We haven’t yet spoken up about the Helping Families in Mental Health Crisis Act of 2013 (HR 3717), sponsored by Rep. Tim Murphy because we were hoping Congress would see through this less-than-subtle attempt to gut SAMHSA, coerce states to pass new forced-treatment laws (even if their citizens don’t want them), and create yet another huge federal bureaucracy in the Department of Health and Human Services that nobody has asked for, with no data to support its creation, and that nobody wants.
Sadly, that hasn’t happened. The least offensive parts of the bill are starting to get passed, and that suggests that there may be some momentum to pass the more offensive, egregious components in the future.
So here are the major problems with this bill, and why it stinks for everyone — especially patients.
You can kind of tell this isn’t a bill directed at patients and helping patients in the mental health system simply by its name, “The Helping Families In Mental Health Crisis Act.” You see that there — families. Not people with mental illness. This is about helping families deal with a family member who has an apparent mental illness — not about helping the actual people with a mental illness.
On May 22, 2013, Tim Murphy — the only clinical psychologist in Congress today — held a hearing to discuss the problems, as he saw it, with mental health in America and SAMHSA, the U.S. federal agency that is primarily charged with dispersing money for mental health treatment programs, substance abuse prevention programs, substance abuse treatment programs, and health surveillance. About one-third of SAMHSA’s $3 billion annual budget is devoted to mental health, and the remaining two-thirds to substance abuse — as directed by Congress. ((SAMHSA has little say in how this money is proportioned))
Federal grants from SAMHSA are how states largely pay for public mental health and substance abuse treatment, usually via community mental health centers.
You’d think when discussing the problems with the public mental health system you might have, well, some actual patients there. You know — the people who actually use the services provided by the government. What’s working with the system? What’s not?? What do you find helpful or beneficial in your treatment and recovery? But not a single patient or advocate was present at the hearing.
And you’d get this same sort of medical paternalism from the tone of some of the questioning as well. Rep. Michael C. Burgess, M.D. (R-TX) — who didn’t have the simple respect of staying in the hearing the entire time so had to have information repeated back to him — asked how many psychiatrists SAMHSA employed. As though SAMHSA provided direct services itself.
Now Burgess didn’t ask how many behavioral health professionals — such as psychologists or other similar kinds of mental health professionals — SAMHSA employed. He only asked about psychiatrists, ((You know, the one guild he was personally interested in, since he himself is a physician.)) which make up a small minority of the providers of mental health and behavioral healthcare services in the U.S.
Another Representative at the hearing asked about a single presentation at the annual Alternatives conference, and whether a federal agency should be funding a conference where such a presentation was given. This at a hearing to discuss a government agency with a $3 billion budget. Yes, please, let’s discuss a single $127k appropriation — that makes a lot of sense. ((It gets even worse, where they argue about whether a painting valued at $22,000 was also ‘worth it.’))
A Boon for AOT, a Boondoggle for States
Should the federal government be telling states exactly how they spend their money?
Well, when it comes to “assisted outpatient treatment” — forced treatment in an outpatient setting — the answer is “yes.” A total of $60 million in funding for grant programs to states will be made, making Congress a new treatment authority in mental health care. Imagine Congress telling docs that they can get reimbursed for treating cancer — but only in the way they dictate. That’s basically what the bill seeks to do — dictating to states how they will handle the treatment of serious mental illness in their state.
But here’s the kicker about the AOT research, and Pamela Hyde, the head of SAMHSA nailed it:
On the assisted outpatient treatment, the research that has been shown for assisted outpatient treatment to be effective also is very clear that it is the treatment and service that is effective. So to the extent that, for example, in New York where there was a major assisted outpatient treatment program and an evaluation of that program that was extensive, there were also a lot of new dollars poured into that system to make it work. So to the extent that the services are there, then assisted outpatient treatment may be effective for some individuals.
That’s the key to why some research shows AOT programs to be effective — the amount of services and coverage of individuals in AOT programs is a cut-above anything available to non-AOT participants today in community mental health.
