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Insane Consequences: How the Mental Health Industry Fails the Mentally Ill
This well-researched and highly critical examination of the state of our mental health system by the industry's most relentless critic presents a new and controversial explanation as to why--in spite of spending $147 billion annually--140,000 seriously mentally ill are homeless, 390,000 are incarcerated, and even educated, tenacious, and caring people can't get treatment for their mentally ill loved ones. DJ Jaffe blames the mental health industry and the government for shunning the 10 million adults who are the most seriously mentally ill--mainly those who suffer from schizophrenia and severe bipolar disorder--and, instead, working to improve "mental wellness" in 43 million others, many of whom are barely symptomatic. Using industry and government documents, scientific journals, and anecdotes from his thirty years of advocacy, Jaffe documents the insane consequences of these industry-driven psychiatric hospitals for the seriously ill are still being closed; involuntary commitment criteria are being narrowed to the point where laws now require violence rather than prevent it; the public is endangered; and the mentally ill and their families are forced to suffer.Insane Consequences proposes smart, compassionate, affordable, and sweeping reforms designed to send the most seriously ill to the head of the line for services rather than to jails, shelters, prisons, and morgues. It lays out a road map to spend less on mental "health" and more on mental "illness"--replace mission creep with mission control and return the mental health system to a focus on the most seriously ill. It is not money that is lacking; it's leadership. This book is a must-read for anyone who works in the mental health industry or cares about the mentally ill, violence, homelessness, incarceration, or public policy.
368 pages, Hardcover
Published April 11, 2017
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April 17, 2022
This is a difficult book for me to review as parts of it shed light on huge issues within the mental health industry but the solutions suggested in the book were nothing less than dangerous.
It’s also difficult to summarize the book as it covers a lot but the basic thesis is that the mental health industry (think major government orgs and non-profits) have pushed aside the “seriously mentally ill” (the book offers a few definitions of “seriously mentally ill”: basically when one’s functioning is severely impaired [which comprises 2-6% of the US population] although the book focuses on those with psychosis). In place of helping the SMI, the mental heath industry concerns itself with the mental well-being of the entire population and those with easily treatable issues (the book constantly uses minor anxiety as an example). Folks with SMI tend to end up in prison/jail or homeless which allows the mental health industry to ignore them. I agree that this is a major problem. As a person with SMI, I know firsthand how the mental health industry treats us. The solutions offered in “Insane Consequences” are Not It however.
It’s hard to boil down all the things I found awful in this book but i’ll highlight a few:
1. The binary between “minor anxiety and other normal human experiences that have been pathologized” and SMI is a false one. The author acknowledges there are blurry lines between any mental unwellness and SMI but focuses entirely on the “extremities” of each. The “seriousness” of mental illness exists on a large spectrum and even bipolar disorder which the author defines as SMI comes in varying degrees.
2. The author argues for HIPAA laws and other civil rights of the mentally ill to be stripped “before they become a danger to themselves or others.” This was my main issue with the book. The author seems to think that all those with SMI also have loving family members who deserve to know all their business without their signature. I shouldn’t have to explain how this can lead to abuse. Additionally, forced treatment (BEFORE expressing any danger) can also lead to abuse. There is already a history in this nation of Black activists being inaccurately diagnosed with schizophrenia in order to try to exert control.
3. The author wants more input from law enforcement and praises the police. At one point even implies the an officer knows more than a psychiatrist in a particular instance.
4. The author no less than mocks trauma as a diagnosis. While acknowledging PTSD as a diagnosis, he says that the modern qualifications/symptoms have been made too mild, saying flashbacks, nightmares, and panic attacks are not as severe as what WWII veterans experienced. This is so offensive to those who struggle with PTSD. Additionally, PTSD is not the only psychological and even diagnosable response to trauma. Trauma can lead to SMI in the form of BPD, DID, etc.
5. The author argues there is a major problem of fraud in the welfare system because of the pathologizing of “normal human experiences.” He offers no evidence of this other than Ronald Reagan cutting welfare after “investigating fraud.” At the same time, he acknowledges that 90% of those with SMI are unemployed and even says most with SMI are “unemployable.” Huh.
