In a rational world, the real needs of the mentally ill would be identified and addressed in an efficient and cost effective way. Those who need care would receive it. Those who don’t, wouldn’t. The national research portfolio would prudently balance studies aimed at practical solutions to urgent, current problems with those that promise home runs, but only in the remote future.
Unfortunately, policy in the US is based mostly on profit, political power, and ideology- thus producing terrible outcomes that are anything but rational.
Here is a summary of the power players and the aggregate mess they cause:
1) The overtreatment of the worried well is promoted by Pharma, insurance companies, mental health professionals, primary care doctors, patients, and politicians.
Pharma by massive misleading marketing. Insurance companies by requiring premature diagnosis as a requirement of reimbursement. Mental health professionals by cherry picking the easy patients. Primary care docs by careless and excessive prescription of 80% of all psychiatric drugs. Patients by wanting a quick medication fix for the problems of everyday life. And politicians by pandering to all of the above in an effort to gain money and votes.
2) The neglect of the really sick is promoted by state governments, federal agencies, mental health professionals. and anti-psychiatry patient advocacy groups.
"We are the richest nation in the history of the world and yet we provide the worst care ever conceived for the severely ill who most need it."
-Allen Frances, MD
State governments by attempting to cut costs by underfunding and privatizing appropriate community treatment and housing. Meanwhile, they foolishly overspend much more money on prison beds for the 350,000 mentally ill who wind up getting locked up inappropriately for nuisance crimes avoidable had treatment been available. Federal agencies by shirking their responsibility to the really sick and instead diverting scarce funding and attention to appealing but ineffective prevention and wellness programs. Mental health professionals and associations by preferring to cater to the large group of the nearly well and avoiding advocacy for the small group of the really ill. Consumer advocacy groups dominated by former patients understandably resentful of psychiatric treatment they found harmful or unhelpful by fighting against all use of psychiatric medicine and involuntary treatment—even for those much sicker than they who desperately require such help lest they wind up in prison, homeless, or harming themselves or others.
3) Research efforts provide no help for the currently ill because they are funded either by the NIMH or Pharma—neither of which has much interest in their welfare.