If you poured the same amount of money into non-AOT programs, who knows what you’ll find. Perhaps coercion isn’t a necessary component of what makes AOT so effective. But you wouldn’t know the answer to this question, because there hasn’t been a single study examining AOT versus treatment with AOT-level services, minus the coercion.
Let’s Create Even More Federal Bureaucracy
Since Tim Murphy doesn’t believe SAMHSA is up for the job that Congress has given it, he wants to give a lot of SAMHSA’s work to a new agency that SAMHSA would have to report to. That’s what Congress does best — when one thing isn’t working as ideally as it would like, rather than fix it, they create something else they hope will do better.
The new “Assistant Secretary for Mental Health and Substance Use Disorders” (that’s a mouthful!) will oversee the public mental health block grants given to states. And it will be tasked with collecting and analyzing outcome data, to see what’s effective (and what’s not). These are tasks SAMHSA already does.
Oh, and those public block grants? They won’t be granted to states who don’t implement AOT laws. So the federal government is basically telling states how they will treat their citizens’ mental health concerns — whether those citizens in those states want those laws or not. Justified how?
Judges, mental health professionals, and family members have had trouble getting a loved one with a mental illness [sic] because 23 states use an unworkable standard requiring a person to be “imminently dangerous” before they can receive inpatient medical care.
An unworkable standard according to whom or what research? Tim Murphy doesn’t say. Apparently we need a weaker standard such as, “My family thinks I’m crazy, therefore let’s commit me.”
And it creates yet another agency, the “National Mental Health Policy Laboratory” where all of this analysis and oversight will occur.
Is such an “Assistant Secretary” necessary in the Department of Health and Human Services? We think not. It’s just another bureaucratic layer that will detract from the government’s ability to stay focused and coordinated, and to us anyway, seems like an effort to remove a lot of the responsibility from SAMHSA — that SAMHSA itself could do just as well in its current form.
24 comments
This is an example of the federal government’s inability to address a national health priority.
Sadly, with a few cases of violence perpetrated by individuals known to have had mental health issues, there was talk of bringing mental health treatment a national priority. Mental health had always been placed secondary to other major health issues affecting our national population.
Mental health must become a focus of our health care system and significant resources must be directed to answer to this ‘hidden’ problem only spotlighted when a violent act occurs by someone with a mental health disorder.
The vast majority of people who suffer from this disease do not seek to harm another or themselves but instead live an unbearable life.
Recent breakthrough discoveries in Ketamine and derivatives show extreme promise particularly with some research showing these agents actually repair brain synapse and communications along with growth of new brain cells, damaged by stress, which significantly reduces depressive and related symptoms and this research should be a national priority in releasing these new drugs to those afflicted immediately along with strengthened public mental health programs such as counseling.
With the WTO declaring that depression and related diseases placing first in rendering those afflicted disabled, thereby unable to contribute to society and GNP, I would imagine that the need to find a cure or control of this disease would be in the national interest.
I only work and produce instead of being on the disability roll because of an off-label treatment but after a few years of this treatment working, I find myself increasingly unable to participate in a productive life.
I beg those who are afflicted, our representatives and treatment providers and advocacy groups to prod the government to place this debilitating disease as a national priority and the possible cure may be found relieving millions who live very, very difficult lives.
I’ve recently lost my services for outpatient services in an area of Northern Michigan. The agency is closing everyone who does not have insurance as there apparently is no general fund dollars. Michigan has recently adopted “Healthy Michigan” medicaid expansion under Obamacare. I am devistated!
Thank you for this post and for seeing through this bill. Many, many other sites and news outlets think just because this bill has been proposed and proclaims to fix the broken system, it is great and should be passed.
“Imagine Congress telling docs that they can get reimbursed for treating cancer — but only in the way they dictate. That’s basically what the bill seeks to do — dictating to states how they will handle the treatment of serious mental illness in their state.”
And there it is, why you don’t look to politicians to set health care policy, especially mental health care policy. I really think that most politicians go through some process to lose their souls to be in public office for more than 5-10 years.