6. Speaking of jobs, the author argues that peer support jobs should be cut and that people with SMI need not be at the table in policy. “Insane Consequences” rarely takes into account the opinions of the mentally ill. The author is much more concerned with the feelings of family members and the safety of the public.
7. Speaking of safety, the author cites many studies which prove those with psychosis are more prone to violence than the general population. While true, the author constantly fear mongers with extreme examples such as perpetrators of mass shootings. If 2-6% of the US population were on the edge of becoming serial murderers, I think we’d know.
8. Stigma is an issue and this book says it is not. While I agree it is not the biggest issue facing the SMI, it is a problem and this book contributes to it by painting all those with schizophrenia, bipolar, etc. as on the verge of violent outbursts.
9. While the book acknowledges that the SMI are often imprisoned to take them out of society unfairly, the book also bemoans the closing of state institutions. I should not have to point out the irony here.
10. I had a lot of other issues with the book but those were the highlights.
I would not recommend this book.
It’s also difficult to summarize the book as it covers a lot but the basic thesis is that the mental health industry (think major government orgs and non-profits) have pushed aside the “seriously mentally ill” (the book offers a few definitions of “seriously mentally ill”: basically when one’s functioning is severely impaired [which comprises 2-6% of the US population] although the book focuses on those with psychosis). In place of helping the SMI, the mental heath industry concerns itself with the mental well-being of the entire population and those with easily treatable issues (the book constantly uses minor anxiety as an example). Folks with SMI tend to end up in prison/jail or homeless which allows the mental health industry to ignore them. I agree that this is a major problem. As a person with SMI, I know firsthand how the mental health industry treats us. The solutions offered in “Insane Consequences” are Not It however.
It’s hard to boil down all the things I found awful in this book but i’ll highlight a few:
1. The binary between “minor anxiety and other normal human experiences that have been pathologized” and SMI is a false one. The author acknowledges there are blurry lines between any mental unwellness and SMI but focuses entirely on the “extremities” of each. The “seriousness” of mental illness exists on a large spectrum and even bipolar disorder which the author defines as SMI comes in varying degrees.
2. The author argues for HIPAA laws and other civil rights of the mentally ill to be stripped “before they become a danger to themselves or others.” This was my main issue with the book. The author seems to think that all those with SMI also have loving family members who deserve to know all their business without their signature. I shouldn’t have to explain how this can lead to abuse. Additionally, forced treatment (BEFORE expressing any danger) can also lead to abuse. There is already a history in this nation of Black activists being inaccurately diagnosed with schizophrenia in order to try to exert control.
3. The author wants more input from law enforcement and praises the police. At one point even implies the an officer knows more than a psychiatrist in a particular instance.
4. The author no less than mocks trauma as a diagnosis. While acknowledging PTSD as a diagnosis, he says that the modern qualifications/symptoms have been made too mild, saying flashbacks, nightmares, and panic attacks are not as severe as what WWII veterans experienced. This is so offensive to those who struggle with PTSD. Additionally, PTSD is not the only psychological and even diagnosable response to trauma. Trauma can lead to SMI in the form of BPD, DID, etc.
5. The author argues there is a major problem of fraud in the welfare system because of the pathologizing of “normal human experiences.” He offers no evidence of this other than Ronald Reagan cutting welfare after “investigating fraud.” At the same time, he acknowledges that 90% of those with SMI are unemployed and even says most with SMI are “unemployable.” Huh.
6. Speaking of jobs, the author argues that peer support jobs should be cut and that people with SMI need not be at the table in policy. “Insane Consequences” rarely takes into account the opinions of the mentally ill. The author is much more concerned with the feelings of family members and the safety of the public.
7. Speaking of safety, the author cites many studies which prove those with psychosis are more prone to violence than the general population. While true, the author constantly fear mongers with extreme examples such as perpetrators of mass shootings. If 2-6% of the US population were on the edge of becoming serial murderers, I think we’d know.
8. Stigma is an issue and this book says it is not. While I agree it is not the biggest issue facing the SMI, it is a problem and this book contributes to it by painting all those with schizophrenia, bipolar, etc. as on the verge of violent outbursts.
