The Many Problems with the Helping Families in Mental Health Crisis ActWe 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.1

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,2 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.3

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.

That’s Okay, We’ll Micro-Manage SAMHSA Too

Demonstrating they have little faith in many of SAMHSA’s current public education campaigns, programs and advocacy efforts, Tim Murphy also wants to micro-manage whatever SAMHSA has left to manage after it’s gutted of its community mental health blocks grant oversight.

With several exceptions, transfers all responsibilities for oversight of mental health policy from SAMHSA to the Assistant Secretary for Mental Health.

Requires that SAMHSA notify the House Energy and Commerce Committee and Senate Health, Education, Labor, and Pension Committee 90 days prior to sponsoring or hosting any conference.

Prohibits SAMHSA from providing any financial assistance for any program relating to mental health or substance use diagnosis or treatment, unless such diagnosis and treatment relies on evidence-based practices.

Prohibits SAMHSA from establishing any program or project that is not explicitly authorized or required by statute.

By the end of fiscal year 2014, any SAMHSA program or project that is not explicitly authorized or required by statute will need to receive congressional approval to continue.

Want to run an advocacy program? Forget it. Want to sponsor a conference? Forget it (say bye-bye Alternatives 2015!).

Want to do anything on the cutting edge or innovative? Forget it. Want to do anything that isn’t arbitrarily “evidence-based”? Forget it.

Imagine if we put these same kinds of handcuffs on military spending. “Oh, you have no data to show this new jet fighter at $2 billion apiece will be as effective as our current jet fighter? No problem, let’s authorize 100 of them anyway.”

Or the FDA? “Oh, dying cancer patients want access to an experimental drug that may kill them just as well as help treat their cancer? No, we don’t want the FDA running any kind of program like that… just let ’em die.”

You get the picture. Mental health is again being singled out for special attention for no other reason than because it’s mental health. For anything else, we’d call that discrimination.

Why This Bill Should Die

Look, there are some good ideas buried within the guts of Tim Murphy’s H.R. 3717.4 But this bill does very little to actually “fix the nation’s broken mental health system.” Instead, it’s an obvious attempt to force ideologies of certain kinds of medicine and treatment onto the system — and by extension, all states — that will likely do little to help in the long-run.

It mandates state legislatures pass laws their citizens may not actually want in order to continue to receive funding traditionally provided by the federal government to help fund states’ mental health treatment programs.

It attempts to micro-manage a federal agency through egregious restrictions that have no basis in any data, facts or science, but instead appear to be purely politically motivated. It’s narrow-mindedness of purpose and intent is scary, especially in its promotion of only one simplistic view of how mental illness should be treated. It ignores the complexities of the problems faced by real people struggling with real mental illness.

It completely ignores the importance and primacy of the role of the patient, with patients completely shut out of hearings that led to the formulation of the bill. It has no virtually no patient endorsement of support of it. It instead elevates the paternalism of both the government and professionals — “those who know what are in the best interests of the patient.”

And it demonstrates a complete lack of appreciation, understanding and insight into what it means to be in recovery for a mental health or substance abuse issue. It is the kind of bill that appears to be written by policy makers, physicians, and experts who never bothered to actually get their hands dirty in talking to patients and those therapists who work in community mental health every day.

That’s why Psych Central — and the over 350,000 Americans we represent — is against the Helping Families in Mental Health Crisis Act. Instead of simply providing what’s needed — more money and resources to states with no strings attached — it seeks to force a particular patient-hostile ideological agenda down everybody’s throat. While parts of it deserve passage, taken as a whole, it’s a bad bill that deserves to die.

Footnotes:

  1. SAMHSA has little say in how this money is proportioned []
  2. You know, the one guild he was personally interested in, since he himself is a physician. []
  3. It gets even worse, where they argue about whether a painting valued at $22,000 was also ‘worth it.’ []
  4. Which, today, has only 72 co-sponsors, compared to the 274 co-sponsors the Paul Wellstone Mental Health and Addiction Equity Act of 2007 had. []