Call your Representative and ask him/her to support HR 3717. To find your Rep phone number, enter your zip code at http://www.opencongress.org/people/zipcodelookup
BACKGROUND
SPENDING AND SCOPE OF PROBLEM
In 2014, the U.S. will spend $203 billion on mental health.
Due to mission-creep, the funds are now spent ‘improving mental health’ rather
than treating those with serious mental illness. Moms who have children known
to be seriously mentally ill are virtually powerless to see they receive care. While the public becomes aware of the failure of the mental health
system after high-profile rare acts of violence, the everyday tragedies faced
by people with serious mental illness and their families go unnoticed.
SERIOUS MENTAL ILNESS
While up to 40% 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% of population) and includes those with schizophrenia
or treatment-resistant bipolar disorder. Because the organ charged with regulating
behavior (the brain), is the one not working right, they may not know they are
ill (anosognosia) or be able to regulate their own behavior. Usually moms can
help them get through. But eventually, their untreated hallucinations,
delusions, paranoia and bizarre behavior may cause them to become a headline.
Treatment works, but it is not available
REP. TIM MURPHY
In 2011, after Newtown, Rep. Tim Murphy (R., PA) and the
members of the Energy and Commerce Subcommittee on Oversight and Investigations
began to hold hearings narrowly focused on the elephant in the room: getting
treatment to people with serious mental illness. It would have been
easy for the committee to focus on the higher-functioning and propose softer solutions that would please the mental health industry, but not help people with serious mental illness. But they did not. On December 12, 2013 before the
anniversary of the shootings at the Sandy Hook Elementary School in Newtown,
Rep. Murphy released his proposals. Following is our quick analysis of some of the
proposals. Please check with his office to confirm our research.
These proposals will improve care, keep the police
and public safer, and save tax payers money.
Call your Representative and ask him/her to support the "Helping Families in Mental Health Crisis Act" (HR 3717) sponsored by Rep. Tim Murphy. The fastest way to find your Rep phone number is to enter your zip code at http://www.opencongress.org/people/zipcodelookup.
Selected Provisions
1. PROVISIONS TO IMMEDIATELY
IMPROVE CARE TO PEOPLE WITH SERIOUS MENTAL ILLNESS
Encourages the
creation of up to 50 Assisted Outpatient Treatment Pilot (AOT) Programs for
three years each (and provides $15 million annually in funding). 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. 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 to prevent
parents from getting the information. This bill allows information otherwise
protected by HIPAA (patient confidentiality laws) 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 info educational institutions can provide to family members
of students).
Addresses the
psychiatric hospital bed shortage. It would be nice if no one with mental illness ever needed long-term
care. But some persons with serious mental illness do and there are not enough
beds available for them. There is a nationwide shortage of over 100,000
psychiatric hospital beds for persons with serious mental illness, even if
community services were perfect. An increasing percentage of the existing state
psychiatric hospital beds are being allocated to forensic patients, further
fueling the shortage and creating an intolerable backup at local emergency
rooms. ERs have become so crowded that anyone well enough to walk in for care
is not considered sick enough for admission. This means becoming ‘danger to
self or others’ is the only sure route in, so many untreated seriously mentally
ill do. This is all due to an
obscure provision of Medicaid Law (“IMD Exclusion”) that prevents Medicaid from
reimbursing states for mentally ill who need long term hospital care. Murphy’s bill would address this federal discrimination
against the mentally ill by allowing Medicaid to reimburse states under certain
conditions for people who meet Medicaid criteria, but have a disorder in their
head.
Ends Medicaid
provision that prevents people with mental illness from receiving Medicaid
reimbursable mental health services and primary care services within the same
day.
Limits the ability of
Medicaid programs to restrict access to medications that treat major
depression, bipolar disorder, panic disorder, obsessive compulsive disorder,
schizophrenia, and schizoaffective disorder.
Funds Mental Health
Courts by Reauthorizing Mentally Ill Offender and Crime Reduction Act. It
also makes improvement to the bill so more persons with mental illness (ex.
Veterans) can benefit.
Allocates resources to suicide prevention
2. PROVISIONS TO
IMPROVE THE FEDERAL RESPONSE TO SERIOUS MENTAL ILLNESS
Creates an Assistant
Sec. for Mental Health and Substance Abuse Disorder 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. The
SAMHSA Administrator will now report to the Asst. Sec.