9. While the book acknowledges that the SMI are often imprisoned to take them out of society unfairly, the book also bemoans the closing of state institutions. I should not have to point out the irony here.
10. I had a lot of other issues with the book but those were the highlights.
I would not recommend this book.
June 21, 2018
As the parent of an adult child with schizophrenia who is disabled by his illness, I found this book to be accurate and validating. The system is broken and even though my husband and I possess advanced degrees and are upper middle class, we have found it nearly impossible to navigate the system. Try finding a psychiatrist first of all. It takes months to get an appointment and most of them don’t take insurance. $300 per session out of pocket. Try getting the insurance you have to cover your child’s meds-nope. Instead we are paying almost $3k a month out of pocket as our savings and dreams of retirement fade. I guess they want him to end up back in the hospital or worse. And on and on.
This quote from the book sums it up well. “The family is the new mental institution. Aging parents try to provide case management, housing and treatment to psychotic and delusional loved ones without the information they need or the authority to enforce compliance. Trying to get treatment for an ill family member takes countless hours, scores of daily calls, callbacks, hours on hold, and visits to facilities, and success is not guaranteed.”
Whether you have an ill family member or not, read this book if you want to see what we as family members are up against. Then, please get involved to help change the system. You never know when these illnesses might strike someone you love. It was certainly never on my radar that one of my children might be so terribly afflicted, threaten to kill himself and his dad and me. Heartbreaking grief every single day for the person he was before he became ill at age 19.
This quote from the book sums it up well. “The family is the new mental institution. Aging parents try to provide case management, housing and treatment to psychotic and delusional loved ones without the information they need or the authority to enforce compliance. Trying to get treatment for an ill family member takes countless hours, scores of daily calls, callbacks, hours on hold, and visits to facilities, and success is not guaranteed.”
Whether you have an ill family member or not, read this book if you want to see what we as family members are up against. Then, please get involved to help change the system. You never know when these illnesses might strike someone you love. It was certainly never on my radar that one of my children might be so terribly afflicted, threaten to kill himself and his dad and me. Heartbreaking grief every single day for the person he was before he became ill at age 19.
March 23, 2017
This is an amazing book. If you are a mental health advocate, you need to read it, now. It details what the mental health system in the United States really is like for those with serious mental illness. This book focuses on the 4% of people who are seriously ill with bipolar, schizophrenia and the like, and skips the issues of the "worried well". I consider myself an educated mental illness advocate and I learned so much. There are real-life stories here that you likely won't read about anywhere else. They may break your heart at times, but they are extremely important to read. The statistics are fascinating and the chapter on solutions is something everyone should read.
DJ Jaffe should be extremely proud of this work. It is unlike anything else and it needs to be read.
DJ Jaffe should be extremely proud of this work. It is unlike anything else and it needs to be read.
January 30, 2024
It’s not often that I finish reading a book out of pure spite, but here I am. What a dangerous, hateful load of tripe.
October 17, 2017
DJ Jaffe tends to have very polarizing views on how mental illness should be approached and often appoints himself as spokesperson for seriously mentally ill. I almost put this book down when he characterized people on disability as high functioning people who game the system so they don't have to work.He is dismissive of efforts to fight stigma saying that prejudice and discrimination should be fought by changing laws the way he says it is for African Americans and gays which made me think he didn't realize the extent to which prejudice has been experienced by any of these groups. He also dismisses peer support efforts though he sings the praises of clubhouses which seem similar in nature. I guess maybe this would be an extreme counterpoint to someone like Robert Whitaker but at this point I wouldn't appoint either to be spokesperson for mentally ill.
January 5, 2019
This book is extremely thought provoking for anyone interested in improving the lives of people that suffer from serious mental illnesses or in learning more about how our mental health system is a blatant failure. DJ Jaffe raises important but harsh criticisms of many mainstream organizations working to improve mental health. Jaffe claims that a shifting focus towards wellness has led to the exclusion of the seriously mentally ill from federally funded and other advocacy orgs and treatment providers. Organizations like the ACLU argue that involuntary civil commitment laws must remain extremely strict. I am a firm believer in civil rights, but what do we do when supposed "respect" for someone's civil liberties now compromise that same person's civil liberties down the line? Our inability to commit those who need treatment against their will essentially guarantees they will end up incarcerated later and remain so LONGER than someone who is not ill. How does incarcerating someone for their illness equate to respecting their civil liberties?
