The National Alliance for the Mentally Ill (NAMI) bills itself as "a grassroots organization of individuals with brain disorders and their family members." The alliance was a prominent participant in last June's White House Conference on Mental Health. Earlier, President Clinton named its executive director, Laurie Flynn, to the National Bioethics Advisory Commission.
But some mental health activists say the Arlington, Virginia-based organization -- which is widely viewed as an independent advocate for the mentally ill, and an influential voice in mental health debates -- is overly influenced by pharmaceutical companies. It's certainly well funded by the industry: According to internal documents obtained by Mother Jones, 18 drug firms gave NAMI a total of $11.72 million between 1996 and mid-1999. These include Janssen ($2.08 million), Novartis ($1.87 million), Pfizer ($1.3 million), Abbott Laboratories ($1.24 million), Wyeth-Ayerst Pharmaceuticals ($658,000), and Bristol-Myers Squibb ($613,505).
NAMI's leading donor is Eli Lilly and Company, maker of Prozac, which gave $2.87 million during that period. In 1999 alone, Lilly will have delivered $1.1 million in quarterly installments, with the lion's share going to help fund NAMI's "Campaign to End Discrimination" against the mentally ill.
In the case of Lilly, at least, "funding" takes more than one form. Jerry Radke, a Lilly executive, is "on loan" to NAMI, working out of the organization's headquarters. Flynn explains the cozy-seeming arrangement by saying, "[Lilly] pays his salary, but he does not report to them, and he is not involved in meetings we have with [them]." She characterizes Radke's role at NAMI as "strategic planning."
As a matter of policy, NAMI does not reveal the amounts of specific donations. But spokesman Bob Carolla acknowledges that the group receives substantial funding from drug firms, who provide "most if not all" of the antidiscrimination campaign's $4 million annual budget. In addition, Carolla told Mother Jones, corporate donations account for $310,000 of NAMI's 1999 core budget of $7.1 million -- with most of that coming from pharmaceutical firms. The rest of the budget, he says, comes from charitable and membership contributions. (Another affiliated program, the NAMI Research Institute, has a budget of $20 million. Focusing on the biological causes of mental illness, it is fully funded by the private Stanley Foundation.)
Janet Foner, a co-coordinator of Support Coalition International, an activist organization of "psychiatric survivors," says NAMI does a good job in some areas, but argues that the group's corporate sponsors help shape its agenda. "They appear to be a completely independent organization, but they parrot the line of the drug companies in saying that drugs are the essential thing."
Many experts believe that the umbrella term "mental illness" embraces a broad array of conditions with equally diverse causes. NAMI spokesman Carolla says the group views mental illness as a disease, like diabetes or Alzheimer's, that can be treated most effectively with medications. "Mental illness is a biologically based brain disorder," he says. "That's not to say that other factors can't affect mental illness, but the core problem is biologically based."
NAMI's critics agree that mental illness can be triggered by biological factors, but point also to environmental causes such as incest, child abuse, family dysfunction, and other traumas. NAMI's approach "reduces human distress to a brain disease, and recovery to taking a pill," says Sally Zinman of the California Network of Mental Health Clients. "Their focus on drugs obscures issues such as housing and income support, vocational training, rehabilitation, and empowerment, all of which play a role in recovery." Furthermore, Zinman argues, Thorazine, Prozac, and other drugs routinely prescribed for the mentally ill can be counterproductive and even harmful.
NAMI's Flynn says her group is "not a captive of any outside industry." But she acknowledges there is at times a "synergy" in goals between NAMI and the drug companies. For example, both favor so-called health care parity laws, which would require insurers to view mental illness as they do other diseases. "[The drug companies] want more and greater markets, and we want access and availability to all scientifically proven treatments. We don't think drugs are everything, but for the vast majority they are important."
Flynn says the Campaign to End Discrimination is funded separately to ensure that drug industry money is not comingled with funds earmarked for NAMI's core budget. Sally Zinman, for her part, says that taking money for any purpose from drug companies -- which have a direct financial stake in the mental health debate -- is at odds with the ideal of independent advocacy. "NAMI is seen by the media as the voice of the mental health community, but the integrity of its work is called into question by its sources of funding," she says.