Much like the nation’s infrastructure, our mental health system is in dire condition. Major changes are on the horizon as two mental health bills seem headed to votes on the floors of the House and the Senate. The question is: will they be enough? H.R. 2646—Helping Families in Mental Health Crisis Act introduced by Rep. Tim Murphy (R-PA-18) was voted out of the Energy and Commerce Subcommittee on Health 53-0. With 205 co-sponsors, including 59 Democrats, the bill is a genuine bipartisan effort to make significant alterations to the nation’s mental health system. A related bill, S. 2680—Mental Health Reform Act of 2016, introduced by Tennessee Senator Lamar Alexander and co-sponsored by Connecticut’s Chris Murphy passed through the Committee on Health, Education, Labor and Pensions (HELP) by a voice vote. The House is expected to vote on H.R. 2646 when they return from the July 4th recess this week.
From a political standpoint, passing this legislation will provide cover for Republicans in tight races back home against charges they are doing nothing to address gun violence. Both bills would create an Assistant Secretary for Mental Health within the Department of Health and Human Services (HHS) and direct more resources to the treatment of severe mental illness and reduce spending on moderate forms of mental health broadly defined as behavioral health, which includes substance abuse services. Severe mental illness has been associated with mass killings and is the one issue on which Republicans are not constrained by the National Rifle Association. While the Democrats’ 25-hour sit-in on the House floor may not have generated movement on gun control legislation, it probably hastened passage of the mental health bills.
Congressman Murphy, the lone psychologist in the House of Representatives, fervently took up the cause of severe mental illness in the wake of the 2013 stabbing of Virginia State Senator Creigh Deeds by his 24-year-old son, Gus, who then fatally shot himself. These events occurred after he was released from psychiatric care because no bed could be found for him. The elder Deeds survived his stab wounds and, in January, sued the state of Virginia for $6 million in a wrongful death suit. This sordid tale underscores the crisis the nation is facing because of the shortage of psychiatric beds available. A report by the Treatment Advocacy Center found the number of states’ psychiatric beds have fallen to 37,559, a 17-percent drop since 2010. This amounts to less than 13 beds per 100,000 persons which is much less than the minimum 50 beds per 100,000 needed. In 1955, there were 300 beds per 100,000 people until several federal policies led to rapid deinstitutionalization that was accelerated by a race for Medicaid dollars. Half of current beds are reserved for clients in the criminal justice system.
An Energy and Commerce memo details the many problems Murphy and others have with SAMHSA’s oversight of mental health services, such as the lack of medical staff, questionable practices in the grant-screening process, and possible violations of federal lobbying bans. Critics of the legislation take issue with its easing of privacy protections such as the Health Insurance Portability and Accountability Act (HIPPA) and promoting Assisted Outpatient Treatment (AOT) which some see as coercive and a curtailment of civil liberties. Despite these concerns, many major behavioral health care organizations are supporting the legislation with a few caveats. The National Association of Social Workers (NASW) and other organizations have signed onto a letter encouraging the bill’s sponsors to increase resources for health information technology. Three of the six social workers in the House, Reps. Barbara Lee, Karen Bass, and Kyrsten Sinema, have signed on as co-sponsors of H.R. 2646. Senator Debbie Stabenow is a co-signer on S. 2680.
The comprehensive House bill begins with the assumption that the $130 billion the Office of Management and Budget (OMB) identified as federal spending on mental health care would be adequate if resources were redirected from less priority areas of prevention and advocacy to more critical areas of treating people with severe mental illness. That is, of course, if you eliminate waste and fraud. The bill pays rightful attention to the crisis of warehousing mentally ill people behind bars but offers few concrete plans to right the ship other than half-hearted measures such as expanding the use of drug courts. There are many moving pieces in this legislation. However, if our government is not willing to collect adequate taxes to provide the resources to rebuild the entire system, we may find ourselves doing little more than the proverbial rearranging the deck chairs on the Titanic.
Major Changes Await in Mental Health Legislation—But Will They Be Enough? was originally published @ Charles Lewis – Congressional Research Institute for Social Work and Policy and has been syndicated with permission.
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