I appreciate Jaffe's book because it is clearly well researched and backed by facts. It also includes recommendations for what should be changed rather than just criticism. However, his approach may be polarizing to some and I found his language a bit harsh at times especially with regard to a recent societal push for wellness and stigma reduction. While my experience is anecdotal I certainly believe that stigma against those who suffer from serious mentally illnesses (including psychotic disorders) face stigma in many areas of their lives.
I appreciate Jaffe's book because it is clearly well researched and backed by facts. It also includes recommendations for what should be changed rather than just criticism. However, his approach may be polarizing to some and I found his language a bit harsh at times especially with regard to a recent societal push for wellness and stigma reduction. While my experience is anecdotal I certainly believe that stigma against those who suffer from serious mentally illnesses (including psychotic disorders) face stigma in many areas of their lives.
January 16, 2026
Jaffe is one of the most passionate advocates for people living with SMI I’ve read. He also has strong clarity of message, and I appreciate the boldness that requires. You can agree or disagree with many of the points he makes (I do) but he argues them well. Agree so much more focus on SMI is needed in the “mental health” space and particularly in where we put funding. Disagree that the importance of housing, freedom from incarceration, etc as baseline outcomes for people living with SMI make softer/more qualitative outcomes like empowerment, agency, etc currently unimportant in program development/funding. However should the lion’s share of funding be focused on the former? Definitely. I need to go back and reread the sections on policy and court cases because I was feeling a little beaten over the head with the message by that point in the book so only skimmed them, but I’m sure they have good info. His treatment of “stigma” as an issue was a really good nuanced take, and I appreciated his reframing of the issue of violence rates among people with ~untreated~ SMI. I did feel like the beginning of the book with mug shots and names of people living with SMI was sensationalist and problematic, let’s focus on the issues not the individuals who were also victims to the broken system he describes.
June 7, 2018
I am a social worker in a psychiatric hospital so my opinions on this may be biased.
Jaffe makes many clear and emotionally driven points about how messed up our mental health care system is. There were many eye opening moments for me. We can thank the deinstitutionalization movement for the current mess we are in. Once many of the state hospitals closed, the most seriously mentally ill had no place to go. Now, the majority of our sickest are stuck in jails or on the streets.
If you're not in the field or know how to navigate the mental health system, this book may be challenging. Additionally, every state has different laws about the treatment of our seriously mentally ill which may make Jaffe's points further confusing.
I could go on a further rant and discussion about what to do, but the bottom line is that if we want to save money and help the seriously mentally ill, we need to provide more supportive housing and affordable treatment to this population. Additionally, we need more psychiatrists and APRNs willing to work in the community with the sickest of the sick.
Jaffe makes many clear and emotionally driven points about how messed up our mental health care system is. There were many eye opening moments for me. We can thank the deinstitutionalization movement for the current mess we are in. Once many of the state hospitals closed, the most seriously mentally ill had no place to go. Now, the majority of our sickest are stuck in jails or on the streets.
If you're not in the field or know how to navigate the mental health system, this book may be challenging. Additionally, every state has different laws about the treatment of our seriously mentally ill which may make Jaffe's points further confusing.
I could go on a further rant and discussion about what to do, but the bottom line is that if we want to save money and help the seriously mentally ill, we need to provide more supportive housing and affordable treatment to this population. Additionally, we need more psychiatrists and APRNs willing to work in the community with the sickest of the sick.
April 27, 2025
No amount of characters can begin to describe how insanely angry I felt reading this book.
