Healing the Broken Mind: Transforming America’s Failed Mental Health System

1. Men in Diapers: A System in Shambles

This page intentionally left blank vii Contents Acknowledgements ix List of Abbreviations xi 1 Men in Diapers: A System in Shambles 1 2 That Which Is Measured Improves 35 3 Monopolies Don’t Work 65 4 Fair Is Fair: Parity for Mental Health Coverage 91 5 Let the People Speak 115 6 Transforming America’s Mental Health System 139 Postscript—Information on Mental Illness 165 Notes 167 References 173 Index 181 About the Author 193 This page intentionally left blank ix Acknowledgments I T To o K m e over ten years to write this book, which started out as a series of articles after I stepped down as Virginia’s ninth mental health commissioner. There are many among my friends, family, students, and colleagues whose support and encouragement kept me going, and I apologize that I cannot list everyone here. Nonetheless I am deeply grateful for each one, as without you this book would not have been written. I must begin by thanking Broderick Leaks, doctoral student and DePree Fellow, who worked hard to check references, review drafts, and do anything else that was needed as the manuscript progressed. Likewise, I am grateful to my editor, Jennifer Hammer, who patiently shepherded me from first contact to final manuscript, with many great suggestions for improvements. I also wish to thank Dr. Ron Manderscheid and Charles Currie for their feedback on an early draft, while noting that they are not to blame for any questionable opinions that may reside in this book, since those are mine alone. I could never have completed this book without a boss who, like Max DePree (leadership and management expert; see “Leadership Is an Art” at www.depree.org), believes in providing employees whatever they need to succeed. My heartfelt thanks to Walt Wright and the Max DePree Center for Leadership. I have been privileged to work with hundreds of people over the years who have come to me as a psychologist for help with their mental illness, and it occurs to me that I received more than I gave. I thank each one of you and wish you well from the bottom of my heart. Your trust and honesty , tears and challenges, moved me to become more than I was, even as you grew toward recovery. I hope you will hear the echoes of your voice in these pages, for it is your voice that drove me to write this book. Withouttheloveandsupportofmyfamily,Iwouldstillbewonderingwhat todowithmyinstinctstowardauthorship.Mywife,ClaireKelly,mydaughters, JoAnn Kelly and Christine Maurer, and my son, Patrick Kelly, all deserve a greatportionofanyrecognitionthisbookmaydeserve.Youbelieveinme,and Iinyou,andinthatcontextweareallabletoflourish.SoloGloriaDeo. This page intentionally left blank xi Abbreviations ADA Americans with Disabilities Act ADHD attention deficit/hyperactivity disorder CMHC community mental health center DSM-IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision EAP Employee Assistance Program NAMI National Alliance for the Mentally Ill NOMs national outcome measures OCD obsessive-compulsive disorder PACT Program for Assertive Community Treatment POMS Performance Outcomes Measurement System PTSD post-traumatic stress disorder SAMHSA Substance Abuse and Mental Health Services Administration SSRI selective serotonin reuptake inhibitor This page intentionally left blank 1 1 Men in Diapers A System in Shambles A nation’s greatness is measured by how it treats its weakest members. Mahatma Gandhi America’s mental health service delivery system is in shambles . . . [and] needs dramatic reform. The President’s New Freedom Commission on Mental Health, Interim Report to the President (2002) m e n TA l I l l n e s s c A n be frightening both for those who experience it and for their family and friends, who may try in vain to somehow just make it all go away. It strikes young and old, rich and poor, Democrat and Republican alike. Some of our greatest leaders have experienced it, such as President Lincoln, who struggled with depression. Some of the most talented artists have experienced it, such as Mozart, who is likely to have had bipolar disorder. Some of our most brilliant scientists have experienced it, such as Dr. John Nash, the “Beautiful Mind” mathematician. Nobody is exempt, nobody is somehow “above” being able to become mentally ill. That may be scary, but it should not keep us from figuring out what to do about it. Mental disorders are...