WASHINGTON -- In a harsh indictment of America's mental health establishment, two advocacy groups charged yesterday that public programs for people with severe mental illness are a "disaster" that leave 250,000 Americans untreated and languishing in shelters, on the streets and in jails.
The groups said only five states -- Vermont, New Hampshire, Rhode Island, Connecticut and Ohio -- provide even "minimally acceptable" programs for people with serious mental illnesses such as schizophrenia, manic-depressive disorder and severe depression.
Hawaii's programs were the worst, according to the report, while Maryland ranked near the middle of the pack -- criticized for a disjointed array of outpatient programs that leaves many patients untreated because they cannot figure out where to go to get help.
"Even if one's brain is working normally, it is virtually impossible to figure out [in Maryland] who goes where to get what, and to someone with psychosis the system must look completely byzantine," said the report, prepared by the National Alliance for the Mentally Ill and the Public Citizen Health Research Group.
Leaders of the two groups laid much of the blame on psychiatrists, charging that many of them got trained with public funds but then abandoned public programs that serve the poor to begin lucrative private practices.
Meanwhile, they said community mental health centers that receive public funds to provide free or low-cost services to the mentally ill are "an abysmal failure" because they spend little time serving the most troubled patients and much time counseling easier-to-manage patients about stress, anxiety and the difficulties of daily living.
"As long as this country continues to believe that it's all right for large numbers of people with serious mental illness to be on the streets, in jails and shelters, we will be shameful among the nations of the world," Dr. Sidney Wolfe, director of Public Citizen Health Research Group in Washington, said yesterday.
Dr. Fuller Torrey, a psychiatrist with Public Citizen, said many states offering salaries in the neighborhood of $130,000 cannot lure qualified psychiatrists to their hospitals and outpatient programs.
To fill the gap, the groups suggested that states launch pilot programs to train psychologists, physicians' assistants and nurse practitioners to write prescriptions for psychiatric medications -- a privilege given only to psychiatrists.
They also suggested that states require psychiatrists, psychologists and psychiatric social workers to donate one hour a week of work to public programs. Also, the organizations called for withdrawal of federal and state funds from public mental health programs that fail to devote three-quarters of their resources to people with severe mental illness.
Stinging criticism of psychiatrists brought a swift response from the American Psychiatric Association.
"The invectives against psychiatrists do nothing but cloud the greater issue of providing a good 'systems approach' to care," said spokesman John Blamphin, adding that the burden of providing a wide range of services for the mentally ill rests primarily with government.
Mr. Blamphin said recent surveys of the APA's 36,000 members found that 20 percent already work in the public sector while members on average spend 3 1/2 hours a week delivering free care to patients.
Maryland ranked 16th in the assessment by the two groups but " actually landed closer to the middle of the pack because the report assigned the same ranking to groups of states that earned matching scores.
The state's 40 community mental health centers were faulted for devoting only half their time to the most troubled patients, but the report lauded a "client tracking system" in Baltimore that directs confused patients to services.
James Stockdill of the Maryland Mental Hygiene Administration said the assessment of the state was "exaggerated" but contained some truth.