We know the system is bad, but to discredit PTSD and other mental illnesses, while suggesting ECT is a solution and forcing people to take medication and dismantle SAMHSA???? Don’t worry buddy everything will work out with trump for the second-oh wait a minute RFK is going to cut medication off for those with mental illnesses including antipsychotics! and state fundings for hospitals and mental health treatment have been slashed? Hmmmm that’s weird and not 100% what I expected when you root for capitalist to run a government😐
We know the system is bad, but to discredit PTSD and other mental illnesses, while suggesting ECT is a solution and forcing people to take medication and dismantle SAMHSA???? Don’t worry buddy everything will work out with trump for the second-oh wait a minute RFK is going to cut medication off for those with mental illnesses including antipsychotics! and state fundings for hospitals and mental health treatment have been slashed? Hmmmm that’s weird and not 100% what I expected when you root for capitalist to run a government😐
July 22, 2025
There is some good inside. Agree with some of the messaging. Not a fan of the author.
December 19, 2017
An excellent book if you want to get furiously angry at someone -- specifically, in this case, at the mental health industry and its supporters. DJ Jaffe's book is extensively documented and well noted, and would be difficult to argue against I suspect. It's a troubling work, as many of the efforts those in government agencies and in civil rights organizations work against the best interest of the seriously mentally ill individual in the name of civil rights. The results are tragic, not just for those individauls, but for those around them.
I highly recommend this book for anyone hoping to understand the real struggle we have in aiding those who suffer from serious mental illness and the various roadblocks put up by the very agencies supposedly raised up to support them. Jaffe is also careful to present solutions at the end, which leaves this work with a bit of hope at the end. If we can reorganize, restructure, and refocus on those that truly need help, then we can change things for the better.
As things stand at the end of the reading of this book, the morass remains. Hopefully many will read this, those in position to effect change and those who can lift up or influence the former. Even the average citizen can do well to understand the issues in this book and how to look for answers and help for those who need it.
I highly recommend this book for anyone hoping to understand the real struggle we have in aiding those who suffer from serious mental illness and the various roadblocks put up by the very agencies supposedly raised up to support them. Jaffe is also careful to present solutions at the end, which leaves this work with a bit of hope at the end. If we can reorganize, restructure, and refocus on those that truly need help, then we can change things for the better.
As things stand at the end of the reading of this book, the morass remains. Hopefully many will read this, those in position to effect change and those who can lift up or influence the former. Even the average citizen can do well to understand the issues in this book and how to look for answers and help for those who need it.
September 1, 2017
This is a must read for anyone concerned with services for those with mental illness. If you are a provider; an advocate; a policy maker; a relative, friend or other significant person in the life of someone with a mental illness you are negligent if you do not read this book. This is a clear headed, fact based assessment of the state of the system of care for those with a mental illness in this country today. It details what works, what doesn't, where money is being wisely spent and wisely misspent, what are the legal and institutional roadblocks to needed care, and provides a road map of where we must go if we hope to ever help those who are most disabled by mental illness disorders.
January 14, 2018
DJ Jaffe knows his stuff and is very passionate with good intentions but his agenda is an extreme one. He has done his research. He exposes much about agencies that are doing a disservice to the seriously mentally ill and although I agree we can do better as an industry this book is very emotionally driven and radical in it's approach. His recommendations for solutions are just to cut all programs completely that he doesn't agree with. Which makes it hard to take him seriously. I certainly agree SMI population needs more of a focus but not to the detriment of milder mental health. There's a need for services for both.
April 19, 2017
Shortlisted and cherry picked info
First the author uses cherry picked info. He appears to be obviously biased as well. Recommendations do not take variables into account. He appears to use emotional language in place of solid information. I am not against all the ideas, but many do not have the critical thinking in place to be taken seriously.
First the author uses cherry picked info. He appears to be obviously biased as well. Recommendations do not take variables into account. He appears to use emotional language in place of solid information. I am not against all the ideas, but many do not have the critical thinking in place to be taken seriously.
January 14, 2018
DJ Jaffe knows his stuff and is very passionate with good intentions but his agenda is an extreme one. He has done his research. He exposes much about agencies that are doing a disservice to the seriously mentally ill and although I agree we can do better as an industry this book is very emotionally driven and radical in it's approach. I also don't agree with some of his views on trauma.
February 26, 2018
This is a well documented book on the state of the mental health care industry in this country and how we got there. This book hits close to home, reading the anecdotes from those who have suffered from not being able to get care for a loved one who is severely mentally ill. One hopes that detailed picture provided in these pages, though sick, sad, and angering, will lead to change.
