H.R. 2646 Passes out of Committee

On June 15th, H.R. 2646 (“Murphy Bill”) passed out of the House Energy and Commerce Committee.

As the Autistic Self Advocacy Network (ASAN) points out, this is cause for concern:

Despite recent revisions, H.R. 2646 continues to focus on interventions that isolate and stigmatize people with mental health disabilities. It was not only written without significant participation by people with mental health disabilities but also would exclude people with mental health disabilities from positions of leadership in mental health programs.

  • H.R. 2646 would create new administrative burdens for home health care and personal attendant services for people with disabilities.
  • H.R. 2646 would subsidize long-term institutionalization of children and young adults.
  • H.R. 2646 would not ensure that people with psychiatric disabilities are represented in the programs that it would authorize.
  • H.R. 2646 promotes outdated ideas about the capacity of individuals with mental health disabilitiesincluding its apparent promotion of plenary guardianship for individuals with mental health disabilitiesand makes no mention of available alternatives to guardianship, such as supported decision-making.
  • The draft bill would urge the Department of Health and Human Services to revisit (or “clarify”) its existing HIPAA regulations in a way that could potentially expand access to protected health information without the consent of a person with a mental health disability.

Read the full press release here.

Call to Action: HR 2646 Markup This Week

TIME SENSITIVE! Call or write before 5:00 pm on Tuesday, June 14, 2016.

The most current draft of the Murphy Bill, HB 2646, will be addressed by the House Energy and Commerce (E&C) Committee next Wednesday, June 15, 2016.

If your House representative is on the E&C Committee CALL THEIR HOME OFFICE by the end of Tuesday, June 14. (Instructions on how to find your Rep and who to call are at the end of the announcement.)

WHETHER YOU HAVE A REP ON THE COMMITTEE OR NOT, please call the Washington offices of Chairman Fred Upton and Ranking Member Frank Pallone. Here is their contact information:

Fred Upton (R, MI), Chairman

Frank Pallone, Jr. (D, NJ), Ranking Member

LEAVE A MESSAGE stating you are strongly opposed to Murphy Bill HB 2646 and you want them to vote against it on June 15, 2016.

Below are the key points for opposing the bill. More details are at our website.

Press release from NCMHR on this proposed legislation.

The National Coalition for Mental Health Recovery is strongly opposed to HR 2646, the Helping Families in Mental Health Crisis Act of 2016, for the following reasons:

Continues to weaken the Substance Abuse and Mental Health Services Administration by creation of unnecessary oversight by an Assistant Secretary for Mental Health. SAMHSA has been indispensable in supporting the recovery of individuals with mental health conditions.

Would violate civil rights by authorizing new funding for assisted outpatient treatment, despite the lack of evidence that mandated outpatient treatment is effective.

Would expand Medicaid funding for institutions, rather than putting the money into evidence-based services in the community, as has been mandated by the Supreme Court’s Olmstead decision.

The crisis in mental health care has been painted as a problem of “undeserved” rights. It is, in fact, a problem of grossly inadequate resources that are poorly allocated. Consumer-driven services in the community complement traditional mental health programs with highly effective outcomes that are significantly less expensive than other forms of community care. We recommend language and funding for peer support specialist grant programs and other consumer-driven supports.

More than 50 years after deinstitutionalization, mental health systems across the country are still unable to provide the appropriate care in the community that was promised long ago. Time and again, research has proven that the public perception of the relative “dangerousness” of people with mental health conditions is unfounded. Sensationalized, distorted media coverage and the sustained influence of some stakeholders have fueled arguments for forced treatment and an overly medicalized system of care. The march toward re-institutionalization and coercive care is abhorrent. Having a mental health condition does not constitute a life sentence to poverty, marginalization, aberrant behavior or an inability to become a fully functioning citizen who can contribute meaningfully to his/her community. We know that recovery is possible because we are the evidence.

