In Reply: The history of care for people with serious mental illness in the United States has been one of broken promises. Dr. Torrey has done more to expose this shameful history than anyone else. In so doing, he has become a true hero to NAMI members throughout the country. Thus it is surprising that Dr. Torrey would suggest that monies saved by prescribing first-generation rather than second-generation antipsychotic medications would be reinvested into more community mental health services. If this were so, then the dollars saved in recent years through downsizing and closing state hospitals should have translated into more community services. Sadly, this has not happened. Rather, states have taken these dollars and reinvested them in roads, prisons—anything but services for people with serious mental illness.
Dr. Torrey points out that NAMI receives contributions from the pharmaceutical industry. However, this does not mean that NAMI's advocacy agenda is driven by these contributions. NAMI has advocated consistently over many years to protect access to a wide range of treatment and services for people with serious mental illnesses, including antipsychotic medications. This position has solid grounding in science. Antipsychotic medications are not interchangeable. A medication that works for one person may not work for another. Thus, for people with schizophrenia and related disorders, a wide range of medications must be available so that clinicians can make informed choices in partnership with their patients about what works best.
Public education advocates would not argue among themselves about whether to prioritize funding for teachers or textbooks. Advocates for people with serious mental illness should similarly not argue over whether funding for medications or case management should be prioritized. Both are desperately needed.