Rep. Tim Murphy is back and here to help the families of people with mental health concerns — but not necessarily the patients themselves. And this time he’s pitching his Helping Families in Mental Health Crisis Act of 2015 (HR 2646) as a “new and improved” version of the same bill he introduced in 2013.
I wish I could say the bill is a more actually a better, more refined vision of the 2013 act. But despite some advances and changes made in it, it still has some major issues — issues that mean it is still problematic to pass it as written today.
According to Politico, the new bill has been softened:
The new bill no longer requires states to have court-ordered treatment programs for the seriously mental ill with a history of medication non-compliance in order to receive certain federal grants [called AOT]. He’s replaced that with an incentive program allowing states to get a 2 percent boost on their SAMHSA block grants if they set up the programs.
Murphy has also tightened his proposed revisions to HIPAA — the new version narrows who can get patient information in cases where patients pose threats to themselves or others — and exactly what information they can get.
Finally, the latest version no longer slashes funding for protection and advocacy activities.
These are all good things — much-needed improvements that address some of the concerns I raised regarding the original bill. The mandated assisted outpatient treatment (AOT) for the states in the original bill made that bill a non-starter.
HIPAA Privacy? Share Mental Health Information with Your Family!
Is discrimination and prejudice still alive when it comes to mental illness? You bet, and you need look no further than the new revision of this bill. While the HIPAA privacy violations have indeed been toned down, they are still there — with a bunch of completely subjective, unscientific conditions that could be interpreted in any way a physician deems fit.1
Imagine that this was a cancer bill being proposed instead, and it too had HIPAA privacy violations, letting any family member access to your cancer medical records without your consent. Wouldn’t people get very angry and up-in-arms about such violations?
Yet when it comes to mental illness, some lawmakers still believe it’s okay to discriminate against people with these conditions. And that under circumstances which are not at all very specific or well-prescribed, your protected healthcare information could be released to a family member without your explicit permission.
Why Do We Need Even More Bureaucracy?
For whatever reasons, Rep. Tim Murphy wants to do away with SAMHSA. Maybe he doesn’t agree with its mission, or its current head, Administrator Pamela Hyde. But because Murphy can’t fire Hyde, he’s just going to spend tens of millions of taxpayer dollars into creating a brand new agency that has the exact same responsibilities as SAMHSA. Yeah, that makes sense — to absolutely no one outside of DC.
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. All of SAMHSA’s assets get transferred over to this new office and agency. And Hyde is out of a job.2
This makes no sense — except for someone who has a vendetta against a government agency. Which, by all accounts (outside of the Beltway), SAMHSA has done a pretty darned-good job in the more than two decades it’s been around.
The new office will also establish a new federal bureaucracy — the National Mental Health Policy Laboratory (NMHPL) — that will be charged with conducting research on grantees, and establishing national mental health policy.
It appears that grants will only be given to those utilizing evidence-based practices and must focus on people with “serious” mental illness. Everything from here on out is to be data-driven. So any of those SAMHSA programs that helped people in things that don’t have science behind them, or can’t quantify their results? Gone.
Until the Vendetta is Given Up…
Much of what Murphy proposes can largely be rolled out within existing agencies. If you’re conducting research, why aren’t you proposing to do that under the National Institute of Mental Health. You know, the federal agency already charged with leading the research effort into mental illness? How hard would it be to give them additional duties and budget, to work with an existing infrastructure (instead of creating this redundant National Mental Health Policy Laboratory)?
SAMHSA has been doing a good job for 23 years. It’s not time to end the agency, but rather expand it. If you think it has problems, suggest reforms for the current agency — not a replacement for it. Murphy’s bill would end SAMHSA — for no good reason — and put new restrictions on its mental health block grants to the states.
Until ends his apparent vendetta against SAMHSA and its current head, it’s unlikely this bill will enjoy any more traction or forward movement than his failed 2013 attempt. Because most people see this for what it really is — a shameless power grab.
For further reading…
Children’s Mental Health Network: The ‘Murphy bill’ (H.R. 2646) fails its own home inspection
Western Mass Recovery Learning Community: The Murphy Bill: Take 2
- This is the part of the bill where you can clearly understand that the lobbyists and staffers who wrote it are hypocrites. While decrying elsewhere in the same bill about the need for “evidence-based” interventions, in the HIPAA component, they say things like, “The information to be disclosed will be beneficial to the treatment of the individual” and is “necessary for the continuity of care” and “will contribute to a worsening prognosis.” No doctor can say with any certainty about any of these things — or whether a disclosure would help with a person’s care or not. These are squishy statements made to seem like there are a lot of conditions on a HIPAA protected healthcare information release — when in fact, there are not. [↩]
- Strangely, the new name of the agency will be “Mental Health & Substance Use Disorders” or MHSUD. It’s like they didn’t even think of what its acronym might spell — it sounds like “Mushed.” [↩]