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Bush Should Lead the Way

November 17, 2002

In a round-table discussion last April, in a conference center set amid the native pines of the New Mexican desert, President Bush talked with Ohio mental health director Michael Hogan just before naming him to head the nation's first mental health commission in 25 years. "You know, you and I both grew up in the Southwest," Bush said, "where the ethic is, 'You have personal problems? Suck it up.' " Bush related how his attitude changed when he saw antidepressants give a suicidally depressed friend a new lease on life. And that, he said, was part of his decision to create his New Freedom Commission on Mental Health.

Bush that day accurately described the current mental health system as one that lets "many Americans fall through the cracks ... [failing to] confront the hidden suffering of Americans with mental illness ... on the streets ... in our jails, our prisons, our juvenile detention facilities." He asked for a system that "treats mental illness with the same urgency as physical illness."

Hogan's commission got as far as agreeing with the president about how bad the problem is. "America's mental health service delivery system is in shambles," its report said this month. However, repairs are simply off the Washington radar. That's why Bush should spend some of his formidable political capital right away to get beyond hand-wringing to practical solutions. He should:

* Require programs including federal disability, Medicare and Medicaid to focus their spending on what works. The current shambles partly results from the fact that none of these big programs is really focused on mental health -- it's just a sideline to them. And, as Hogan said in an interview with The Times last week, "The current system spends tens of billions of dollars each year 'helping' people once they've hit rock bottom but little on programs with a proven record of helping people get back on their feet."

Hogan cited one model, the Village, which he visited last week in Long Beach. At the Village, professional staff and former "members" help the mentally ill and addicted kick their drug habits, get proper medication and find a place to live and work.

* Back a bill that the late Sen. Paul Wellstone (D-Minn.) co-authored with Sen. Pete V. Domenici (R-N.M.) to outlaw disparities in coverage between mental and physical illness. The House passed a much weaker bill last week, but Bush should push the new Congress for something better early next year. The Wellstone-Domenici bill in its current form covers too many afflictions, not all of which pass a common-sense test as serious ailments. So the White House should work now with Domenici's staff to restrict the measure to serious mental illnesses like schizophrenia and autism.

As anyone in that New Mexico audience would attest, Bush can talk the talk. By backing a strong parity bill and from-the-top reforms in the way federal agencies help the seriously mentally ill, he could walk the walk.

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