By Taylor Sisk
A national Day of Action was held last Wednesday to encourage opposition to the newly revised and reintroduced “Helping Families in Mental Health Crisis Act,” sponsored by Rep. Tim Murphy, a Republican member of the U.S. House of Representatives from Pennsylvania.
The day was sponsored by the Campaign for Real Change in Mental Health Policy, a coalition of mental health professionals, advocates and others who take issue with a number of the bill’s provisions. The coalition encouraged people to contact their Congressional representatives throughout the day.
Many mental health advocates call the Murphy bill, HR 2646, “well-intentioned but misguided.”
These include Winston-Salem’s Laurie Coker.
Coker, director of the North Carolina Consumer Advocacy, Networking, and Support Organization, said the bill might make legislators feel like they’re “doing something” about addressing the need for better mental health services in the U.S., but that the bill heads in the wrong direction.
Coker and like-minded advocates object to provisions they feel restrict the privacy of people with mental health problems and their ability to determine their own future. They also believe the bill would deprive people of care that directs them toward recovery.
In contrast to traditional mental health care, which has focused on primarily getting people’s mental health issues “under control,” recovery-based care focuses on helping people live full and fulfilling lives while learning to live with their symptoms.
Recovery-based care and treatment is becoming more widely accepted and used nationwide.
Nonetheless, a number of mental health professional and advocacy organizations, including the American Psychological Association and National Alliance on Mental Illness, have endorsed the bill.
In a letter to the bill’s sponsors, the national NAMI office praises “provisions designed to improve the integration of mental health and physical health care in Medicaid, spur early intervention in the treatment of psychosis, improve the use of health information technology in mental health care, and provide resources for suicide prevention.”
A fundamental difference in opinion rests on the fact that the Murphy bill is designed foremost to address the needs of those living with the most severe and persistent mental illnesses while, critics say, failing to address many of the needs of those who have more prevalent issues, such as substance use and depression, and that it limits funding for prevention programs.
‘Hopeful now’
There are, actually, two mental health bills circulating on Capitol Hill: Tim Murphy’s in the House and another in the Senate. The Senate bill was introduced in August by Sens. Bill Cassidy (R-La.) and Chris Murphy (D-Conn.). It contains many of the same provisions as the House bill, and is supported and opposed along similar lines.
Tim Murphy introduced his original bill last summer in response to a succession of mass shootings. The federal government, he wrote at the time, “has never approached serious mental illness as a health-care issue.”
He wrote that what he proposed would be “the most significant overhaul of the nation’s mental-health system since President John F. Kennedy established community mental-health centers 51 years ago.”
Murphy, a child psychologist, said in a recent interview that the “core parts” of his original bill remain in the revised version. “What’s different is how we word such things,” he said.
“I’m far more hopeful now,” Murphy said.
Points of contention
Almost all concerned parties support several provisions in the bill, including funding for law-enforcement training, reauthorization of a program that serves college students with mental health or substance-abuse issues, funding for suicide-prevention programs and expansion of telepsychiatry grant money.
But there are other provisions that most particularly rankle those who advocate for recovery-oriented approaches to care. These include a reduction in funding for, and a ban on lobbying by, Protection and Advocacy for Individuals with Mental Illness programs. These are federally funded programs that advocates for the rights of individuals with psychiatric diagnoses.
Vicki Smith, executive director of Disability Rights North Carolina, said the bill would prevent her organization, and others like it, from advocating for people who face discrimination in housing and employment.
The Murphy bill also would change the Health Information Portability and Accountability Act, or HIPAA, to give physicians and mental health professionals the authority to disclose “protected health information” to family members or other caregivers about a loved one believed to be in a mental health crisis.
The revised bill is less expansive than the original version in what could be disclosed.
Involuntary treatment
The primary bone of contention in the bill is the funding of incentives for states to implement assisted outpatient treatment initiatives.
AOTs allow a court official to order outpatient services as an alternative to institutionalization if it’s deemed that the person’s mental illness is leading to repeated arrest or hospitalization or to violence. The bill proposes block grants to counties, cities, mental health systems and mental health courts to set up AOT pilot programs.
North Carolina is one of 45 states that have AOT laws in effect.
Many families of people with mental health issues support AOTs, saying they believe it provides their loved one with a level of safety.
Mental health patients’ advocates counter that recovery begins with an assertion of rights and the recognition that with those rights come responsibilities.
Coerced treatment, Coker said, “removes a person’s voice and his will from the equation…. We take away the hope he might otherwise have had which could motivate him to recover”
“This is not sensible.”
The National Disability Leadership Alliance writes that the AOT provision would lead to “an increase in institutional levels of care, rewarding states that rely too heavily on hospitals and promoting needless institutionalization in violation of the ADA and the Olmstead decision.
The alliance believes that money allocated in the bill for AOT programs would be better spent on community services that have been shown to reduce psychiatric hospitalization.
‘Many good things’
The broader argument for most opponents is that the Murphy bill embraces a medical model of mental health care at the expense of other approaches.
“Despite an expressed preference for evidence-based practices,” a statement from the Campaign for Real Change in Mental Health Policy, organizers of the Day of Action, reads, “the bill focuses on a narrow range of interventions to the exclusion of many other interventions that have been shown to be effective.”
Coker cites as examples evidence-based services such as assertive community treatment, integrated treatment for co-occurring disorders and permanent supportive-housing programs.
In the past, Coker said, mental health treatment has been focused on medical interventions, often against the person’s will. She contrasted that with recovery-based treatment that’s based “on a more holistic model that makes mental health care more attractive and welcoming to people so that they choose treatment.”
“This bill is not solutions focused,” she said. “It’s about establishing a process with lots of bureaucratic checks and balances that takes us further from the progress we need to make.”
“I think there are many very good things in the Murphy bill and I would like to see it pass,” said Ann Akland, executive director of NAMI’s Wake County chapter. Akland is also a mother to someone with a serious mental illness.
Akland cites, for example, loosening of the Institutions for Mental Diseases exclusion, which prohibits the use of Medicaid funding of hospitals and nursing homes larger than 16 beds.
She’s also in favor of easing HIPAA restrictions.
“If someone is having a stroke, the hospital will do everything to locate family members,” Akland said. “Why isn’t the same true for mental illness?”
At the same time, she agrees with Coker that the “system is broken, and it needs to be fixed.”
“The Murphy bill probably isn’t perfect,” Akland said, but, she added, it’s “a step in the right direction.”
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