Who needs to be called? Members of the House Energy and Commerce Committee should be called by their constituents:

Not sure who your representative is? Go to this link and type in your zip code:

An icon for your representative will appear, and you should be able to locate their contact information. If you prefer email, use the address provided on your representative’s page.

However, THE BEST IMPACT will come from calls to the home district offices. The staff at the home offices will communicate with the DC staff accordingly.

Don’t see your representative on the Energy and Commerce Committee? That’s okay, you can still help by calling the Washington, DC offices of the Chairman and Ranking Member and sharing your views:

Chairman Fred Upton (R, MI)

Ranking Member Frank Pallone, Jr. (D, NJ)

TIME SENSITIVE! Call or write before 5:00 pm on Tuesday, June 14, 2016.

Senate Markup of Mental Health Bill Today! Watch it Live

Most progressive mental health groups are supporting this version of the Senate bill, as it does not include the rights and dignity violations in the House version.

Markup of Mental Health Reform Act of 2016

Wednesday, March 16, 2016, 10:00 AM

Link to Webcast – should go live approximately 15 minutes prior to the mark-up.

Senate discussion draft bill – announcement from HELP Committee
Bill is link at the bottom of announcement.

Summary of draft
Full text of the draft

Press on the bill
The Hill: Here is a link to an article that reports that the author of proposed mental health legislation in the House has criticized the bipartisan U.S. Senate bill.

Morning Consult – Rep. Murphy Hits HELP Committee’s Mental Health Bill

Roll Call: Amid ‘Crisis,’ Senate Bill Seeks Boost Access to Mental Health Care

The Tennessean: Lamar Alexander Takes on Mental Health ‘Crisis’ (Real MH Change quoted here)

Thank you to the National Disability Rights Network for compiling this information.

What you can do:
We invite you to engage on social media during the markup, if you cannot be there in person. Let these committees know what you think of the conversation and what should and should not be a part of mental health legislation. Please use the hashtag #realmhchange. We will be Tweeting from @realmhchange.

Tweet your thoughts to the HELP Committee:

(Ranking Member)




Leave a comment

109 Groups Urge Congress to Oppose the Murphy Bill

Please share this letter widely, which was written by the Leadership Conference on Civil and Human Rights and signed on to by a massive array of groups.

March 8, 2016

The Honorable Fred Upton
Chair, House Committee on Energy and Commerce
United States House of Representatives
2183 Rayburn House Office Building
Washington, DC 20515

The Honorable Frank Pallone, Jr.
Ranking Member, House Committee on Energy and Commerce
United States House of Representatives
237 Cannon House Office Building
Washington, DC 20515

Oppose the “Helping Families in Mental Health Crisis Act of 2015” (H.R. 2646)

Dear Chair Upton and Ranking Member Pallone:

On behalf of The Leadership Conference on Civil and Human Rights, a coalition charged by its diverse membership of more than 200 national organizations to promote and protect the civil and human rights of all persons in the United States, and the 109 undersigned organizations, we write to urge you to oppose H.R. 2646, the “Helping Families in Mental Health Crisis Act of 2015.”

We believe that this legislation will result in outdated, biased, and inappropriate treatment of people with a mental health diagnosis. There are a number of troubling provisions including those that would:

• End innovative or newly created programs;
• Require involuntary outpatient commitment, creating an adverse effect on the work being done to provide community based treatment and peer-to-peer services, particularly affecting African Americans, who are overrepresented in forced outpatient treatment programs;
• Reduce the privacy protections of confidential health information for persons with mental illness; and
• End the important work of the Protection and Advocacy for Individuals with Mental Illness (PAIMI), a program that positively impacts millions of individuals with psychiatric disabilities by working with individuals, families, and the police to foster better understanding and relationships.

While we agree that there is a clear need to update the current mental health services system, especially for communities of diverse backgrounds, we have significant concerns with several of the provisions set forth in H.R. 2646. The legislation will cause serious harm to many of the programs used in the community that provide support and services to people with psychiatric disabilities. We ask that you oppose the bill until these concerns are addressed.

