The editorial board of The Washington Post has endorsed the Helping Families in Mental Health Crisis Act introduced by Rep. Tim Murphy (R-PA) the only psychologist serving in the U.S. Congress. In doing so, the newspaper takes a stand in a controversy that has split the mental health community in predictable ways.
The Post editorial writers noted:
The Helping Families in Mental Health Crisis Act is more comprehensive than other recent efforts to reform the system and perhaps has the brightest prospects in a divided Congress. The bill would reorganize the billions the federal government pours into mental health services, prioritizing initiatives backed by solid evidence and tracking their success . It would change the way Medicaid pays — or, in this case, underpays — for certain mental health treatments. It would fund mental health clinics that meet certain medical standards. And it would push states to adopt policies that allow judges to order some severely mentally ill people to undergo treatment.
Not everyone is satisfied. Some patients’ advocates have condemned Mr. Murphy’s approach as coercive and harmful to those who need help. The government should not be expanding the system’s capability to hospitalize or impose treatment on those going through severe episodes, they say. It should instead be investing in community care that heads off the need for more serious treatment.
We do not see those aims as mutually exclusive, and neither do the bill’s backers. It makes obvious sense for the government to back community-based clinics that promise to prevent individuals’ mental illnesses from spiraling out of control, when possible. But some people with very severe disorders do not know or do not admit that they are sick. For a small class who will not accept treatment between hospital visits or repeat arrests, states have good reason to require them to accept care, under judicial supervision.
Mental Health America’s interim director, David Shern, criticized the bill during a recent hearing. Before retiring, Michael Fitzpatrick, the former director of the National Alliance on Mental Illness went on record saying NAMI supported the bill’s passage. However, the president of the NAMI board, Keris Myrick, was more cautious when talking recently to The New York Times.
The New York Times quoted her saying:
“It’s the most comprehensive mental health bill we’ve seen in a long, long time, and that in itself is an accomplishment,” said Keris Myrick, chief executive of the Project Return Peer Support Network and president of the board of the National Alliance on Mental Illness, which supports some parts of the bill. “I think almost everyone sees things in the bill that are long overdue, but also things they’re very concerned about.”
The Times story gives an excellent break down (click here) of who supports and opposes the bill. The players are pretty predictable. The story notes:
…The bill’s backing for involuntary treatment is highly contentious. It would provide state grants for so-called assisted outpatient treatment programs under which certain mentally ill people with a history of legal or other problems get court-ordered therapy, which in most cases means trying to ensure they take their medication.
The result: more people treated earlier, and more treated against their will.
“This becomes a civil rights issue quickly, and it can drive people away from seeking services when they fear treatment will be forced on them or they’ll be locked up,” said Gina Nikkel, president and chief executive of the Foundation for Excellence in Mental Health Care, which advocates a more holistic, less medication-oriented approach to recovery.
In the last two decades, 45 states have adopted laws allowing compelled treatment in some cases, with varying requirements and levels of enforcement. Kendra’s Law, passed in New York in 1999, is one that researchers have monitored closely. One recent analysis, led by investigators at Duke University, found that since the law was passed, patients were much less likely to land back in the hospital or be arrested. Mental health and Medicaid costs for them dropped by about half.
The feud between mental health advocates is one reason why the Post’s editorial support is significant. The bill contains language that would require states to drop “imminent danger” as a criteria for involuntary commitment in favor of a need for treatment standard — a move that I have long supported. It would bring common sense reforms to HIPAA, create a so-called mental health czar to coordinate the delivery of mental health services throughout federal agencies, and push states to increase the use of Assisted Outpatient Treatment. You can read my take on the bill by clicking here. If you care about mental health, you should let your representative know your views because both sides have mobilized for a major fight.
During my travels, I often meet others who have written books or used their talents to call attention to mental health. Here are three examples.
A new book, entitled You Need Help: A Step-by-Step Plan to Convince a Loved One to Get Counseling, written by Dr. Mark Komrad is now on sale. Dr. Komrad is a Baltimore psychiatrist, author, and on the board Maryland NAMI. He also teaches at John Hopkins and Sheppard Pratt, both premier Baltimore facilities. As the title suggests, his book is a guide for families and loved ones struggling with a troubled relative or friend who needs psychiatric help but doesn’t think they are sick.
Dr. Komrad discussed his book with me in an email exchange.
With a Foreword by former First Lady Rosalyn Carter and cover endorsements from Senator Patrick Kennedy and author/actress Carrie Fisher, the book is a guide for those struggling with a troubled relative or friend to try and convince them to get psychiatric help. Starting with the techniques for successful encouragement and persuasion, the book proceeds through increasing uses of the power inherent in relationships: from working with key allies, to the use of “therapeutic coercion” within a family. In it’s step-by-step approach, the book takes the reader all the way through mobilizing the involuntary evaluation process should that be necessary, including tips to maximize the outcomes of that process based on my 25 years of experience.
As a young girl living in Bangalore, Gayathri was surrounded by the fragrance of jasmine and flickering oil lamps, her family protected by Hindu gods and goddesses. But as she grew older, demons came forth from the dark corners of her idyllic kingdom — the scariest creatures lurking within her.The daughter of a respected Brahmin family, Gayathri began to feel different. “I can hardly eat, sleep or think straight. The only thing I can do is cry unending tears.” Her parents insisted it was all in her head. Because traditional Indian culture had no concept of depression as an illness, no doctor could diagnose and no medicine could heal her mysterious malady.”
Pearl Ji-hyon Park tackles a similar subject with a different twist in her documentary CAN which will be shown by the Manhattan based New York Women In Film and Television organization on Tuesday, April 29th, beginning at 7 p.m. at Anthology Film Archives, 32 Second Avenue at 2nd Street, New York, NY 10003. You can click here for details.
Park spent nearly four years following 33-year old Can Truong, a Vietnam war refugee who was among the millions of boat people who fled Vietnam in 1979. Can has been diagnosed with a mental illness.
Over twelve years, Truong tried more than 20 different medications, was hospitalized seven times and underwent 15 electroconvulsive treatments with little success. Fighting despair and suicidal impulses, he embarks on a different kind of healing journey — trying to reconcile cultural differences with his traditional Confucian father and making sense of his childhood wounds.
In an email exchange, Park wrote:
Due to cultural and systemic barriers, Asian Americans utilize mental health services at significantly lower rates than the general US population. Southeast Asian refugees like Truong experience extremely high rates of mental illness (60-80%) due to the traumatic experience of war in their countries of origin. Many Southeast Asians are reluctant to seek psychiatric support for fear of shaming their families.
You can read more about CAN by clicking here. It is a thought provoking film.