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Wednesday, December 16, 2015

A Bad Bureaucracy

Federal leadership for mental health and mental illness is supposed to rest in the Substance Abuse and Mental Health Services Administration (SAMHSA), a component of the Department of Health and Human Services. With 553 employees and a budget of $3.5 billion, SAMHSA’s official mission is to reduce “the impact of substance abuse and mental illness on America’s communities.”
How well is SAMHSA doing in its mission? The 2015 ranking of the Best Places to Work in the Federal Government, released December 7, provides an answer. This annual survey, administered by the nonprofit and nonpartisan Partnership for Public Service, is based on a questionnaire filled out by 433,300 federal employees in 320 federal agencies. It includes questions such as “considering everything, how satisfied are you with your organization?” Thus, it is a good measure of what federal employees think about their own agency.  This year SAMHSA ranked 317th out of 320 federal agencies. The only agencies that ranked lower were the Secret Service and two other agencies in the notoriously troubled Department of Homeland Security
The dismal rating of this federal agency is not a surprise. The House Subcommittee on Oversight and Investigations held hearings on SAMHSA in 2013, at which time Chairman Tim Murphy (R., Penn.) said that “it’s as if SAMHSA doesn’t believe that serious mental illness exists.” In 2014, the Government Accountability Office issued a scathing indictment of SAMHSA’s role in coordinating federal mental-health efforts, saying that “coordination related to serious mental illness has been largely absent across the federal government.” Despite its official mission, SAMHSA does not employ a single psychiatrist, the last one having exited six months ago in disgust. Pamela Hyde, SAMHSA’s administrator for the last six years, recently resigned, but the agency’s problems go much deeper than having the wrong person at the top.