The current formulation of H.R. 2646 will function to eliminate basic civil and human rights protections for those with mental illness. We urge you to oppose this legislation and to move forward with mental health legislation that strengthens and improves many of the current programs working to change lives as well as protect the civil and human rights of persons with psychiatric disabilities.

Thank you for your consideration. If you have any questions, please feel free to contact Lisa Bornstein, Legal Director, at or .

Respectfully submitted:

The Leadership Conference on Civil and Human Rights
ADAPT Montana
Advocates For Children of NY
African Caribbean American Parents of Children with Disabilities, Inc.
Alyssum Inc
American Association of People with Disabilities (AAPD)
American Civil Liberties Union (ACLU)
American Federation of Teachers (AFT)
American Foundation for the Blind (AFB)
Amnesty International USA
Another Way Inc.
The Arc of the United States
Asian Americans Advancing Justice – Los Angeles
Asian Pacific American Labor Alliance, AFL-CIO (APALA)
Association of University Centers on Disabilities
Autistic Self Advocacy Network
Bazelon Center for Mental Health Law
Behavioral Health & Wellness
Campaign for Real Change in Mental Health Policy
Center for Disability Rights (NYS)
The Center for Exceptional Families, Inc
Centro Margarita
Coalition for Mental Health Reform
Connecticut Legal Rights Project, Inc.
Crump Attorney’s at Law
Delaware Family Voices
The Daniel Initiative
Disability Policy Consortium
Disability Rights Education & Defense Fund (DREDF)
Empowerment Temple AME
Exceptional Children’s Assistance Center (NC)
Family Connection of South Carolina
Family Network on Disabilities
Family Voices Colorado
Family Voices Indiana
Family Voices of California – State Affiliate Organization of Family Voices
Family Voices of NJ
Family Voices of Tennessee
Federation for Children with Special Needs
Federation of Families of South Carolina
Focus On Recovery -United
Georgia Mental Health Consumer Network
Grassroots Empowerment Project
Human Rights Campaign (HRC)
Individual Citizen
Iu-Mien Community Services
KEY Consumer Organization, Inc.
Korean American Resource and Cultural Center
Korean Resource Center
Lambda Legal
Maine Parent Federation, Inc.
Mommieactivist and sons
MS Family2Family HIEC
National Association for the Advancement of Colored People (NAACP)
NAMI Connecticut
National Asian Pacific American Families Against Substance Abuse
National Association of County Behavioral Health and Developmental Disability Directors
National Association of Rights Protection and Advocacy (NARPA)
National Association of the Deaf (NAD)
National Bar Association
National Center for Transgender Equality
National Coalition Against Domestic Violence
National Coalition for Mental Health Recovery
National Council of Churches
National Council on Independent Living (NCIL)
National Disability Rights Network (NDRN)
National Down Syndrome Congress (NDSC)
National Fair Housing Alliance (NFHA)
National Juvenile Justice Network (NJJN)
National Korean American Service and Education Consortium
National Legal Aid and Defender Association (NLADA)
National LGBTQ Task Force Action Fund
The National Network for Arab American Communities
National Network to End Domestic Violence
National Partnership for Women & Families
National Women’s Law Center (NWLC)
New Jersey Parents Caucus, Inc.
New York Association of Psychiatric Rehabilitation Services
Not Dead Yet
Oklahoma Parents Center
Oregon Consumer Survivor Coalition
Oregon Mental Health Consumer and Psychiatric Survivor Coalition
Paralyzed Veterans of America
Parent Educational Advocacy Training Center
Parent to Parent of Georgia
Parent to Parent USA
The Parents’ Place of Maryland
Partners Resource Network TEAM Project
PEAL Center
Pennsylvania Mental Health Consumers’ Association
Pyramid CPRC
Southeast Asia Resource Action Center
Statewide Parent Advocacy Network (SPAN)
Transformative Justice Coalition
Treatment Access Expansion Project
Treatment Communities of America
United Spinal Association
United We Stand of New York
Vermont Family Network
Vermont Psychiatric Survivors, Inc.
Western Mass Recovery Learning Community
Women Who Never Give Up

Cc: House Education and Workforce Committee Leadership – Chair John Kline and Minority Leader Representative Robert C. “Bobby” Scott
House Ways and Means Committee Leadership – Chair Kevin Brady and Minority Leader Sander M. Levin

LGBT Organizations Oppose the Murphy Bill (H.R. 2646)!

