Response to Dr. E. Fuller Torrey regarding progress in recovery

I write this commentary in response to the recent comment published in National Review from Dr. E. Fuller Torrey. This response is from the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD), the National Association for Rural Mental Health (NARMH), and from me personally.

As my former colleague at the National Institute of Mental Health (NIMH), Dr. Torrey knows that we have been searching for effective interventions and solutions to the problem of serious mental illness for more than six decades. Work in this area extends from NIMH, to the other Institutes in the National Institutes of Health, to the Substance Abuse and Mental Health Services Administration (SAMHSA), and even to the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC).

I am exceptionally pleased to report that significant progress is being made:

Bringing Life: My own research shows that persons with serious mental illness are much more likely to have chronic physical illnesses than other people. Tragically, this research also shows that they die 25 years earlier than others as a result of these chronic illnesses, such as heart disease and diabetes. Wellness initiatives are an exceptionally important effort to confront this issue head-on. Persons with serious mental illness do not want to die in their early 50s; hence, they have embraced wellness efforts with great enthusiasm. National Wellness Week is intended to promote broad national efforts to confront these life threatening diseases. Current national initiatives under the Affordable Care Act to integrate mental health, substance use, and primary care services are another dimension of this ongoing work.

It also is very important to point out that such wellness initiatives are not restricted to the mental health field or to SAMHSA. The US Department of Health and Human Services and CDC endorse and promote wellness efforts. Further, many corporations have undertaken wellness initiatives for their employees and family members. Finally, many individuals engage in wellness activities every day, including running, yoga, and other exercises.

Bringing Recovery:  As Dr. Torrey knows, we did not use the word "recovery" in the mental health field until almost the year 2000. Now, people with schizophrenia and other types of serious mental illness understand that they can engage in an ongoing process of recovery to regain a full life in the community. This is new, very new, and it is exceptionally important. In part, it results from our new understanding that the majority of mental illnesses are due to personal trauma rather than brain disease. SAMHSA has played a very significant role in developing the tools of trauma informed care and recovery. In my own work with the counties, I see the positive effects of this work every day among those with serious mental illness who have been able to regain their lives as productive citizens in the community.

Bringing Hope: More than a quarter century ago, while Dr. Torrey and I were still at NIMH, a middle age person with serious mental illness once told me, "You people have driven hope out of me." That comment has always stuck with me. Today, I would be delighted to tell that person that we have been able to rekindle hope. As we develop the capacity to prevent early death from chronic disease, and as we develop the capacity to provide help on a long-term trajectory to recovery from serious mental illness, then, indeed, one can have hope. Much of the credit for the rekindling of hope is due to the work of SAMHSA over the past two decades.

As Dr. Torrey also knows, we still have many service issues confronting us. These include the need for a capacity to provide early recognition of signs and symptoms before mental illness becomes severe, reducing the stigma of mental illness so that people are willing to seek care when needed, the development of advance directives for use when a person is incapacitated, reducing the prevalence of persons with mental illness in jails and prisons, among others. Addressing these issues will require the very best efforts of SAMHSA, NIMH, and all of the agencies in the US Department of Health and Human Services.

In all of our work, it seems very clear to me that we definitely do not want to go down legislative paths that will undo the wonderful progress that has been made over the past quarter century. That would be quite tragic. Therefore, we oppose the Mental Health Bill introduced by Representative Tim Murphy (R-PA) in its current form. We support the Mental Health Bill introduced by Representative Ron Barber (D-AZ) because it will advance the work described above. We do hope that Representatives Murphy and Barber will work together collaboratively to produce a single piece of legislation that we all can support.

I encourage Dr. Torrey to work collaboratively with me and others to continue to move our field forward. Much can be done in this era of the Affordable Care Act. We hope that Dr. Torrey will join us.

As full disclosure, neither NACBHDD, nor NARMH, nor I receive any funds from SAMHSA or its components.