The Washington Post’s lead editorial Monday was a strong endorsement of Rep. Tim Murphy’s Helping Families in Mental Health Crisis Act, H.R. 2646, which calls for major changes in how future mental health services would be delivered. The House Energy and Commerce Subcommittee on Health will begin markup hearings on Murphy’s bill, starting today (Tuesday November 3) at 3 p.m. in room 2123 of the Rayburn House Office Building for opening statements only.  The subcommittee will reconvene on Wednesday, November 4, at 10 a.m. in 2123 Rayburn to consider amendments to the bill.

Wednesday’s hearing is important because other committee members will offer specific amendments as the bill is read, one section at a time. This is when critics of the bill have an opportunity to amend the sections they don’t support.  You will remember that Democrats kept Murphy’s bill bottlenecked in committee because of complaints from Curtis Decker, executive director of the National Disability Rights Network, the National Empowerment Center, Mental Health America, and the Bazelon Center For Mental Health Law.

With 156 co-sponsors,  H.R. 2646 is being supported by the National Alliance on Mental Illness (NAMI), Treatment Advocacy Center, American Academy of Child and Adolescent Psychiatry, American Psychological Association and American Psychiatric Association.

Murphy (R-PA.) recently told attendees at a breakfast sponsored by the International Bipolar Foundation, which supports his bill, that opponents were spreading misinformation to scare persons with mental illnesses. One of Murphy’s strongest supporters, D.J. Jaffe, founder of  Mental Illness Policy Org ,wrote on his website that federal mandated Protection and Advocacy groups and consumer groups who get the bulk of their funding from SAMHSA had written misleading letters to members of Congress about Murphy’s bill.

Supporters of the bill are being asked to call key members whose names and numbers are at the end of this blog.  If you are familiar with Congress, you will recognize that members depend heavily on their staff’s to tell them what is actually in bills that they are being asked to vote on. Consequently, some members don’t understand the complexities of Murphy’s bill.

The most controversial sections of his bill are calls for modifying HIPAA, rewarding states that implement Assisted Outpatient Treatment, restructuring SAMHSA, prohibiting lobbying by federally mandated Protection and Advocacy groups, and requiring programs to be evidence based to continue receiving funding. Murphy believes these changes will refocus the federal government’s attention on the most seriously mentally ill and remove impediments that keep families from intervening to help a loved one.

There is a companion bill making its way through the Senate co-authored by Sens. Chris Murphy (D. Conn.) and Bill Cassidy (R. La.) but it takes a more limited approach to SAMHSA reform than Murphy’s and leaves out the provisions related to AOT (assisted outpatient treatment) that are a mainstay of Rep. Murphy’s bill, opting instead for policies that promote psychiatric advanced directives and assertive outreach programs to engage patients in treatment.

Rep. Murphy launched his bid to overhaul mental health services after the Newtown shootings and has been tirelessly pushing his bill forward.  There are still many steps to go after markup but for supporters of his legislation, this is a major move forward. “We hope to be able to pass comprehensive mental health reform this Congress,” Murphy told The Washington Post.

I expect Wednesday’s markup hearing to spark fireworks.

Here’s a list of key House members: Gene Green (TX), Ranking Member 202-225-1688

Doris O. Matsui (CA)- 202-225-7163

Lois Capps (CA) 202-225-3601

G. K. Butterfield (NC) 202-225-3101

Eliot L. Engel (NY) 202-225-2464
Jan Schakowsky (IL) 202-225-2111
Kathy Castor (FL) 202-225-3376
John Sarbanes (MD) 202-225-4016
Ben Ray Lujan (NM) 202-225-6190
Kurt Schrader (OR) 202-225-5711
Joseph P. Kennedy, III (MA) 202-225-5931
Tony Cardenas (CA) 202-225-6131
Joseph Pitts (Chair Health Subcommittee) PA16(R)202-225-2411
Michael. C. Burgess (TX) 202-225-7772

 

Movement on mental-health care

By Editorial Board The Washington Post

MASS SHOOTING after mass shooting, Democrats call for more gun regulations while Republicans stress the importance of improving mental-health care. Both are necessary. Yet the depressing result of this partisan routine has been that nothing happens on either issue.

That might soon change, at least on the mental-health front. Solid, bipartisan mental-health bills are poised to move in both chambers. They should be passed, reconciled and signed into law.

The House’s version is the stronger of the two. Championed by Rep. Tim Murphy (R-Pa.), it would start by reforming the way Medicaid treats mental-health care, making it easier to reimburse hospitals for treatment and removing a rule blocking payment for mental and physical health care delivered on the same day. It would then offer more money to states that adopt “assisted outpatient treatment” — essentially, mandatory care for people with severe mental illnesses, such as schizophrenia, monitored outside mental-health facilities. It would relax privacy standards that have served to keep families dangerously in the dark about the condition of their sick loved ones. It would insist the federal money go to programs that have some evidence to suggest they would help those with mental illness. And it would invest in community mental-health centers.

Some advocates for those with mental illness dislike the bill, arguing that forcing people into treatment is unduly coercive and that the government should stick to the sort of assistance many people really need, such as housing aid. Yet the whole point is to help people most in need — the severely mentally ill, particularly those who may not understand they have problems. These people may not be willing to take necessary medications or accept housing subsidies, and their families might not know much about their illnesses. The state has good reason to step in.

There are still several outstanding questions for lawmakers to work out. Among them is how to merge the House version with the Senate’s, which focuses more on funding several grant programs than on pressing for things such as assisted outpatient treatment. The question of how much to tell families is also open, though lawmakers appear to be wisely steering clear of opening therapy notes or reducing penalties on doctors who break patient confidentiality. Lastly, there is the issue of cost. Removing barriers to mental-health care coverage in Medicaid, for example, could well cost large amounts of money. It’s unclear if lawmakers will be able to keep costs manageable or to find additional funding to offset the price tag.

Any of these issues could sink the bill somewhere in the legislative process. That would be a shame. The Affordable Care Act has gone a long way to increase access to mental-health services in a landmark moment for psychiatric care. But the government has every reason to insist that the billions it spends on mental-health services are well-targeted and effective.