Rainbow_flag_breezeFriends in both the disability and the LGBTQ advocacy communities:

Below is the following statement sent today to members of Congress on behalf of various LGBTQ organizations against H.R. 2646, Helping Families in Mental Health Crisis Act (the Murphy Bill).

January 28, 2016

To Whom It May Concern:

On behalf of the undersigned organizations, which advocate on behalf of lesbian, gay, bisexual and transgender (LGBT) communities, we wish to express our opposition against H.R. 2646, the Helping Families in Mental Health Crisis Act. While our nation’s mental health system is in dire need of reform, H.R. 2646 is not the answer. Although a few of the proposed reforms in this bill have the potential to positively impact the lives of some individuals with psychiatric disabilities and should be incorporated into alternative legislation, many of the current bill’s provisions would cause irreparable harm to both our mental health system and to many Americans with psychiatric disabilities—including many LGBT individuals. LGBT individuals are disproportionately affected by mental illness, face pervasive discrimination in health care settings and can experience unique vulnerabilities when denied privacy or decision-making power in their treatments.

LGBT individuals may be disproportionately impacted by H.R. 2646.

In the face of systemic discrimination, stigma and lack of access to culturally competent health care, the LGBT community experiences significant health disparities, including high rates of mental illness. LGBT individuals are more likely to experience depression, anxiety and suicidal behavior and ideation. For example, the 2011 National Transgender Discrimination Survey reported that 41 percent of transgender respondents had previously attempted suicide—a stark contrast to the national suicide attempt rate of 1.6 percent. Studies have also consistently shown that lesbian, gay and bisexual adults face an increased risk of suicidal ideation and attempts, with their lifetime prevalence of suicide attempt estimated to be between two and four times higher than that of their heterosexual counterparts. These indications of mental health outcomes suggest that LGBT people face higher rates of certain mental health conditions, and may therefore be disproportionately impacted by H.R. 2646.

As currently written, this bill could also apply to a significant number of transgender people regardless of whether they are experiencing an ongoing mental health crisis. H.R. 2646 applies to “individuals with serious mental illness,” defined as individuals whose conditions meet diagnostic criteria under the DSM-5 and substantially interfere with a major life activity. A natural reading of this definition would include gender dysphoria, a DSM-5 diagnosis applicable to many (though not all) transgender people, when it is severe enough to interfere with a major life activity. We are concerned that the bill, if enacted, could be interpreted to authorize the infringement of transgender individuals’ medical privacy or decision-making power based on their diagnosis of gender dysphoria, or allow health care providers to disclose treatments connected with gender dysphoria (such as hormone therapy, surgical procedures or changes in social roles) regardless of whether they are directly relevant to an ongoing mental health crisis.

Infringements on privacy and decision-making power may endanger the wellbeing of LGBT individuals.

H.R. 2646 would create a special exception to the confidentiality protections established by HIPAA and FERPA that singles out people with psychiatric and developmental disabilities. The bill would exclude such individuals by authorizing health care providers to disclose critical information about an individual’s diagnosis, treatment plan and medications to family members, with almost no meaningful and objective safeguards against abuse or misapplication of the rule. Under this bill, an individual would have no right to identify the appropriate caregivers who should be involved in their care or choose which family members are given access to their medical information.

