Hippie healthcare policy: while one government agency searches for the cure to mental diseases, another clings to the '60s notion that they don't exist.

• Author: Torrey, E. Fuller

IN 1999, 31-YEAR-OLD JULIE RODRIGUEZ drove her car into the Sacramento River, killing herself and her two toddlers. Rodriguez had been suffering from serious mental illness, including paranoia and psychosis. Her family had tried repeatedly to get her into treatment, but she had refused to go, and California had no law that would enable them to commit her to a hospital against her will.

Rodriguez's story helped prompt the state legislature to do something few states have been willing to do: wrestle publicly with a failing mental health system that is as costly as it is ineffective. As home to an estimated 630,000 severely mentally ill adults, California spends $2.5 billion a year to care for the indigent mentally ill, yet those programs reach no more than half the people who need them. Because they cannot be treated or hospitalized against their will, a scandalously high proportion of the state's mentally ill simply end up homeless or in prisons and jails instead. At least 15 percent of the state prison and jail inmates are severely mentally ill, costing the state $1 billion a year.

Among several pieces of legislation introduced in 2000 to address this growing crisis in California was a bill that would, in extreme cases, allow authorities to treat mentally ill people against their will. More than 60 people testified in support of the bill, including one man whose mother had been murdered by his unmedicated sister with schizophrenia, and it was championed by virtually every major newspaper in the state. Yet, in the end, the bill went nowhere, largely because of a campaign organized by a federally funded advocacy group.

In 1998, the primary federal agency devoted to improving mental health services, the Center for Mental Health Services (CMHS), awarded $200,000 to a group of former mental patients in California whose nonprofit organization is committed to vigorously opposing laws that would make it easier to forcibly treat and commit people like Julie Rodriguez. Strengthened by its federal grant, the California Network of Mental Health Clients organized rallies, hired vans to bring people to Sacramento, distributed T-shirts, and created the erroneous impression that there was widespread opposition to the commitment bill.

Such efforts appeared reasonable in the '60s, when scientists believed that severe mental illnesses were caused by bad mothers and social stresses. Four decades later, however, such views appear anachronistic in the face of overwhelming evidence that severe mental illnesses are brain diseases. Furthermore, research demonstrates that approximately half of all individuals with severe mental illnesses lack awareness of their condition because of damage to the parts of the brain that afford self-awareness. As a result, many severely disturbed people are fundamentally unable to ask for help or seek treatment on their own, making involuntary treatment laws both necessary and humane.

Yet the California group is not the only anti-psychiatry organization to receive federal funding for its reactionary mission. This obscure agency in the U.S. Department of Health and Human Services continues to use its nearly $800 million annual budget to fund mental health programs that largely ignore 30 years of research into the organic nature of mental illness. At its headquarters in Rockville, Md., policy wonks and grant-makers seem to be nostalgic for the days when mental health policy was inspired by Ken Kesey's book One Flew Over the Cuckoo's Nest, in which oppressed patients in a mental hospital revolted against Big Nurse and other symbols of authority.

CMHS's outlook has changed little since the days when libertarian psychiatrist Thomas Szasz asserted that mental illness did not exist, and British psychiatrist Ronald Laing argued that schizophrenia was really a growth experience. At CMHS, mental illness is still a state of mind rather than a neurological illness. Its policies are still driven by a symbiotic political relationship with a movement started in the '60s by a small group of ex-mental patients who called themselves "consumer survivors."

Like Szasz, many of them deny the existence of mental illness and see involuntary treatment as a form of social control rather than medical care. All of them are united in vociferously opposing any form of involuntary hospitalization or treatment, and CMHS has provided millions of dollars to support those efforts. An analysis of CMHS's portfolio suggests that as...