Creates an
Interagency Severe Mental Illness Coordinating Committee under the Asst.
Sec for Mental Health and Substance Abuse Disorder that will “develop and
annually update a summary of advances in severe mental illness research related
to causes, prevention, treatment, early screening, diagnosis or rule out,
intervention and access to services and supports for individuals with severe
mental illness” “Monitor federal activities with respect to severe mental
illness” This is the first time there will be a federal level program focused
on the most seriously mentally ill. In addition to members of the mental health community it will include a person with serious mental illness; a family member of
someone with serious mental illness, a judge, law enforcement officer and
corrections officer. This will bring
needed focus to the workgroup.
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. SAMHSA seemed to look the other way, or actively promote 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 saves money by eliminating
counterproductive expenditures by SAMHSA and transfers some responsibilities
previously assumed by SAMHSA to other more mission-focused agencies. It
eliminates the programs that were most abused, and transfers some of the
savings to NIMH for productive research.
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. This has facilitated the diversion of resources meant to help people with serious mental illness to other favored causes leaving persons with serious mental illness underserved. 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'.
Funds a Behavioral
Health Awareness Program that is limited to serious mental illness. (Most
‘awareness campaigns’ focus on high-functioning individuals and ignore those
with the most serious illnesses)
Refocus the Protection and Advocacy for Individuals with Mental Illness Program (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 all persons with mental illness are always well enough to make their own decisions. Rather than help the most seriously ill, they abandon them. They have used their federal funds to lobby state and federal agencies in favor of systemic change compliant with their ideology. 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.
Refocus the Protection and Advocacy for Individuals with Mental Illness Program (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 all persons with mental illness are always well enough to make their own decisions. Rather than help the most seriously ill, they abandon them. They have used their federal funds to lobby state and federal agencies in favor of systemic change compliant with their ideology. 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.
3. FOCUSED FUNDING
FOR SERIOUS MENTAL ILLNESS RESEARCH.
Establishes a
National Mental Health Laboratory that will “give preference to models that
improve the coordination, quality and efficiency of health care services
furnished to individuals with serious mental illness”. Specifically it will
analyze patient-level outcomes and public health outcomes such as reduced
mortality, rates and reduced hospitalization from psychotic episodes” Programs
funded may include the North American Prodrome Longitudinal Study and the
Recovery After An Initial Schizoprhenia Episode (RAISE) Research project at
NIMH which look into the possibility of diagnosing serious mental illness as
early as biologically possible and ensuring help as soon as possible after a
first psychotic break respectively.
Increases research
budget of NIMH that is earmarked for “research on the determinants of self
and other directed violence in mental illness, including studies directed at
reducing the risk of self harm, suicide and interpersonal violence, or Brain
Research through the Advancing Innovative Neurotechnologies Intiitiaves.” The
$40 million incremental research budget is being funded by eliminating SAMHSA
programs that were not helping people with serious mental illness.
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 with
individuals with mental illness, and to establish programs that enhance the
ability of law enforcement agencies to address the mental health, behavioral,
and substance abuse problems of individuals encountered in line of duty.” 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 AG or FBI to
collect data to document effect on the criminal justice system of mental health
system letting serious mental illness go untreated. Requires existing
reports “with respect to the incidences
of homicides, law enforcement officers killed and assaulted, or individuals
killed by law enforcement" include “data with respect to the involvement of
mental illness in such incidence.”
Requires Comptroller
General to report on “the cost of imprisonment for persons who have serious
mental illness at the local state and federal level. The report will
“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” Historically
mental health systems have reduced their budgets by offloading the seriously
ill to prisons and jails. This causes an overall increase in costs, because
incarceration is more expensive than the community treatment. This provisions
will allow the size and scope of the needless expense to be documented.
There are many other useful and important provisions in the bill as well.
Call your Representative and ask him/her to co-sponsor the "Helping Families in Mental Health Crisis Act" (HR 3717) sponsored by Rep. Tim Murphy. The fastest way to find your Rep phone number is to enter your zip code at http://www.opencongress.org/people/zipcodelookup Call now.
Researcher: DJ Jaffe
