If you are wondering what is happening to Rep. Tim Murphy’s Helping Families in Mental Health Crisis Act, also known as House Resolution 3717, you are not alone.
Here’s the latest.
About two weeks ago, Democrats who oppose the bill sat down with Rep. Murphy and his supporters. That meeting was called after the Energy and Commerce Committee Chairman, Rep. Fred Upton (R-Mich.), privately warned all sides that he wouldn’t move the bill forward unless a “consensus” was reached. If the bill doesn’t get released from Upton’s committee by the end of July, it will die and Rep. Murphy will have to start over when a new legislative year begins.
Several key players were at the sit down, including Rep. Diana DeGette, (D.-Colo.) who is the ranking member of the Energy and Commerce subcommittee on Oversight and Investigations which Rep. Murphy chairs, and Rep. Ron Barber (D- Ariz.) who was wounded during the Tucson mass shooting and who is serving as the Democrats’ front man in blocking Murphy’s bill.
For those of you with short memories, here’s a recap.
Rep. Murphy introduced his legislation after holding a half dozen hearings, including one where I testified about the problems my family experienced when we tried to get my adult son help. His bill would drastically change our mental health care system. Among other things, it would transfer money for mental health programs away from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) into the National Institutes of Mental Health’s coffers, and gut the federal government’s Protection and Advocacy For Persons With Mental Illness Program (PAIMI). It also would require states to adopt a “need for treatment standard” for involuntary commitment (something I favor) rather than requiring dangerousness and also require states to implement Assisted Outpatient Treatment (AOT) programs — a hot button with many consumer groups and civil libertarians.
Groups that opposed those changes didn’t pay much attention to Murphy’s bill nor did they respond when he offered early on to meet with them to hear their concerns. That dismissive attitude changed when Murphy, the only psychologist in Congress, surprised the bill’s opponents by gaining both bipartisan support for his bill and endorsements from such publications as The Washington Post and Wall Street Journal.
The opponents, including Mental Health America, the Bazelon Center for Mental Health Law, and the National Disability Rights Network, along with an assortment of smaller consumer advocacy groups, suddenly took Murphy’s legislation seriously. At that point, they grumbled that Rep. Murphy had stacked the deck against them during his subcommittee hearings by selecting witnesses who were aligned with the views of Dr. E. Fuller Torrey, one of the founders of the Treatment Advocacy Center, which promotes AOT. Dr. Torrey has been a long-time vocal critic of SAMHSA and PAIMI, both of which have been anti-AOT laws if not vocally, passively.
With the support of House Minority Leader Nancy Pelosi (D-Ca.), Rep. Barber introduced legislation aimed at undermining Murphy’s bill. You can put lipstick on a pig, which is what Rep. Barber attempted to do when he appeared recently on the Diane Rehm show on NPR but it is still a pig. He told listeners that he’d drafted his bill to streamline and improve mental health services. That’s nonsense. The bill’s main purpose always was to block Murphy’s bill and maintain the status quo.
Murphy’s supporters reacted by sending letters to the editors of local papers in Barber’s district criticizing him and other elected officials who oppose their bill. They also sought grassroots support. The state legislatures in Louisiana and Michigan both passed resolutions supporting Murphy’s legislation.
That’s what led up to the recent sit down.
I’ve been told the two sides found at least four or five reforms that they agreed needed to be passed. Everyone involved said they wanted to get some sort of mental health bill approved this session. But the meeting ended without a consensus and so far, neither side has blinked.
Are you surprised with this log jammed Congress?
Irony one: both sides insist this is not a partisan or personality driven squabble. It has become both.
Irony two: Earlier this year, Congress approved legislation to fund AOT pilot programs in eight states. President Obama has signed that bill into law and it was endorsed by both Democrats and Republicans. Getting pilot programs authorized and financed is different from requiring states to implement AOT, but several Democrats — who now are opposing Murphy’s bill — signed off on the AOT pilot program. Go figure.
Another interesting twist came this week in San Francisco, a city that prides itself on being liberal and defending civil rights for persons who are different. A campaign by PAIMI funded groups to stop the city from adopting an ordinance that mandates AOT lost by a 9-to-2 vote after the city’s chief of police spoke adamantly about the need to require individuals with severe mental illnesses to receive treatment, if necessary, against their will. That was a major defeat for PAIMI advocates and, I believe, a reflection of a shift in public attitudes. (You can read an editorial about the vote here.)
PAIMI was created in every state in 1986. The PAIMI program was supposed to investigate reports of abuse in state facilities to insure that patients never ended up again in the horrific state mental hospitals of the 1960s. But as more and more of those hospitals began to shut down and consumer groups gained a much louder and stronger voice, PAIMI groups began recasting themselves as “patient advocates” and that soon translated into defending the rights of their clients to do whatever they wished even if it was harmful to their overall health and public safety. Incidents of PAIMI groups defending the rights of clearly psychotic individuals to refuse any sort of treatment became commonplace.