Besides, as I wrote at my blog earlier tonight, we live in a society that has easily and pervasively signed over being “FREE” to allegedly avoid “FEAR”, and in doing so emboldened those who only corrupt and diminish the very values that this society used to embrace and practice which made the country great.
First we let the Republicans allow torture without accountability be acceptable, and then the Democrats allow taxation without restraint be acceptable. Solely to give the illusion of having less fear. No, these are attitudes and agendas of fairly much antisocial policy. Just my opinion.
Well, keep allowing these people in public office rule you, I think the fear will be palpable sooner than you think. Or want to feel!
Thank you for your article. I looked on Rep. Murphy’s Web site and was amazed at the number of mental health organizations that support this bill, mainly because it restores funding for other programs that have since lapsed. This seems typical of our government: if you want the good stuff back, you have to accept the parts that stink.
The thing about patients testifying, though, left me with a question. Where would these folks come from? The average mental health patient probably wouldn’t read or understand this bill. Would they come from an organization that supports it? I don’t think there would’ve been unbiased testimony if it did happen.
Overall, though, a good article and a lot to think about.
Sadly, not a single patient organization is listed there amongst its supporters (NAMI is focused on families and caregivers of those with mental illness, not really patients themselves). It’s a bunch of guild and industry groups would would benefit financially from the changes listed within the bill — hardly unbiased support there.
But of course, Rep. Murphy makes no mention of these conflicts of interest on his website. Apparently transparency isn’t a core component of his efforts for reform.
There was a “patient” who testified, a witness with “lived experience.”
Nancy Jensen had a moment to testify, and then had no follow up. She was isolated as the only voice for consumers, though she was excellent. Murphy then went on to his agenda.
The involvement of parents is important, but they are a mixed bag. For several years I edited the newsletter of the local NAMI affiliate. I was fired for speaking the truth about a local provider, who was in turn fired.
The “ownership” of their children, may have precipitated the trauma that led to cortisol poisoning, that eventually surfaces in sensitivity to stress. It is hard to discern what is the real interest of family members. I am one of them.
Family members tend to look for authorities that will tell them “what’s good for them.” EFT for instance. And, therefore, forced treatment against your will masquerading as Assisted Outpatient Treatment. And also D.J.Jaffe with an organization that looks benign.
“The average mental health patient probably wouldn’t read or understand this bill.”
Wow! I have to say that I found that to be a telling statement. First it says that stigma is alive and well and living at Psych Central as even the good Dr.G didn’t bother to dispute its validity. Next it tells me that you don’t really know the people with whom you live and work. And third our mental health system is so broken that even the people closest to it do not expect it to work. All of that made me afraid and sad, but mostly afraid.
I can, however, also find hope in the knowledge that we are out there among you. We are holding down jobs, raising families and comprehending things a lot more complex than The Families in Mental Health Crisis Act. Though not many people know that we exist it is a very good thing that we can go about our lives unnoticed.
Thank you for your comments. I’d like to point out that Murphy and the Treatment Advocacy Center folks who are whispering in his ear at the behest of Big Pharma are trying to hijack the discussion and focus on the “most severely ill.” The problem is that they want to be the ones to define those terms. Their definition of those who are most severely ill includes only those who’ve been labeled by psychiatry as having schizophrenia, bipolar or major depression. (Sometimes they also include schizoaffective and OCD.) They believe these labels ought to be included because these are the ones that Big Pharma supposedly has a drug to throw at some of the symptoms. I would argue that SAMHSA does treat those at the extreme end of the diagnostic spectrum. SAMHSA addresses the needs of a full range including those who are not yet identified as ill (we call it prevention). Murphy and TAC want all the funding to only go to those they call the worst. That’s like setting up a triage system where no funding will go to anything else except heart transplants. Anything less goes without. We’d soon be seeing people fall into the category of needing a heart transplant. It’s foolish nonsense. And as far as those that they define as the worst, what gives them the right to set the definition? Years ago, I argued that we ought to include those with personality disorders (not that I’m particularly enamored with that term either) because those with personality disorders complete suicide at a higher rate and suicide is a pretty serious indicator. Of course, the NAMI folks hated me. I don’t understand Murphy’s agenda. What’s he really want? He claims he wants to force people into treatment. But, laws are already on the books in every state for civil commitment. What else does he want? Oh yeah, he wants to decimate SAMHSA and HIPAA so the families can force someone to accept treatment and interfere in their adult child’s life. It seems to me that a better approach would be to make “treatment” interesting and something that actually works. If “treatment” were appealing, they’d have to bar the doors to keep people away. So, how are they doing? We’re dying at an average age of 52 (those receiving public mental illness services). That’s over 25 years younger than the rest of the population. So, is Murphy really the leader of this latest incarnation of the eugenics movement? I think we ought to applaud SAMHSA for their work in preventing suicide and for helping people cope with trauma issues. Ooops, there, I said it. Trauma. So, we’ve got kids who were traumatized and they grow up and have life difficulties. Some actually go on to shoot others before their life ends. Maybe we ought to not treat “mental illness” and instead treat people’s anger issues. We’d be a lot less violent and a lot safer.