June 26, 2018
This book describes, in detail, the failure of our government to address the needs of severely and persistently mentally ill people, why jails and prisons all across America have become de-facto, but totally inadequate and inappropriate mental health facilities, and what must be done to reverse this national nightmare. Well researched, it is an eye-opener and a call to action.
May 3, 2020
On its face, Mr. Jaffe's "Insane Consequences: How the Mental Health Industry Fails the Mentally Ill" appears to be a strong indictment of the shortcomings of the mental health industry. The multiple appendixes and notes suggests the book is well researched. The preface sets the stage for the author's bias when he describes the experience with a relative with schizophrenia. Beyond that, Mr. Jaffe uses language that identifies a person's disability before the person. For example, he writes, "Mentally ill John Zawahri wasn't known to be in treatment when he killed five and wounded more in a mass shooting at Santa Monia College" (p. 28). Given that this book was published in 2017, it is surprising that Mr. Jaffe did not use people-first language.
Mr. Jaffe makes a point of distinguishing between "mental illness" and "serious mental illness" in his opening author's notes. Throughout the book, he references several cases of those with mental illness but often obfuscates or omits details. For example, Mr. Jaffe describes Chirlane McCray's struggle to get her daughter (Chiara McCray) into a psychiatrist (p. 39). What he fails to disclose is what Chiara's "serious mental illness" was. On the very next page, Mr. Jaffe shares the story of Laura Pogliano's struggle to get her child, Zac, hospitalized. After outlining the four hearings to get Zac hospitalized, Mr. Jaffee writes, "In spite of her heroic ongoing efforts, on January 18, 2015, Zac was found dead in his room" (p. 40) leading the reader to believe that Zac died while in the hospital. In fact, Zac died of heart failure in his apartment.
Additional examples of the blurring of details include the story of Moshe Pergament. Mr. Jaffe brings up Mr. Pergament while discussing suicide by cop. Writing that Mr. Pergament pointed a toy gun at police resulting in police fire, Mr. Jaffe fails to mention that Mr. Pergament had recently accrued $6,000 in gambling debt, and that suspension of any "mental illness" or "serious mental illness" is missing.
While in the midst of a discussion of anosognosia, Mr. Jaffe writes, "Margaret May Ray ... later took her own life by lying down in front of an oncoming freight train" (p. 73). Multiple sources reported that Ms. Ray did not lay down but rather kneeled in front of the train.
Indeed, these may seem like small details to hone in on; one must recognize that the persuasive narrative of "Insane Consequences" utilizes studies and numbers to drive home the point that our mental health system has failed the less than 10% of the population with severe mental illness. While that may be the case, one must question the authenticity of what is presented when these most basic elements are rooted in error.
Mr. Jaffe makes a point of distinguishing between "mental illness" and "serious mental illness" in his opening author's notes. Throughout the book, he references several cases of those with mental illness but often obfuscates or omits details. For example, Mr. Jaffe describes Chirlane McCray's struggle to get her daughter (Chiara McCray) into a psychiatrist (p. 39). What he fails to disclose is what Chiara's "serious mental illness" was. On the very next page, Mr. Jaffe shares the story of Laura Pogliano's struggle to get her child, Zac, hospitalized. After outlining the four hearings to get Zac hospitalized, Mr. Jaffee writes, "In spite of her heroic ongoing efforts, on January 18, 2015, Zac was found dead in his room" (p. 40) leading the reader to believe that Zac died while in the hospital. In fact, Zac died of heart failure in his apartment.
Additional examples of the blurring of details include the story of Moshe Pergament. Mr. Jaffe brings up Mr. Pergament while discussing suicide by cop. Writing that Mr. Pergament pointed a toy gun at police resulting in police fire, Mr. Jaffe fails to mention that Mr. Pergament had recently accrued $6,000 in gambling debt, and that suspension of any "mental illness" or "serious mental illness" is missing.
While in the midst of a discussion of anosognosia, Mr. Jaffe writes, "Margaret May Ray ... later took her own life by lying down in front of an oncoming freight train" (p. 73). Multiple sources reported that Ms. Ray did not lay down but rather kneeled in front of the train.
