Representative Tim Murphy (R., PA) introduced a bill that proposes decreasing mental health spending and increasing mental illness spending. It's a novel, thoughtful proposal that warrants serious consideration.
While up to 40 percent of Americans may have what someone defines as a mental health issue, they don't have serious mental illness. That affects a very small group (5-8 percent of population) and includes those with schizophrenia or treatment-resistant bipolar disorder.
Rep. Murphy proposed the "Helping Families in Mental Health Crisis" Act (HR 3717) to reorient the mental health system away from it's focus on serving the largest numbers of the highest functioning and back towards providing treatment for the most seriously mentally ill. He reforms the bureaucracy, eliminates programs that don't help or are harmful, and invests the savings in programs known to reduce incarceration, homelessness, suicide and hospitalization in the most seriously ill.
1. PROVISIONS TO IMPROVE THE FEDERAL RESPONSE TO SERIOUS MENTAL ILLNESS
Creates an Assistant Secretary for Mental Health and Substance Abuse Disorders to better coordinate services, reduce duplication and mission-creep across government agencies, help ensure that resources are going to the most effective treatments, programs and research, and improve outcomes for people with serious mental illness.
Improves SAMHSA. Historically SAMHSA has given out money for conferences, trainings, and programs but exercised minimal oversight of who gets the funds or how they are spent. Sen. Tom Coburn, a doctor, identified waste at SAMHSA in his 2013 edition of the Government Wastebook. Many believe SAMHSA looks the other way, or actively promotes the misuse of funds. As a result, funds intended to help individuals with serious mental illness receive treatment went to groups that do not even believe mental illness exists, promoters of non-evidenced based programs, harmful efforts, and efforts designed to prevent persons with serious mental illness from receiving treatment. This bill requires that any conferences paid for by SAMHSA, be administered by SAMHSA and any financial assistance SAMHSA provides to others be limited to evidence based practices. It transfers some responsibilities previously assumed by SAMHSA to other more mission-focused agencies.
Focuses Community Mental Health Services Block Grants (MHBG) on people with the most serious mental illnesses. MHBGs are federal funds SAMHSA distributes to states. Unfortunately, the SAMHSA grant-distribution process encourages states to spend the money on unproven programs and those that fail to improve meaningful outcomes like reducing homelessness, suicide, arrest, incarceration, and hospitalization for people with serious mental illnesses. HR 3717 attempts to fix this.
Improves the Center for Mental Health Services (CMHS). CMHS operates under SAMHSA and has many of the same problems. Historically both SAMHSA and CMHS have relied on 'consensus' rather than science to guide the distribution of funds. Those who seek funding can stack meetings and 'vote' for funds or initiatives for themselves. The bill requires CMHS to limit their funding to 'evidence based practices' and engage psychiatrists and psychologists to perform the independent evaluations needed to determine which programs are and aren't. It also encourages use of the funds for serious mental illness as opposed to 'all other'.
Refocus the Protection and Advocacy for Individuals with Mental Illness Program (PAIMI) PAIMI was started with the noble purpose of providing representation to persons with serious mental illness who were being abused by the system. Unfortunately, the program has morphed into a political advocacy machine that wants to change the system to one that assumes that almost all persons with mental illness are always well enough to make their own decisions. Rep. Murphy proposes to return PAIMI to its original focus of helping people who need help and prohibits PAIMI groups from using federal funds to lobby for other agendas.
2. PROVISIONS TO IMMEDIATELY IMPROVE CARE TO PEOPLE WITH SERIOUS MENTAL ILLNESS
Fund pilot Assisted Outpatient Treatment (AOT) Programs. AOT allows courts to require a very narrow group--only people with serious mental illness and a prior history of arrest, violence or needless hospitalizations--to stay in treatment as a condition of living in the community and order the mental health system to provide the treatment. AOT studies have found that after enrollment in AOT, 55% fewer recipients engaged in suicide attempts or physical harm to self; 47% fewer physically harmed others; 46% fewer damaged or destroyed property; 43% fewer threatened physical harm to others; 74% fewer participants experienced homelessness; 83% fewer experienced arrest; 87% fewer experienced incarceration. 48% fewer abused alcohol and drugs. A recent study found it cut cost of care in half, thereby freeing up funds to help others. It is less restrictive and more humane than the alternatives: inpatient commitment or incarceration.
Frees parent/caregivers of persons with serious mental illness from HIPAA Handcuffs. Families need information about the treatments and appointments of their mentally ill loved ones in order to help them provide care. But doctors and mental health authorities routinely keep parents in the dark and hide behind HIPAA (patient confidentiality laws) to prevent parents from getting the information. This bill allows information otherwise protected by HIPAA to be disclosed to family members who are caregivers to persons with serious mental illness if that information is needed in order to "protect the health, safety, or welfare of such individual or the safety of one or more other individuals". Provides similar exceptions under FERPA, which guides what information educational institutions can provide to family members of students.
Ends Medicaid provisions that prevents people with mental illness from receiving Medicaid reimbursable mental health services and primary care services within the same day and limits the ability of Medicaid programs to restrict access to medications that treat major mental illnesses like schizophrenia.
Funds Mental Health Courts by reauthorizing the Mentally Ill Offender and Crime Reduction Act.
3. FOCUSED FUNDING FOR SERIOUS MENTAL ILLNESS RESEARCH.
The National Institute of Mental Health (NIMH) under Dr. Thomas Insel, has done an stellar job in turning their formerly amorphous research portfolio into one that is more focused on developing treatments, cures and programs for the most seriously ill. In light of that, the bill takes the savings from eliminating certain SAMHSA programs, and provides incremental funds, so NIMH can do more of this research.
Establishes a National Mental Health Laboratory that will give preference to addressing serious mental illness. It also increases research budget of NIMH that is earmarked towards studying causes of violence and ways to prevent it.
4. IMPROVES LAW ENFORCEMENT AND CRIMINAL JUSTICE RESPONSE TO SERIOUS MENTAL ILLNESS THEREBY REDUCING INCARCERATION
Because the mental health system primarily focuses on the high functioning, the most seriously ill have been offloaded to jails, prisons, shelters and morgues. There are 300,000 incarcerated and 200,000 homeless. As a result, criminal justice advocates, rather than mental health advocates, have become the biggest supporters of improved treatment for the most seriously ill. Following are some provisions in Rep. Murphy's bill that will improve the criminal justice system response:
Trains Police Officers, Corrections Officials, EMS and first responders to recognize individuals who have mental illness and how to properly intervene. While justifiable homicides by law enforcement officers are down, the number of justifiable homicides due to an attack by someone with mental illness is up. This initiative should help improve outcomes for all.
Requires Attorney General to collect data to document effect on the criminal justice system of letting serious mental illness go untreated. It also requires the Comptroller General to report on "the cost of imprisonment for persons who have serious mental illness at the local state and federal level" and "calculate the number and types of crimes committed by persons with serious mental illness each year, and detail strategies or ideas for preventing crimes by those individuals with serious mental illness from occurring." This will help ensure the criminal justice ramifications of future changes in mental health policy are considered before they are implemented.
There are many other useful and important provisions in the bill as well. The Helping Families in Mental Health Crisis Act received endorsements from the American Psychiatric Association, American Psychological Association, National Alliance on Mental Illness, and numerous others. SAMHSA-funded entities have endorsed specific provisions of the bill, but oppose provisions that would cut their own funding. Representative Murphy is currently looking for more co-sponsors.
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