That’s the argument in this provocative City Journal essay by D.J. Jaffe, who says the “skewed priorities” of the state Office of Mental Health are actually preventing the delivery of adequate care to the most seriously mentally ill.

Jaffe warns that we’ll be seeing more violent outbursts by untreated mentally ill persons unless something is done to get OMH’s priorities in order — which might best be accomplished by eliminating the agency and transferring its most vital functions to the state Department of Health.  Although Jaffe is a longtime advocate for the mentally ill, he isn’t simply demanding a bigger appropriation:

The problem isn’t OMH’s budget, which has plenty of money; it’s how the agency spends it. OMH claims that 50 percent of New Yorkers, including everyone from struggling students to dissatisfied spouses, will have a diagnosable mental-health issue during their lifetimes. Under Commissioner Michael Hogan, OMH continues to spend its resources on these people, rather than on the 3 to 9 percent of New Yorkers who, the agency says, are the most severely impaired, suffering from genuinely serious mental illnesses like schizophrenia and bipolar disorder. Of the 700,000 people whom OMH is serving this year, only 3,600 are seriously mentally ill individuals in state hospitals, according to the agency; another 1,876 seriously ill receive treatment in outpatient programs, and perhaps a few hundred thousand others are scattered throughout the system. Who are the remaining hundreds of thousands? Hogan describes them as people who need “hope filled, humanized environments and relationships in which people can grow.”

One reason to be concerned about OMH’s skewed priorities: studies show that when the truly ill receive treatment, they are no more violent than the general population, but when treatment is lacking, their violence rises. Currently, there are twice as many mentally ill people in prison on Riker’s Island as in all OMH-run psychiatric hospitals combined.

For that reason, Jaffe thinks Governor Cuomo’s Savings and Government Efficiency (SAGE) Commission can promote reform of mental health programs by recommending that OMH be folded into Department of Health.  There’s a precedent for this, he says: after New York City eliminated its own overextended mental health agency in the 1990s, shifting its responsibilities to the city Department of Health, “limited resources were then directed to where they were most needed.”

He also makes these recommendations:

• “The state Legislature should establish a definition of serious mental illness that covers no more than 5 percent of the population. The legislature should then require all programs that get OMH money to use at least 60 percent of their funds for that defined population. State and local hospitals that provide care to truly mentally ill patients should have their resources increased, not cut.”
• “OMH’s education budget should be eliminated, since it tends to be wasted on conferences and brochures of dubious quality and utility. The agency’s public-relations budget should likewise be done away with: it’s largely spent justifying needless expenditures and shifting blame when a mentally ill person commits an act of violence.”
• “Rather than merely reporting increases and decreases in categories of spending, [OMH] should provide specific details on the Internet about where every dollar is spent. The agency used to provide statistics on the specific diagnoses of the people it served, but it has abandoned that practice. What we do know is that OMH sends funds to 2,500 nonprofits. Some serve people with serious and persistent mental illness. Many don’t.”
• Make better use of Kendra’s Law, which allows judges to order potentially violent mentally ill people to stay in outpatient treatment. Although OMH’s own study has shown that court-ordered treatment has “dramatically reduced the rates of arrest, incarceration, psychiatric hospitalization, attempted suicide, and violence to others,” Commissioner Hogan prefers to allow Kendra’s Law to expire in 2015 and has opposed closing loopholes that allow involuntarily committed people to be released into the community, Jaffe says.

All of which raises a more general question: how many other government agencies are squandering resources on misplaced priorities, ultimately undermining their core missions?