “The only thing that stops a bad guy with a gun is a good guy with a gun”. Given the copious amounts of money expended on gun advocacy and lobbying, the focus shifted from gun control to managing and treating “individuals with serious mental illness”.
What does it mean to have a “Serious Mental Illness”? Throughout the course of Congressman Murphy’s discourse, there has been no clear definition distinguishing “mental illness” from “mental health”. At best, Murphy framed the problem by stating, “[m]ore than 11 million Americans have severe schizophrenia, bipolar disorder, and major depression yet millions are going without treatment and families struggle to find care for loved ones” (Tim Murphy’s website). He concludes with the assertion, “Sadly, patients end up in the criminal justice system or on the streets because services are not available”.
While the notion of mental health covers a vast range of concepts, it is unclear whether mental illness can necessarily be detached from mental health. Given that congressman Murphy’s platform hinged on the Sandy Hook tragedy, the notion of mental illness develops an implicit meaning vis-à-vis criminality.
- Mental illness serves as a sufficient (maybe even a necessary) explanation of criminal or deviant behavior.
- Socially undesirable statuses are therefore labeled as “abnormal”.
The most concerning element involves the notion that such a focus inevitably inflates the amount of mental health problems. The bill proposes to de-fund advocacy programs, mental health awareness programs, and mental health services to reallocate funding to the arbitrarily mandated “serious mental illness” treatment. Assume that medical science operates under this same paradigm. If a person tries to get seek help with health related issues without experiencing symptoms, then that person could have difficulty finding assistance. What could have been possible preventative efforts has the potential to become serious and problematic. In reference to mental health, what is to become of treatment for issues such as grief, mild depression, anxiety which was not included into the categorization of “serious mental illness”?
Therefore, should mental health professionals support such a bill? Due to the lack of public promotion, the bill has not been considered from a multitude of perspectives. My purpose in this recent DxSummit post was to bring some discussion to this distinction.