Democrats Balking At AOT Language In Tim Murphy’s Bill — Will He Compromise?


Photo is from Treatment Advocacy Center’s announcement of Rep. Tim Murphy’s award. Pictured with Dr. E. Fuller Torrey

(6-1-15) The question being asked on Capitol Hill is whether Rep. Tim Murphy (R-Pa.) will drop a requirement in his mental health legislation that would require states to begin using Assisted Outpatient Treatment as a condition of receiving federal mental health dollars.  Under AOT, as it is known, states can require persons with a diagnosed mental illness to take anti-psychotic medication if that medication has proven to help him/her in the past and he/she has a documented history of violence or repeated hospitalizations.

It is a hot button issue for those who oppose forced treatment but is supported by many parents.  It also is one of the main pillars in Murphy’s Helping Families in Mental Health Crisis Act, which had been steamrolling through the House during its last session until Democrats introduced a poison pill bill that kept Murphy’s bill stuck in a committee.

Murphy certainly gave no hints that he was willing to abandon AOT when he appeared May 20th at a Capitol Hill rally that was sponsored by the Treatment Advocacy Center and attended by more than a hundred family advocates.

Passing  AOT laws has always been one of TAC’s top legislative priorities. Murphy also received that group’s highest award — the Torrey Advocacy Commendation — last year. It is named after advocate/psychiatrist Dr. E. Fuller Torrey, one of TAC’s founders, and is given to an individual who has “exhibited courage and tenacity advocating for the right of individuals with severe mental illness to receive treatment even if they are unable to seek it,” according to the TAC website.

Earlier this year, Rep. Murphy announced that he had formed an alliance with Senator Chris Murphy (D-CT) to help push a mental health reform bill through Congress. In a statement issued at the time, Sen. Murphy said his bill would have “some differences” from Rep. Murphy’s but would be “substantially similar.” Both said they would introduce their bills shortly.

But while Rep. Murphy has continued to push for AOT, his senate counterpart called AOT a “nonstarter” according to a recent interview published by The Hill newspaper.

“I think in order to win substantial Democratic support, there’s gonna have to be changes in the parts of the bill relative to court ordered outpatient treatment,” Sen. Murphy said. In a Facebook chat about mental health, he called any provision that would withhold funds from states without involuntary treatment laws a “big issue.”

“Rep. Murphy’s bill requires every state to have laws requiring some form of court ordered outpatient treatment and a lower bar for inpatient commitment. We are trying to find a less draconian way to go, but getting parents and primary caregivers is really important,” he said.

Opponents of AOT interpreted Sen. Murphy’s statements to mean that he opposes AOT.

The two largest mental health organizations are split on AOT. Mental Health America is against it. The National Alliance on Mental Illness is on record supporting it but has seen its membership badly split on AOT. That difference of opinion can be seen in Sen. Murphy’s home state. The NAMI Connecticut board includes some consumer members who have been adamant opponents  of AOT.

Here is NAMI’s explanation of Rep. Murphy’s bill. 

Of course, Rep. Murphy’s bill is not the only mental health legislation under consideration.

In April, a bill introduced by Senator Al Franken (D-Minn.) sailed through the Senate Judiciary Committee. Here is a press release account from Franken’s office about the act. It is being introduced in the House by  Rep. Doug Collins (R.-Ga.)

Sen. Franken and Collins introduced the Comprehensive Justice and Mental Health Act, legislation that would help reduce the rates of repeat offenders and improve safety for law enforcement officers. You can download a video of Sen. Franken speaking about the legislation by clicking here.

“Our current criminal justice system is broken-it doesn’t serve the interest of people with mental illness, and it doesn’t adequately protect the safety of law enforcement personnel,” Franken said.  “This is a problem-it’s causing overcrowding in our correctional facilities and forcing taxpayers to foot the bill. My bipartisan legislation will help fix this issue by providing resources to the criminal justice system, crisis intervention teams, and law enforcement to help improve outcomes for people with mental illness, and I’m pleased that it’s one step closer to become law.”

As Franken explained, the bipartisan bill is directed at helping divert persons from mental illnesses from our jails and prisons by supporting the sequential intercept model and promoting mental health courts. You can read the bill here.

Earlier this year, Reps. Grace F. Napolitano (D-CA-32) and Chris Gibson (R-NY-19) reintroduced the Mental Health in Schools Act (H.R. 1211) to fund on-site school-based mental health services for youth. You can read more about it here.

Last year, President Barack Obama signed into law a $1.1 billion demonstration project under the Excellence in Mental Health Act, that was introduced in the Senate by Debbie Stabenow (D-MI) and  Roy Blunt (R-Mo) and in the House by Reps. Doris Matsui (D-Calif.) and Leonard Lance (R-NJ).

 The Excellence in Mental Health Act will provide incentives to our nation’s community mental health centers to ensure the centers cover a broad range of mental health services, including: 24-hour crisis care, increased integration of physical, mental and substance abuse treatment, and expanded support for families of people living with mental health issues.  Centers that met these strengthened accountability standards will qualify to bill Medicaid, just as Federally Qualified Health Centers currently do for treatment of physical healthcare.  

Here is a fact sheet from the National Council For Behavioral Health that explains what the demonstration project will fund. (click here.) It is a major piece of legislation.

Senators Kelly Ayotte (R-NH) and Richard Blumenthal (D-CT) have re-introduced the Mental Health First Aid Act, bipartisan legislation to expand mental health first aid training and help the public identify, understand, and address crisis situations safely.

So far, some 61 bills dealing with mental health have been re-introduced or introduced this session.

But none is as controversial or as ambitious as Rep. Tim Murphy’s bill, which would substantially alter mental health care in this nation — much to the ire of its opponents and glee of its supporters. Here is a short synopsis of his bill that I posted in an earlier blog.

Privately, Democrats are saying they will not adopt a bill that includes AOT and will kill any attempt that Rep. Murphy makes to get it out of committee.  That puts  Murphy, the only psychologist in Congress, in a tough spot given his unflinching support of AOT.

Who, if anyone, will blink?

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.