MENTAL HEALTH AMERICA AND BAZELON HOPE TO DERAIL REPUBLICAN PLAN
House Democrats will introduce a mental health bill later this week to challenge the Helping Families In Mental Health Crisis Act introduced by Rep. Tim Murphy (R-Pa.) the only psychologist in Congress. Murphy was hoping to get his bill submitted for a vote next month on the House floor and had garnered some 70 cosponsors and editorial support recently from The Washington Post.
Fears that Rep. Murphy’s bill was moving forward and might actually become law alarmed mental health groups that oppose the legislation. Mental Health America, the largest consumer mental health grassroots organizations, and the Bazelon Center for Mental Health Law, which is the non-profit organization that championed the fight for civil rights for persons with mental disorders decades ago and remains an influential legal watchdog for consumers, worked tirelessly behind the scenes against the bill. Gina Nikkel from the Foundation For Excellence in Mental Health Care, an upstart umbrella non-profit group initially launched by author Robert Whitaker and championed by Virgil Stucker of CooperRiiss, also criticized the bill.
Before resigning as president of the National Alliance on Mental Illness, Executive Director Mike Fitzpatrick put NAMI on record as supporting Rep. Murphy’s legislation. That move reportedly caused an uproar among NAMI board members, including complaints from NAMI’s growing consumer membership base who feared the new law would infringe on their civil rights. In a New York Times interview, NAMI Board Chairwoman Keris Myrick was quoted saying: ““I think almost everyone sees things in the bill that are long overdue, but also things they’re very concerned about.”
According to Melissa Attias, a reporter with CQ Roll Call, the Democrats responsible for hurrying the bill into production are Ron Barber of Arizona, Grace F. Napolitano and Doris Matsui, both of California, Diana DeGette of Colorado and Paul Tonko of New York. Attias said the bill has the support of Minority Leader Nancy Pelosi of California.
Rep. Murphy introduced his bill after holding a series of hearings and congressional meetings, including one where I testified. I told Congress that I believed civil rights safeguards were necessary to protect persons with mental illnesses, but I felt the current “dangerous to self or others” standard in civil commitment hearings was impractical and contributed to interactions between individuals, who were clearly having psychological problems, and law enforcement. As I’ve explained many times on this blog, I favor a “need to treatment” stand as is common in Europe with civil rights safeguards.
Rep. Murphy’s bill would require states to adopt a “need for treatment” standard. The Democrat’s bill would not. The Murphy legislation also would modify the HIPAA and FERPA regulations so that parents and other caregivers can have access to medical records even if an individual with a serious mental illness refuses to sign a release after they are admitted into a medical facility. The Democrats’ bill would not.
Those two changes, however, are not what outraged the mental health groups whispering in the Democrats’ ears. Under Rep. Murphy’s bill, state governments which want to use federal block grants would be required to implement Assisted Outpatient Treatment laws that would allow judges to require individuals with a history of repeated hospitalizations and/or violence to accept treatment, including compulsory medication.
Getting AOT laws passed has been a primary objective of the Treatment Advocacy Center whose founder Dr. E. Fuller Torrey’s fingerprints could be found all over the Murphy legislation. During his testimony before Rep. Murphy’s subcommittee last year, Dr. Torrey took aim at one of his favorite targets, the Substance Abuse and Mental Health Services Administration, which he accused of caring more about alcohol and drug addictions and feel good recovery programs than helping persons with serious mental illnesses.
Rep. Murphy’s legislation reflected that criticism. If passed, it would strip $460 million in federal block grants from the SAMHSA and put those monies under the direction of the National Institute of Mental Health where Dr. Torrey and Rep. Murphy say it belongs. Rep. Murphy has asked the General Accounting Office to investigate reports of waste, fraud and abuse at SAMHSA.
In addition to pushing states to increase the use of AOT and stripping SAMHSA of its block grant oversight, Rep. Murphy’s bill would modify the Institutions for Mental Disease (IMD) Exclusion, which was what the federal government used to force states to close large state hospitals. The IMB limits inpatient facilities to 16 beds or less — otherwise they can’t get Medicaid reimbursement. Rep. Murphy’s law would allow for 32 bed facilities and also for Medicaid reimbursement for telemedicine under certain conditions.
Rep. Murphy’s bill also targeted the Protection and Advocacy for Individuals with Mental Illness Program. Because of institutional abuses, Congress created PAIMI to insure that persons housed in state run facilities were not being warehoused, abused, neglected or mistreated. But with the closing of state hospitals, opponents claim P and A attorneys have focused on lobbying against AOT and in finding ways to keep ill individuals from being involuntary commitment or helping them get out of hospitals regardless of their conditions. (For an outrageous example of this read William Bruce’s story.)