Indeed, these may seem like small details to hone in on; one must recognize that the persuasive narrative of "Insane Consequences" utilizes studies and numbers to drive home the point that our mental health system has failed the less than 10% of the population with severe mental illness. While that may be the case, one must question the authenticity of what is presented when these most basic elements are rooted in error.
June 2, 2022
DJ Jaffe has been one of the loudest, and most prescient, writers about mental illness policy. This book demonstrates his usual method, which is to provide every fact and research paper imaginable for the reader, and offer a few appropriate guideposts. Although this can be a little hard to wade through, on the whole one can't finish the book without realizing that our mental illness system has been broken for decades, and that we know the reason too.
Jaffe correctly points out that the severally mentally ill, basically schizophrenics and those with bipolar disorder, and some with severe depression, constitute about 4% of the population at most, but the "mental health" industry has tried to ignore them and focus on vague and massive groups of the "worried well," which they define as 20% of the population. They ignore overwhelming evidence that there is no "identifying" the severally mentally ill before their first episode, and that "prevention" does nothing at all, and that the actually severe mentally ill are 300% more violent than the average citizen. The severally ill harm themselves and they harm others, but every time someone tries to bring attention to this, the mental health industry cries "stigma" and then tries to show that most with bad mental health are fine, in effect ignoring the people who need help the most. Their suicide prevention programs and "awareness" advertisements focus on young adults, when they are among the least likely to commit suicide, and ignore those in jails, mental hospitals and other institutions.
The Substance Abuse and Mental Health Services Administration (SAMSHA) and its Center for Mental Health Services (CMHS) have become a hotbed of this kind of activism. They fund groups like the Citizens Commission on Human Rights and the National Coalition for Mental Health Recovery, as well the Protection and Advocacy for Individuals with Mental Illness program (usually called P&A, created by Congress in 1986) whose entire point is destroy psychiatry and empty more hospitals, despite the desparate need. Despite the 2016 Chris Murphy Mental Health Act requirement to focus on "evidence-based" care, SAMSHAs registry of such programs includes dozens whose only evidence is provided by the company or group administering the program.
I would actually recommend this book as the best first stop for contemporary mental illness policy. It's also a handy chapbook providing a roadmap for reforms.
Jaffe correctly points out that the severally mentally ill, basically schizophrenics and those with bipolar disorder, and some with severe depression, constitute about 4% of the population at most, but the "mental health" industry has tried to ignore them and focus on vague and massive groups of the "worried well," which they define as 20% of the population. They ignore overwhelming evidence that there is no "identifying" the severally mentally ill before their first episode, and that "prevention" does nothing at all, and that the actually severe mentally ill are 300% more violent than the average citizen. The severally ill harm themselves and they harm others, but every time someone tries to bring attention to this, the mental health industry cries "stigma" and then tries to show that most with bad mental health are fine, in effect ignoring the people who need help the most. Their suicide prevention programs and "awareness" advertisements focus on young adults, when they are among the least likely to commit suicide, and ignore those in jails, mental hospitals and other institutions.
The Substance Abuse and Mental Health Services Administration (SAMSHA) and its Center for Mental Health Services (CMHS) have become a hotbed of this kind of activism. They fund groups like the Citizens Commission on Human Rights and the National Coalition for Mental Health Recovery, as well the Protection and Advocacy for Individuals with Mental Illness program (usually called P&A, created by Congress in 1986) whose entire point is destroy psychiatry and empty more hospitals, despite the desparate need. Despite the 2016 Chris Murphy Mental Health Act requirement to focus on "evidence-based" care, SAMSHAs registry of such programs includes dozens whose only evidence is provided by the company or group administering the program.
I would actually recommend this book as the best first stop for contemporary mental illness policy. It's also a handy chapbook providing a roadmap for reforms.
