Murphy Introduces Revamped Mental Health Bill: Will It Fly This Time Around?

114TH CONGRESS 1ST SESSION

IN THE HOUSE OF REPRESENTATIVES Mr. MURPHY of Pennsylvania introduced the following bill to make available needed psychiatric, psychological, and supportive services for individuals with mental illness and families in mental health crisis, and for other purposes.

Rep. Tim Murphy (R-Pa.) introduced a new version of his Helping Families In Mental Health Crisis Act on Thursday (June 4^rd ) and it contains compromises aimed at appeasing critics while keeping changes that should please his initial supporters.

I’ve read the 173 page bill twice and have asked for reactions from NAMI’s top lobbyist, Mental Health America, the Treatment Advocacy Center, the Bazelon Center For Mental Health Law, and the National Disabilities Rights Network. I also exchanged emails with D. J. Jaffe at Mental Illness Policy.Org. who testified before Murphy’s subcommittee and has been one of Murphy’s strongest backers. Jaffe was especially helpful in explaining parts of the bill to me. However, any mistakes that follow in this rushed review are my own.

Here’s a quick analysis of what Murphy, along with Rep. Eddie Bernice Johnson (D-Tx) have reintroduced. You can read the bill on your own here.

1. Rather than gutting the Substance Abuse and Mental Health Services Administration (SAMHSA) by shifting its funding to the National Institute of Mental Health, the new bill will move responsibility for mental health care and funding under the direction of an Assistant Secretary for Mental Health and Substance Abuse Treatment within the Department of Health and Human Services. It would require the new secretary be a medical doctor (psychiatrist) or PhD psychologist with practical experience. One of Murphy’s complaints about SAMHSA is that it is being run by an attorney not a mental health expert. According to  Dr. E. Fuller Torrey, who has been a strong backer of Murphy’s bill, SAMHSA recently did not have a single psychiatrist on its staff.
2. Rather than targeting particular SAMHSA funded programs for elimination, which Torrey and other critics have claimed are frivolous, the new bill would tighten funding criteria. Money could only be spent on programs that were recognized as “evidence based” practices as opposed to ones that are popular but not backed by credible evidence.
3. In his initial bill, Murphy threatened to block federal funding to states that didn’t adopt Assisted Outpatient Treatment laws. In his new version, states that implement AOT will be rewarded with a two percent increase in block grant funding but no state would be required to adopt AOT statutes.
4. Murphy originally proposed modifying HIPAA so that caregivers, including parents, could obtain information about a loved one who is hospitalized because of a mental disorder even if the patient doesn’t want information shared. The new bill would modify HIPAA but restrict what information could be shared, whom it could be shared with, and when it could be shared. Diagnoses, treatment plans and information about medications could be released to a caregiver when it was deemed in the patient’s best interest, but not personal psychotherapy notes.
5. Current federal law imposes a 16-bed limit for inpatient beds. This limit was designed to prevent states from re-opening large hospital warehouses. The Feds refused to allow Medicare and Medicaid payments to larger than 16 bed facilities. Murphy’s bill would repeal the so-called IMD exclusion as long as a facility kept patients less than 30 days.
6. One big change in Murphy 2.0 deals with changing the Protection and Advocacy for Individuals with Mental Illness Act (PAIMI programs.) The federal government funds Protection and Advocacy agencies in each state to safeguard the rights of persons with mental illnesses and disabilities. Murphy initially wanted to gut the PAIMI program by stripping its funding. Rather than getting rid of PAIMI, the new bill would limit the powers of PAIMI advocates by restricting their authority. They would only be permitted to investigate cases of abuse and neglect and would be specifically banned from lobbying public officials and from “counseling an individual with a serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of such individual’s caregiver.” That sentence is aimed at William Bruce situations where a PAIMI advocate told Joe Bruce’s son, William, what to say in order to be discharged even though his medical team considered him unstable. William was released and murdered his mother.
7. Murphy adopted a provision from the Democrats’ poison bill introduced last session to bottleneck his legislation. It would eliminate the 190 day lifetime cap on inpatient psychiatric hospitalizations in Medicare.
8. In another concession, Murphy encourages funding and support for peer-to-peer programs, but his bill would set standards for peers and require their work to be monitored by a professional mental health practitioner.

Of course, there lots more in the bill, including funding programs to prevent suicide among school age children.

One item missing — at least I can’t find it — is a requirement in the original bill that would have forced states to replace the “dangerous to self or others” criteria that is the current standard that has to be met before someone can be involuntarily hospitalized. I testified before Murphy’s committee in favor of adopting a “need for treatment standard” because I believe no one can predict dangerousness and waiting until someone is dangerous is foolhardy. As mentioned, it appears to have been dropped. (Someone correct me if I am wrong.) 

The other major mental health legislation gaining steam in Congress is the Comprehensive Justice and Mental Health Act that Sen. Al Franken (D-Minn.) pushed through the Senate Judiciary Committee recently. It would fund prison and jail diversion programs by giving states money to adopt sequential intercept models and create mental health courts. On June 2^nd, Rep. Murphy and two of his colleagues introduced a bipartisan amendment to an appropriations bill that would channel $2 million in new funds to states for CIT training and mental health courts.

Everyone is jumping on the CIT, Jail Diversion and the Mental Health Courts bandwagon in Congress. But will that enthusiasm carry over to Murphy’s revamped bill?

In off-the record chats and emails, opponents of Murphy’s bill told me they don’t believe this new version is any better than the original one. They intend to oppose it.

That doesn’t mean that Murphy and his supporters will not be able to get this modified bill out of committee and onto the House floor for a vote. Because of the Newtown shootings, Congress is feeling pressure to do something about our badly broken system. As I mentioned in a blog published Monday, 61 mental health related bills have been introduced this session.

Whether you agree or disagree with Rep. Murphy, you have to acknowledge that he has been resolute in his determination to change how mental health care is being delivered in our nation. He has especially been eager to hear from parents and other caregivers about their concerns. And he has been willing to meet with those who oppose his views. Only a few hours before introducing his reworked bill, Murphy was scheduled to address Mental Health America’s national convention in Alexandria, Virginia. MHA, which was founded by former patients who had been abused in state hospitals, and is the largest grassroots mental health group composed of persons with mental disorders, testified against Murphy’s original bill.