American Psychosis by M. D. Torrey Executive Director E Fuller Read Free Book Online Page A

the funds were so poorly spent. For human services in general, the federal government is too distant to oversee a country of 308 million people.
At the local level, city and county governments had no interest in assuming responsibility for mental health services that had traditionally been a state responsibility. The only exception to this was the few states, such as Iowa and Wisconsin, in which some responsibility for mental health services had traditionally been assigned to the counties. Thus, throughout the United States, beginning in 1963, mental health financing and services developed in a totally unplanned, random way because nobody was in charge and nobody was responsible. Money for the services arrived—and still arrives—under various federal programs such as Medicare, Medicaid, SSI, and SSDI but with neither coordination nor accountability. The tragic consequences are everywhere visible.
It is apparent, then, that the first—and most important—thing that must be done before mental illness services can be improved is to fix responsibility for the services at a specific level of government. The optimum level of government for such responsibility is to be determined. Clearly, such responsibility should not be lodged at the federal level, given the federal failure of the past half-century. Assigning the responsibility to states would seem logical, given that they had such responsibility for over a century. For small and medium-sized states, this may be the optimal level. Large states such as California, Texas, New York, Florida, and Pennsylvania may be too large and populous to administer at the state level, and such states may wish to devolve responsibility to counties or blocks of counties. Even some counties may be too large, however. For example, Los Angeles County has 9.8 million people, more than the population of the 10 smallest states combined, with a million people left over. Administering human services for 9.8 million people in such a county has nothing in common with, for example, Garfield County in Montana, which has 1,184 people in an area approximately the same size as Los Angeles County. Thus, there should be great flexibility among regions in how such programs are administered and how responsibility is assigned. The one absolute given is that responsibility must be assigned.
10. The single biggest problem with the present anarchic system of mental illness services is that nobody is accountable. It will be necessary to assign responsibility to a single level of government, and to then hold such individuals accountable, before any improvement can occur.
    HOW SHOULD MENTAL ILLNESS SERVICES
BE ORGANIZED AND FUNDED?
    How should mental illness services be organized and funded? The short answer to this question is that we do not know. The history of the last half-century has illuminated many organizational and funding mechanisms that do not work. For example, such services should not be organized as mental health services and should not be delivered by for-profit organizations. But beyond such lessons, we have learned very little regarding the best way to organize and fund such services. To find out, we should allow states and counties to experiment with different systems and then carefully assess the outcomes.
Those who are knowledgeable about the organization and funding of mental illness services in European countries often invoke them as models. To be sure, almost every European country does a better job of providing care for mentally ill individuals than does the United States. Services in countries such as Sweden and the Netherlands are significantly superior to anything that can be found in this country, but they cannot be easily imported. The organization and funding of mental illness services in countries such as Sweden and the Netherlands are intimately tied to their broader organization and funding of medical services, and this is fundamentally different from the American system. It should also