With Time Running Out, The Fight Escalates: Helping Families in Mental Health Crisis Act

Pennsylvania Republican Tim Murphy  urged his fellow House members on Thursday morning to support and pass H.R. 3717, the Helping Families in Mental Health Crisis Act, before August 1st, when Congress goes on recess.  Although more than one-third of House members have agreed to co-sponsor the bill, it remains stuck in the House Energy and Commerce Committee. That committee’s chairman, Rep. Fred Upton (R-Mich.) reportedly has said he will not release the bill to the House floor for a vote unless a consensus is reached between Murphy and Democrats who introduced their own bill to stop Murphy’s.

In his five minute speech, Murphy said that fifty percent of persons with schizophrenia suffer from a neurological impairment that makes them incapable of understanding they are ill.

We deny people the right to treatment. We deny them the right to get better. How cruel is that?…The federal government sits oblivious to the problem, and in some cases, actually creates barriers to treatment for those who need help the most…We tell families that federal laws prohibit you from knowing why your loved one is in a mental health crisis, and doctors tell the family your son is only a little dangerous right now, but please bring them back when they become truly violent and then they can be treated. How absurd. Can you imagine if we told someone with diabetes, your blood sugar is too low but we are going to wait until you are in diabetic shock before we give you insulin? The doctor would be fired, the hospital would be sued, and we would ensure that it never happens again. Yet, for families in a mental health crisis, this scenario plays out every single day and not a word is spoken about it.

Murphy delivered his speech a few days after opponents of H.R. 3717, issued an ACTION ALERT urging persons diagnosed with mental disorders to lobby against Murphy’s bill. The National Coalition for Mental Health Recovery described Murphy’s legislation as “shockingly regressive” and warned that its passage would “reverse some of the most significant advances of the last 30 years in mental health services and supports.”  The group said it was urging its supporters to contact their representatives between July 21 to August 1.

If any of your Representatives are co-sponsoring, you should respectfully request that they remove their co-sponsorship.

I’ve written before about the hearings that Murphy’s subcommittee held before he drafted his bill. I testified at one public forum in favor of adopting a “need for treatment standard” rather than using “dangerousness” as a criteria for involuntary commitment.

While my call for a more realistic standard puts me at odds with the bills’ opponents,  it is only one — and arguably not the main issue — they oppose.

Murphy’s bill would encourage states to expand the use of Assisted Outpatient Commitment, it would transfer control of federal mental health dollars away from the Substance Abuse and Mental Health Services Administration into the National Institute of Mental Health, and it would gut the government’s  Protection and Advocacy For Persons With Mental Illness Program (PAIMI). Opponents object to all of those changes.

While the National Coalition for Mental Health Recovery is leading the most recent lobbying effort against Murphy’s bill, it is hardly alone. Others fighting the bill include:  The National Empowerment Center, state PAIMI groups, the Bazelon Center for Mental Health Law, Mental Health America and The National Disability Rights Network.  These consumer advocacy groups endorse  “self determination” for individuals with mental disorders and generally oppose all  forms of required treatment no matter how psychotic an individual might be.

For the mental health groups cited above this is more than a philosophical debate. All of them receive federal funds either directly or indirectly from SAMHSA and losing those tax dollars would greatly weaken and threaten their advocacy efforts.

Murphy has gathered his own supporters, as well as, editorial endorsements from The Washington Post, Wall Street Journal and other prominent newspapers. His strongest supporter in the mental health community has been the Treatment Advocacy Center, which was founded by long-time SAMHSA critic, Dr. E. Fuller Torrey, specifically to push for adoption of AOT laws and “reduce barriers” to treatment.  Torrey’s protege, D.J. Jaffe, founder of Mental Illness Policy.Org., also has vigorously endorsed H.R. 3717. Both men testified in favor of the legislation at congressional hearings. Neither TAC nor Jaffe’s group accepts SAMHSA funds.

It is difficult to determine exactly how many individuals these groups represent.