January 5, 2019
Jaffe's tireless advocacy work for patients with serious mental illness and their families cannot be denied - he is a man who puts his beliefs into action. I agree with him on many points, and in particular about the shameful way our society has criminalized those with serious mental illness and effectively moved our most seriously ill patients from hospital settings to jails and prisons, and failing to protect these individuals from the consequences of their untreated illnesses. However I found this book to be poorly organized, and early in the book Jaffe would make his points using evidence he wouldn't explore until much further into the reading. I also found his extreme view that only those with schizophrenia or severe bipolar should be served by our mental health system to be too polarized. While I agree that we instead cater policy to the "worried well" I can also attest that the experience of mental illness lies on a spectrum. If those with somewhat more moderate illness were left untreated they would suffer similar consequences as those with the most severe illness. In spite of Jaffe's insistence that recovery is rare, by arguing that forced treatment limits the consequences of a person's serious mental illness he is acknowledging that treatment indeed works. He seemed to negate his own arguments.
August 12, 2023
I didn't like this book at all. Polemic directed against the mental health industry, focused on cost-saving and compulsory treatment of people with serious psychiatric disability. Nuance be damned as Jaffe rails against the waste and violence, but with little real consideration of the abuses of institutional settings, the deficits of pharmaceutical treatment, and the humanity of the millions living the difficult balancing act of life with serious psychiatric disability. I agree that a better job needs to be done curtailing the violence done by those who are seriously impaired, but I recognize that allowing ourselves to become a fully fascist state is probably not a great idea. Cherry-picks lots of information about violence, employing scare tactics, and amplifying danger presented by people with psychiatric disabilities. Still, useful specifically for his focus on violence and mental illness.
August 1, 2022
Jaffe minces no words, as he should not. The plight of individuals living with serious mental illnesses in the United States remains as tenuous in 2022 as when DJ wrote this book in 2017. The full continuum of care as advocated in this book simply does not exist and the trend to focus on preparing individuals solely for “life in the community” is the mainstay of care plans at locked facilities. As a behavioral health nurse, the issues Jaffe raises need to be heard. It’s clear that his unabashed and abrasive style has the potential to be divisive and alienate, but the time for excuses in the mental health advocacy community is well past. Lives count on us all to get it right and Jaffe intimately understands what some are too reserved or sheltered to acknowledge.
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June 12, 2025It’s hard to find someone inside the mental health industry who doesn’t think that it’s broken – fundamentally broken. This is a central point for Insane Consequences: How the Mental Health Industry Fails the Mentally Ill. It’s a mixture of calls for action to address real problems with the industry – and a set of overblown promises of psychiatric care that aren’t supported by research, science, or even what most would call reason. The trick is navigating between the real need for change and the realization that some of the changes that the book calls for are difficult to support.
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January 18, 2020
This is such an incredibly important topic, but I'm afraid this message won't reach a large audience because of how the book is written. There are a couple of excellent narrative passages, but 95% of the book is straight argument, which becomes tedious to even the most interested reader. It reads more like a report. The evidence presented about the problem is substantial, and again -- it's such an important topic. I wish it had been better written.
August 24, 2020
It's refreshing to read an author who unabashedly advocates for people with serious mental illness and their families, no matter whose toes he steps on. Jaffe backs up his assertions with impressive facts and research. His is a needed voice today when so many well-meaning people are trying to be all things to all people but are paying less attention to those who are the very sickest, those who are homeless, in prisons and jails and in criminal courts rather than the mental health "system."
July 17, 2022
Jaffe provides an interesting, but misguided, perspective to change systemic healthcare for the severe and persistently mentally ill. His primary focus is people living with schizophrenia or bipolar, but he forsakes the nuances of psychiatric treatment, research, and advocacy and makes wild claims that are not backed up by evidence.
October 3, 2022
It's a useful book but could be wo much better if the author didn't use the full name of each acronym for every single entity mentioned. This may only be true of the audiobook but it got to where I wanted to give up because of the redundancy.
July 10, 2023
Phenomenal overview of the mental health crisis in North America ... from deindustrialization to the onset of pharmaceutical hegemony in our times and society's inability to question modern day psychiatry. Sad to hear of the passing of DJ Jaffe.
March 26, 2021
An important book on critical issues. Recommended.
January 7, 2022
Poorly written, extremely biased, and cherry picked information. I’m a PhD student in social work focusing on mental health policy and this is just… bad.
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