I’ve tried to bring this up but even here among those who will be affected, most don’t see the problems others are afraid. My biggest fear is the dismantling of PAIMI and peer input into care. The clipping of DR to going into hospitals and treatment centers to take action against those that are misusing restraints and seclusion.
Thank you for posting this.
I have been a consumer of the mental health system for 37 years, having been diagnosed as schizophrenic as a teenager. During the early years of my illness I was often involuntarily confined – not because of any imminent danger, but because various people wanted to keep me quiet about abuse I had endured. I saw many, many people so incarcerated, having committed no crime, because they were an embaressment to their families, because they found out about a husband’s mistress, because their father found out they had confided in a friend that he was molesting them….. the list goes on and on. I have not experienced a loving supportive family, but I have known others who have and I know that those families probably suffer when they don’t feel their mentally ill loved one is taking care of him/herself. But to strip away the constitutional right of an individual to direct his own life, except in cases where laws have been actually violated, is just wrong on so many levels. I believe in access to care, but I believe even more firmly in a person’s right to choose what care is right for him/her. Because in all honesty, the side effects to anti-psychotics are serious business. I have the right to choose whether I will utilize other methods to cope with my illness over a certain early death, especially considering that the medications have already given me diabetes and liver damage. Quite frankly, I function so well that doctor’s have called my counselor and questioned her about the validity of my diagnosis, but if this bill passes a family member would have no difficulty having me locked up and destroying the life I have built for myself. You cannot strip away a person’s constitutional rights and pretend that it does not open the door wide open for abuse of that person….
It seems to me you attack family members when you say “You can kind of tell this isn’t a bill directed at patients and helping patients in the mental health system simply by its name, “The Helping Families In Mental Health Crisis Act.†You see that there — families. Not people with mental illness.”
That’s akin to saying a bill that helps psychologists, psychiatrists or peers is not a bill that helps people with mental illness. I don’t believe you would ever attack peers or fellow psychologists, or attack bills that help them do their jobs but parents of persons with mental illness appear to be fair game.
DJ Jaffe
Executive Director
Mental Illness Policy Org.
While I’m sure parents are a core part of many people’s adult lives, I’m not sure how we fix the broken mental health system by focusing on “families.” Families aren’t where the problem lies, and so, no, I don’t believe it’s appropriate — or very effective — to expend taxpayers money on gutting one federal agency just to form another one. And then have the whole thing be micro-managed by Congressional oversight, because they have their own political agenda that they want these agencies to follow.
I also don’t think it’s very effective to coerce states to pass laws their own citizens may have little interest in passing, in order to retain what little federal funding remains for mental health treatment — funding that has been slashed over the past 3 decades.
In short, it’s a bad bill with an overt political agenda that’s more focused on gutting a government agency it disagrees with its focus, and less about increasing mental health funding support to our citizens who need more treatment resources available to them. Rather than working with what it has already created, this is a Congressional attempt to foist more bureaucracy and paper-pushers onto the system — the last thing anyone needs right now.