A draft of the Democrats’ proposed legislation shows that none of the major changes cited above would be implemented. The only substantive change that the Democrats would keep from Rep. Murphy’s bill is the creation of a so-called Mental Health Czar to oversee and coordinate mental health spending and programs that are currently spread haphazardly through the federal government. The Democrats also would create a National Mental Health Advisory Board to advise the Czar. At least half of the twenty members of that board would be persons who had been diagnosed with a mental illness. One slot would be reserved for a parent or legal guardian of a person with a mental illness.
MHA’s interim director Dr. David Shern didn’t mince words when he testified recently against Rep. Murphy’s legislation on Capitol Hill. Dr. Shern echoed what MHA declared in a press release when the bill was first introduced.
“Mental Health America opposes the elimination of programs at the Substance Abuse and Mental Health Services Administration (SAMHSA) for and by consumers. These are critical supports to ensure that consumers are the catalysts for transforming the mental health and related systems in their state and for making recovery and resiliency the expectation and not the exception.
We are also concerned with the changes in privacy laws that may lead to the erosion of privacy protections—disrupting the patient-provider relationship on a set of health conditions which are still stigmatized and only recently emerging from the shadows.
Mental Health America also rejects the expanded use of involuntary treatment—ignoring the rights of persons with mental health conditions to make decisions concerning their treatment or minimizing the dignity, autonomy and self-determination of persons affected by mental health conditions. We believe that involuntary treatment should only occur as a last resort and should be limited to instances where persons pose a serious risk of physical harm to themselves or others.
Lastly, it is disconcerting that the bill takes steps to unravel the lead public health agency dedicated to mental health and addiction issues through a number of provisions that eliminate key programs, including critical prevention and early intervention supports and services; undermine protection and advocacy for consumers; transfer authority away from SAMHSA; and dismantle key activities within the Department of Health and Human Services.
Rep. Murphy took offense when Dr. Shern acknowledged that he had not read all of Murphy’s bill before attacking it.
Rep. Murphy did not personally react to his Democratic colleagues’ decision to undercut his legislation, but his Chief of Staff Susan Mosychuk issued a statement.
“Chairman Murphy went to great lengths to work with members to fix our broken mental health system but rather than work on a bipartisan effort, Ron Barber teamed up with Nancy Pelosi and Henry Waxman to simply maintain the status quo. The Democrat bill will do nothing to prevent the next Jared Loughner or James Holmes because it does nothing to help those with serious mental illness and continues funding the SAMHSA constituency of legal advocates and anti-psychiatry activists who use taxpayer dollars to force patients out of treatment. Dr. Murphy is advancing real medical solutions; the Democrats are offering a placebo.”
D. J. Jaffe, a protege of Dr. Torrey, and founder of Mental Illness Policy.Org accused the Democrats of stripping the guts from Rep. Murphy’s bill in favor of maintaing the status quo. He specifically chastized the Democrats for their continued support of SAMHSA.
Congress created SAMHSA to “target … mental health services to the people most in need”. SAMHSA fails to focus on the seriously ill and funds programs and groups that make care more difficult. Those groups want to keep their funding. Only four of the 288 programs in the SAMHSA National Registry of Evidence Based Practices are for people with serious mental illness. SAMHSA uses block grant funds to coerce states to replace the medical model with SAMHSA’s recovery model, which requires people self-direct their own care. The most seriously ill, who are psychotic and delusional can not self direct their own care. SAMHSA encourages states to spend on prevention, when there is no way to prevent schizophrenia, bipolar or the other serious mental illnesses. SAMHSA suggests everyone recovers, thereby ignoring those so ill they do not. While accurate diagnosis is key to getting the right treatment, SAMHSA funds 20 Technical Assistance Centers (TAC) and the National Coalition for Mental Health Recovery (NCMHR) which joined the “Occupy Psychiatry” movement by declaring that “psychiatric labeling is a pseudoscientific practice of limited value in helping people recover.” Many NCMHR/TAC leaders do not believe mental illness exists and conduct SAMHSA funded workshops to teach persons with mental illness how to go off treatment. HR 3717 eliminates this nonsense by limiting SAMHSA to funding evidence-based programs and ending their ability to fund anti-medical model advocacy. This has engendered opposition from recipients of SAMHSA funds that do not focus on the seriously mentally ill nor use evidence based practices. This provision of HR 3717 is smart government: replace programs that don’t work with ones that do.
Several of the mental health groups that have been working behind the scenes to thwart Rep. Murphy’s bill receive significant funding from SAMHSA.
Rep. Murphy’s bill moves the block grant from SAMHSA to the Asst Secretary for Mental Health and Substance Use Disorders, and requires the four states without an AOT law to adopt one, and the 27 states without a gravely disabled or “need for treatment” standard to have it. There is a more prominent role in data collection so officials can see if the block grant funds are having an impact on public health (i.e. reduced hospitalization, suicide rates, etc).
On IMD, the legislation allows for Medicaid reimbursement for free-standing psych hospitals provided they have an average-length-of-stay of 30 days (not just a flat increase to 32 beds).