In his special message to Congress on February 5, 1963, President Kennedy identified mental illness and mental retardation as twin health problems deserving of “a bold new approach.” Since then much progress has been made regarding mental retardation.
Not so for mental illness.
But one catastrophe after the next has compelled Congress to address mental health issues. Finally!
Bills pending in the Senate (S.264, S.265) promise expanded access to community mental health centers, improved quality of mental health care for all Americans, and grants for community-based mental health infrastructure. Bills in the House (H.R. 1263, H.R. 628) promote increased access to community behavioral health services, improved Medicaid reimbursement for community behavioral health services, and comprehensive school mental health programs. These are important bills, sure to improve the lives of people with mental illness.
But it is H.R. 3717, “Helping Families in Mental Health Crisis Act of 2013” introduced at the end of December by Representative Tim Murphy (R-PA) that will revive the spirit of President Kennedy’s Community Mental Health Act and make a giant leap forward toward fixing our broken mental health system.
This 135-page bill, sponsored by Murphy, the only member of Congress who is a clinical psychologist, will revise infrastructure and eliminate ineffective programs. Most remarkably, it will decrease spending for mental health and increase spending for mental illness. And this is where we need to put our money. According to the National Institute for Mental Health, 26.2% of American adults suffer from a diagnosable mental disorder in a given year. 1 But it is the 5% with severe mental illness such as schizophrenia or bipolar disorder who bear the main burden of illness.
Under this bill, grants would be available for states to (1) implement, monitor, and oversee outpatient treatment programs, (2) establish a program to train primary care physicians about mental illness, and (3) carry out demonstration programs to improve the provision of behavior health services.
Murphy’s bill would give parents of adult children with mental illness an essential right they currently lack – the ability to talk with their child’s physicians, empowering them to help with treatment decisions, when their child is in crisis. The bill recognizes that many with severe mental illnesses suffer from anosognosia, a lack of awareness of how ill they are. But the bill does not compromise the adult child’s rights to autonomy in the absence of crisis.
A bill like this would have kept my daughter, diagnosed with bipolar disorder and borderline personality disorder and deemed incompetent to make decisions about her own healthcare by every professional consulted, from living on the streets, becoming addicted to methamphetamines, and being jailed.
Murphy’s bill would provide training to law enforcement officers and other first responders enabling them to recognize individuals with mental illness and know how to effectively intervene. Assisted outpatient treatment programs would be an alternative to jails and prisons, keeping sick people out of jail and off the streets.
Reforms to Medicare and Medicaid regulations would enable people to get the care and treatments they need.
Increased funding would exist for research about violence and mental illness as well as research supported by the Brain Research through Advancing Innovative Neurotechnologies Initiative (BRAIN).
A continuum of treatment plans would be available, giving patients the opportunity to live in the least restrictive environment. These plans would be evaluated, ensuring they avert relapse, repeated hospitalizations, arrests, incarceration, suicide, and violent behavior.
A national awareness campaign, part of the bill, would help reduce the stigma of mental illness.
Finally, the bill proposes increased efforts to develop programs designed to target youth at risk for mental illness and suicide.
Where H.R. 3717 is weak is its lack of attention to increasing the capacity of inpatient hospital facilities. The reality is that some people with mental illness are so ill that they cannot be treated on an outpatient basis. In 1963, there were 530,000 hospitalized psychiatric patients. Today there are roughly 50,000 state hospital beds and, like the son of Virginia Senator Creigh Deeds, people clearly in crisis very frequently are turned away because there are no available beds.
H.R. 3717 has the support of professional organizations representing mental health providers, including the American Psychological Association, the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, National Council for Behavioral Health, and National Association of Psychiatric Health Systems. Law enforcement agencies including the New York State Association of Chiefs of Police and the National Sheriffs’ Association support the bill. Mental Illness Policy Org, a group that provides unbiased mental health information to policy makers, supports the bill. So too does the National Alliance on Mental Illness and the Treatment Advocacy Center, organizations devoted to mental health education, advocacy, and support.
To be sure, the bill has its opponents, mostly organizations focused on consumer rights. The National Coalition for Mental Health Recovery, the National Disability Rights Network, and the Bazelton Center for Mental Health Law blasted H.R. 3717 on the basis of highly emotional distortions and self-serving propaganda.
They contend that H.R. 3717 threatens the rights of people with mental illness.
Nothing could be further from the truth. This bill proposes that a continuum of first-rate care should be available to persons with mental illness. Rather than requiring that a person be dangerous before he can be helped, this legislation focuses on need for treatment. Making treatment available does not rob people of their rights. It empowers them to assert their “inalienable rights to Life, Liberty, and the pursuit of Happiness.”
They contend that H.R. 3717 would exchange low-cost services that have good outcomes for higher-cost ineffective interventions.
If existing services are so effective, why are our jails, prisons, and streets are filled with people with mental illness? This bill demands that states be held accountable for developing interventions that will reduce suicides and homicides while getting people into treatment and back to work.
They contend that H.R. 3717 promotes stigma and discrimination by linking mental illness and violence.
In fact, the bill proposes a national awareness campaign involving public health organizations, advocacy groups, and social media. The proposed campaign targets high school and college students with the goal of reducing the stigma of mental illness, recognizing the signs of mental illness, helping people who appear to have mental illnesses, and developing an understanding of the importance of seeking treatment from a qualified provider. If this were about discrimination, the bill wouldn’t be encouraging students to help their friends get treatment.
This is a bill that John Kennedy would have liked.
Last week I did something I’ve never done. I called my congressmen and asked them to support H.R. 3717 – legislation that will make life better for people with mental illness and their families.
Neither of my congressmen was even aware of Murphy’s bill. I was able to educate them and direct their attention to it.
It felt good. It felt empowering.
Now I want to suggest that you do it, too. Go to the govtrack.us website. Hit the yellow “Call Congress” button and follow the instructions.
Talk to your congressmen and let me know how it makes you feel.
1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.