Frankly, it is inversely proportional in true agenda what is sought the louder and more sustained politicians clamor for mental health controls by state/federal regulations. I know in my heart that politicians want to marginalize, if not silence, the mental health care portion of society, that involving patients providers and families/invested collateral contacts.
Simply because there is a sizeable portion of mental health dysfunction in these very politicians. But, they know not only is their dysfunction NOT amenable to effective and applicable care interventions, but they don’t want society to be aware of their dysfunction in the first place.
Can’t solely medicate personality disorders. Not that these people in public office are interested in any care anyway, the problem is their constituents, not their colleagues in office!
The problem with your argument is that everyone knows that you feel too much effort is being placed on mental health and not what you define as mental illness. You do not seem to consider the effect of trauma or the fact that in many cases that trauma generates from the very families that you want to give carte blanche to access information and make decisions for people with mental illness. You seem to completely disregard constitutional rights, mountains of evidence showing that recovery oriented services work, and the stigma that such a bill would create. You write and speak as if there are legions of dangerous mentally ill people roaming the streets attacking innocent civilians at will, while deliberately ignoring overwhelming statistical evidence to the contrary. Your blind allegiance to the pharmaceutical and institutional model of care undercuts any credibility you might have on this issue and your associations with multiple for profit organizations who stand to gain considerable financial gain should your policies be enacted belie your alleged concern for what you define as the “seriously mentally ill”.
So, as a member of a Board of Directors of a National Organization who supported this bill with a mention of the controversial aspects, I have spent the last several months doing what I can internally to get the organization to discuss with Rep. Murphy the reprehensible aspects of a bill. we have completed a document to do that. I don’t understand Mr. Jaffee’s comments that if you critisize psychiatrists and psychologist, you are attacking those living with mental illness. Coercion and force do not bring about longterm outcomes and it is evident to my perspective that Dr. Murphy believes in the old “talk down model” and the patient should just follow doctors orders. The ideas of recovery and resiliency do not exist in the bill, have never been discussed in hearings. I am sorry he trotted out only folks who agreed with him for the most part. It is unfortunate that Dr. Shern did not read the bill but Murphy would have eviserated him anyway. He says he wants open discussion but it is suspect that he really does. Another bill is forming in Congress that could force him to accept changes.
Jeff Gordon
We need this discussion. Why are we blind to those who become homeless or incarcerated..due to untreated mental illness/ My two sons finally received good meds..after 7 years of pure hell. But, the ‘good meds’ cost a lot of money..so few professionals in the community mental health arena..prescribe them. There are side effects.. but they got their minds back. The laws in effect today, would put them in jail..due to their actions when they were untreated.
We MUST help these most ill folks.
Most of these drugs do not address the pathology
Of the illness nor are they safe for everyone.
Antipsychotic work with dopamine which had
More to do with Parkinson’s patients than anyone
Would know in the medical field today. There
Are also about three other theory’s and one that
Even involves serotonin and a sugar.
In the case of most psychotic episodes we are
Talking about a protein or some other indirect
Component a cell is making.
I am the mother of a 47-year-old learning-disabled paranoid schizophrenic son for whom I have been unable to obtain treatment for 14 years. My son is now so paranoid that he will not take Pepto-Bismo when he has an upset stomach let alone go to a doctor or dentist. He is living under sub-human conditions. There is no end in sight.
When I first heard the notion that the mentally ill were capable of making their own decisions about treatment(Psychology 101 during the ’70s), I thought, “no one will be stupid enough to believe that.” I badly overestimated the intelligence of the American people. Now, I curse my ancestors once a day, every day, for emigrating from Switzerland to the United States. Had they remained in Switzerland, my son would have received care as soon as he started having symptoms.
I was in New York City when psychiatric hospitals were closed being closed. One day, when I was walking down the street with my boss, I noticed that the number of floridly psychotic individuals outnumbered others on the street. I asked my boss (whose wife worked in a psychiatric hospital) if there were any patients left in psychiatric wards. He said, “What you see is a cynical attempt by NYS to balance the budget on the backs of the mentally ill.” Nothing I have seen since then has convinced me otherwise.
