Opinion: CARE for Mental Illness

In april, nih released Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE), a study to guide treatment choices in schizophrenia, which found that 19 percent of schizophrenics studied had experienced a violent episode over the prior six-month period. One of the hallmarks of such behavior is treatment non-compliance. The CATIE study demonstrates that improved compliance improves outcomes. Remarkably, there is not even the semblance of a national policy to address this issue.

Mark Senak

Imagine, at the beginning of the AIDS epidemic, if infected people were put into jails when they exhibited symptoms of the disease in public. Once in jail, they were cut off from their medications and lost their Medicaid and Medicare benefits. Upon discharge from jail, no one bothered to hook them up with their benefits again.

Fortunately, in the case of AIDS, that did not happen. Instead, Congress passed the Ryan White CARE Act, a law that became the backbone of support for people in the United States with AIDS. Under the act, block grants are made to states, which then use the funding for AIDS prevention and treatment services. States finance support systems that fill gaps in healthcare coverage and subsidize access for those with low incomes to life-saving medications.

According to the US Department of Justice, 16 percent of people in prison and jail are suffering from a mental illness—nearly three times the rate of the general population. When a person who is mentally ill commits a crime, it is often because they have either discontinued much-needed medication or have poor access to care and support, prompting organizations like the Treatment Advocacy Center to promote expanded use of assisted outpatient-treatment programs. Once a patient enters jail, access to entitlement programs, such as Medicaid and Social Security, are interrupted. When discharged from prison, the mentally ill go into a world without medication or medical care or money. If they are lucky, they reconnect and stabilize. If they are not, they often end up back in jail or homeless. While some jails have discharge planners who help prisoners transition back to being patients, most do not.

This neglect also takes a toll on our criminal justice system. The rate of recidivism among the mentally ill is high. Los Angeles County jails, for example, have a 90-percent recidivism rate, with 31 percent of mentally ill recidivists arrested and placed in jail at least 10 times. It is costly, and law enforcement is being asked to do a job for which they are not qualified.

Why not a CARE Act for the mentally ill? In California, there is proposed legislation that would provide funding to develop a pilot program to reinforce access to treatment for mentally ill offenders. That is a step in the right direction, but it should be the subject of a national policy, not a localized effort.

If the federal government provided block grants to the states to support a continuum of care for mental illness, programs like the one proposed in California would take root across the country. Patients who become noncompliant and enter jail would be released under programs that would work to ensure their continued benefits and assisted outpatient treatment.

Further, if systems were set up as "prevention" services, to identify individuals who are at risk and reinforce assisted outpatient treatment, mentally ill people who might have otherwise committed a crime would not.

The Ryan White CARE Act did not come about on its own. Patient groups and the pharma industry were its stewards. Likewise, industry should join with mental health patient groups, law enforcement, and homeless advocates to spearhead a movement that would result in better care for the mentally ill. It truly would demonstrate the value of the pharmaceutical industry at a time when people are so focused on price.

A CARE Act for the mentally ill is not a cure for all of the problems involving psychiatric conditions and crime. However, it is clear that a national policy and federal investment in this area would pay off for regions with jails that are overburdened not with criminal behavior, but mental illness. It is a humane investment, and one that would pay for itself.

Mark Senak is a lawyer at Fleishman-Hillard and the author of EyeonFDA.com. He can be reached at msenak@comcast.net