The National Alliance on Mental Illness is widely acknowledged to be the largest grassroots mental health advocacy group in the country with several hundred thousand members and chapters in every state. NAMI is on the record supporting AOT legislation and before its former executive director resigned last year, he testified at one of Murphy’s public forums and said NAMI favored Murphy’s bill.

However NAMI has not issued any action alerts to counter the bill’s opponents nor has it urged its members in letters or emails to lobby for Murphy’s bill.  Given that Murphy’s legislation was crafted to address complaints by parents and families, NAMI  leadership’s decision to not mobilize its members suggests that its national directors and board are wary of being drawn into a divisive membership fray.

While NAMI was founded by parents, its membeship has expanded in recent years to include more and more consumers and that has lead to a questioning of  the organizations’ traditional viewpoints.

It will be interesting to see if Rep. Murphy’s bill is discussed during NAMI’s  upcoming national convention in Washington D.C. this September.

The American Psychiatric Association gave Murphy two standing ovations when he spoke at a recent conference and also thanked him publicly in a Dec. 12, 2013, letter for introducing legislation “calling for significant reforms to a broken public health delivery system.” But the APA has stopped short of urging its 33,000 members to lobby for Murphy’s bill.

The powerful National Council for Behavioral Health, which represents more than two thousand mental health provider agencies that employ 750,000 workers, endorsed four reforms in Murphy’s bill when he introduced it, but stopped short of supporting the bill’s most controversial changes, saying:

The introduction of the bill is the first step in a long process of discussion, debate, and potential future hearings or votes. The National Council has expressed our desire to work with Congressman Murphy throughout the legislative process to ensure that the bill fully meets the needs of mental health consumers, family members, and providers.

That’s Washington-speak for saying the Council was not going to back a bill that cut SAMHSA funding nor embroil its membership in a fight about AOT and a percieved scaling back of consumer protections.

While Murphy’s supporters would have welcomed a stronger membership lobbying campaign, especially from NAMI, the real obstacle to passage of  their legislation has been House Democrats. House minority leader Nancy Pelosi and California Representative Henry Waxman have reportedly assured opponents  that they will block Murphy’s bill from moving forward this session.

An unconfirmed rumor recently surfaced at the Capitol that Murphy’s supporters  had approached former Rep. Patrick Kennedy, who has become a major voice in mental health reform since leaving Congress, about wooing Democrats to support their side. So far in public, Kennedy has not commented about Murphy’s legislation. Other high profile Democratic advocates, such as Rosalynn Carter, haven’t either.

“While there are parts of Murphy’s bill that are needed, he bit off too much for most of us to swallow,” one insider told me.

Another said, “People are afraid of consumer/survivor groups. They are loud, relentless and often nasty.”

The bill’s opponents see Murphy’s suggested changes as a legal issue. They consider his bill an affront on civil rights. The supporters view the bill as a medical issue.  It would help individuals who are psychotic get  treatment. These clashing views are difficult to reconcile.

Murphy’s floor speech and his opponents Action Alert came during the same week that Connecticut businessman Ted Stanley announced that he was giving $650 million dollars for research aimed at  identifying the genetic underpinnings of mental illnesses. In my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, I describe how the Stanley’s son, Jonathan, suffered a mental breakdown while in college. The Stanleys contacted Dr. Torrey who suggested they begin donating funds to NAMI. The family later decided to move the bulk of its donations to two projects that Torrey helped found: TAC and the Stanley Medical Research Institute. The $650 million donation, the largest ever in mental health giving, will support research through the Stanley Institute in collaboration with MIT and Harvard.

One Murphy supporter sent me an email about  the $650 million donation. “Wish he’d chipped off a few million for lobbying to get Rep. Murphy’s bill passed — or at least enough cash to counter the groups who are  spending OUR tax dollars to oppose the bill and feather their own nests.”

The bills opponents feel confident Murphy’s bill will stay in committee given Pelosi’s and Waxman’s opposition to it and their ongoing lobbying efforts. As his speech indicates, Murphy has not given up and has suggested that he will reintroduce his bill in the next legislative session if it fails to reach the House floor this year.


About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.