My son is as capable of requesting treatment as a double amputee is of tap dancing. He exists in a world of constant fear and dread, hallucination, delusion, and terror. I can no longer enjoy a movie with him because he pounds the furniture and walks out. I can no longer go camping with him because his constant hallucinations make others “uncomfortable.” He has no joy in his life, only anger and fear.
I have a friend who has been on SSI for years because of depression. She once told me that the sexual abuse she underwent as a child was worthwhile because she did not have to work. At one point, she was seeing three therapists and I, who always worked even though I have always suffered from depression, could not afford to see even one. I surmise that she is the type of “consumer” who is fighting HR 3717 – high functioning and not seriously mentally ill, but enjoying the benefits that come with being mentally ill.
I regret that their selfishness keeps my son from receiving any treatment whatsoever. I don’t care how many times I hear that schizophrenics are less violent that non-psychotic individuals, I will never believe it. Crimes committed by the mentally ill are vastly underreported and the media aids and abets the coverup by using euphemisms like “disturbed” and “troubled.” Whenever euphemisms – like “consumer,” for example, is used, you can be sure the truth is conspicuous for its absence.
If we are going to refuse treatment to the mentally ill, then we ought to ban Altzheimer’s patients from nursing homes. Altzheimer’s patients are there against their will and are being treated against their will. We ought to close homes for the profoundly mentally retarded because they are their against their will and are being treated against their will. We ought to close hospices for seriously neurologically impaired individuals because they are there against their will and are being treated against their will. (Why is only one form of mental disorder deprived treatment?)
I truly believe that were this bill to pass, the number of “consumers” would be drastically reduced overnight . . . as “consumers” would miraculously be cured, and then the really seriously mentally ill would be treated and given the custodial care they drastically need. Just saying . . .
If you actually post this, I will be amazed.
Exactly. Speaks volumes that nobody responded to what the above person said. Nobody seems to actually care or consider what families of the most severely mentally ill want. Let me tell you as a son of a mother who is severely ill and has been homeless for more than three years for not accepting her illness or treatment, coercion absolutely needs to be a part of the plan and, yes, we are desperate for help. Seems to me the lot of you are more concerned about your jobs, financing and reputations.
Wow, you so speak the truth. Please keep speaking, we need you. So Many Thanks, Mary
As a relative of two children labeled with “severe and persistent mental illness” (by their mother, who learned that term from NAMI) I can attest to the fact that “family” is not always warm and fuzzy, and cannot uniformly be trusted with a patient’s best interest. Sad but true. The majority of parents, no doubt (like yourself), have their child’s best interest at heart. However, there are also parents with their own issues (personality disorders [borderline, anti-social, or narcissistic], substance abuse, past histories of child neglect/abuse) which make them clearly unfit to make decisions on behalf of their children. How’s that for a conundrum? While parents with personality disorders are a small proportion of the general population, their children (understandably) are overrepresented among children/teens/young adults suffering from severe depression, anxiety disorders, PTSD and more. There’s no doubt we direly need better, and more, services for those afflicted with mental health challenges, but those services need to be things other than giving parents carte blanche to force meds. It’s unfortunate, but true, that protecting vulnerable patient’s rights makes it more difficult for other parents.
I am overweight, have severe hypertension, type 2 diabetes, and gum disease.
My doctor told me I need to exercise, eat a balanced diet, take meds for my blood pressure, measure my blood sugar and inject myself with insulin. My dentist tells me I need gum surgery or I could lose my jaw or worse due to infection.
I just ate a Big Mac and just eat less sugary things. I feel dizzy sometimes and my feet tingle, but I don’t take insulin cuz I really don’t need it.
In short, I am completely non compliant with my doctor’s treatment plan.
Some say I’m a danger to myself for not taking care of these so called life threatening illnesses.
Good thing only mentally ill people are subject to court ordered forced treatment. I need my cheesecake.