The classic example is a PAIMI attorney for the Maine Disability Rights Center in Augusta who told William Bruce, who had schizophrenia and was hospitalized, exactly what he needed to say in order to be released even though doctors considered the twenty-year old a danger to himself and others. As the Wall Street Journal later reported:
According to medical records, the advocates — none of them physicians — appear to have fought for his right to refuse treatment, to have coached him on how to answer doctors’ questions and to have resisted the medical staff’s efforts to contact his parents.
After Bruce was discharged, he went home and murdered his mother with an axe.
Recently, PAIMI has been filing or threatening to file lawsuits against states that adopt AOT provisions. Because of that, Dr. Torrey and his supporters have been trying to undercut PAIMI funding, which Rep. Murphy’s bill would do. It would reduce the PAIMI program, which is operated by SAMHSA and receives somewhere around $38 million per year, to $5 million.
If all you knew about PAIMI was the Bruce case and its advocacy against AOT, you might agree that PAIMI needs to be cut. But it was a PAIMI funded organization in South Carolina which recently cast a spotlight on how that state was abusing and neglecting persons with mental illnesses who were in jails and prisons. What did that PAIMI expose? Conditions such as the following as reported by The Atlantic Magazine:
James Wilson, a mentally ill man, was kept in solitary confinement for at least 2,491 consecutive days… An intellectually disabled (and schizophrenic) man was abused and neglected, and then left to rot in his own feces and vomit, until he died of a heart attack…Force was used 81 times on a severely mentally ill inmate named James Howard…Some mentally ill inmates were restrained at length in what they called a “crucifix position…Some mentally ill prisoners were “routinely placed” naked “in shower stalls, ‘rec cages’, interview booths, and holding cells for hours and even days at a time.” ..Suicidal prisoners who were supposed to be receiving anti-psychotic medication were not receiving them.
These are not abuses that happened in the 1960s. These are abuses that are happening right now. Who would have exposed these abuses if the state PAIMI organization hadn’t? Who would expose them if PAIMI funding gets cut to a minimum?
What might need to be done with PAIMI is not bankrupt the program but have Congress draw up a clearer mandate about what it should and shouldn’t be doing instead of letting local PAIMI groups decide what their role should be as patient advocates. The same can be said for HIPAA reform. Rep. Murphy’s hearings exposed how HIPAA often is used to keep information from families of persons with mental illnesses. Testimony by my friend, Pat Milam, before Rep. Murphy’s committee showed flaws in HIPAA that prevented Pat from helping his son. (You can read Pat’s story here.) Does this mean that HIPAA needs to be rescinded? No, I want my son to have HIPAA protections. But, as Pat’s testimony revealed, it could use some fine tuning. Changing HIPAA is something the Murphy bill would achieve and something the bill’s opponents appear adamant about not allowing.
Where has the National Alliance on Mental Illness ( NAMI ) been during this debate? Before its former executive director, Mike Fitzpatrick, stepped down, he announced that NAMI supported Murphy’s bill. That did not go over with some board members. Meanwhile, NAMI has chosen to not take a position on Rep. Barber’s bill. For the record, NAMI has endorsed AOT although some consumer members would like that endorsement rescinded.
It will be unfortunate if no legislation emerges from the committee. Opponents of Murphy’s bill might see “no action” as a victory but that view is short sighted. Murphy’s hearings raised legitimate concerns — mostly by parents — that need to be addressed. It is also important to realize that the public is ripe for some sort of legislative act. The Washington Post dedicated nearly three full pages to a story about a family who was unable to help a man who didn’t think he was ill but had become isolated and started acting in ways that suggested he was mentally ill. USA Today also has been publishing stories by Liz Szabo about the need for mental health care reform. These stories reflect a frustration that, if ignored, will simmer and eventually could result in changes that both sides might find objectionable.
This week, Diane Rehm asked guests discussing bills before Congress a question about mental health reform . Only one bothered to answer. Here is what Charlie Cook, editor of the Cook Political Report, said:
Diane, you brought up mental health. And I have his theory, it’s probably simplistic, but that liberals can screw things up and conservatives can screw things up. But if you really want to completely bollocks it up, it takes both. And between the difficulty that ACLU types have made it in terms of getting people institutionalized who need to be institutionalized, and on the conservative side budget cuts, where there just simply aren’t institutions and programs to take care of these people who really shouldn’t be out walking around — between the left and the right, we have a totally dysfunctional system.
Rep. Murphy’s tireless efforts have raised issues that need to be addressed. It’s time for Congress to put aside partisanship and work out a reasonable compromise.