For many LGBT individuals, this erosion of privacy can have counterproductive and dangerous consequences. While the number of supportive families has steadily grown, family members of many LGBT individuals continue to struggle to understand or accept their sexual orientation or gender identity. For example, 57% of transgender respondents in a national study reported experiencing family rejection because of their gender identity.7 Family rejection can exacerbate an individual’s mental health concerns and place them in harmful conditions: they may have family cut off contact with them, be kicked out of their homes, be cut off from financial support, or be subjected to abuse and violence.

Consequently, many LGBT individuals choose to delay coming out to their families or avoid coming out at all, and may, for example, enter into same-sex relationships or begin transitioning without their family’s knowledge. This bill could potentially strip many LGBT individuals of the power to decide whether, when or how to come out to their families. For example, the bill could allow a mental health professional or paraprofessional to disclose to unsupportive family members a transgender individual’s diagnosis of gender dysphoria, their treatment plan, and any related medications, such as hormone therapy, that they take to treat their gender dysphoria. Disclosing this information against a transgender individual’s consent can wreak havoc on their lives at a time when they are particularly vulnerable and empower misguided or even abusive attempts by their families to interfere with their transition-related care.

H.R. 2646 can force LGBT people into treatment that is ineffective, harmful or discriminatory.

H.R. 2646 would condition huge block grants upon states enacting particular types of Involuntary Outpatient Commitment (IOC) statutes, under which a court can order an individual to follow a judge’s treatment plan, such as taking specific medications, attending medical appointments or refraining from associating with certain individuals.

We believe that the expanded reliance on coercive treatment is an inappropriate solution to the problems in our mental health system, in part because it is grounded in the assumption that available mental health services are likely to be nondiscriminatory, affirming and effective—an assumption that does not hold true for much of the LGBT community. Many LGBT people struggle to find affirming mental health care that understands their unique needs and respects their gender identities or sexual orientations. For example, transgender patients frequently find that mental health providers lack a basic understanding of needs related to gender dysphoria and fail to provide them with the care that they need.9 In many cases, mental health professionals have reacted to their patients’ gender identity or sexual orientation with hostility, turned them away, subjected them to harassment and abuse, and even traumatized them through conversion therapy or other discredited attempts to change their gender identity. The expansion of involuntary outpatient commitment may be particularly harmful for LGBT people of color: studies suggest that people of color are disproportionately admitted to IOC programs, and face a range of barriers to culturally competent and nondiscriminatory care. This problem may be compounded by the fact that many IOC statutes rely on police to enforce court orders and lead to more contacts with the criminal justice system.

When so much of the available care is based on an insufficient understanding of the needs of LGBT individuals, or is discriminatory or actually harmful, it is critical that LGBT people have as much control as possible over their mental health treatment and retain the ability to opt out of hostile or unsafe therapy settings. With few effective safeguards to protect vulnerable individuals in the mental health system, programs that strip LGBT people of control over their health care are often unnecessary, ineffective and potentially dangerous.

H.R. 2646 limits advocacy and research critical for LGBT people.

H.R. 2646 would hamstring the civil rights and nondiscrimination protections of the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program, the largest network of legal service providers for Americans with disabilities. PAIMI currently addresses thousands of complaints each year about abuse, neglect and civil rights violations in the provision of mental health care. This bill would require PAIMI agencies to focus exclusively on protecting individuals from abuse and neglect and prevent them from investigating and seeking remedies for civil rights violations. In light of the rampant discrimination and civil rights violations that LGBT and other individuals with disabilities still face in medical settings, this severe restriction on PAIMI’s jurisdiction can deny them access to advocacy services essential to their ability to obtain safe and lawful treatment.

H.R. 2646 further intends to eliminate SAMHSA, which has been an important resource for advancing the behavioral health and wellness of individuals with mental illness, including the LGBT population, for over 24 years. By replacing SAMHSA with an Assistant Secretary for Mental Health and Substance Use Disorders, a portfolio with a dramatically narrower mandate, H.R. 2646 would end support for many public health initiatives addressing the full range of LGBT health needs and concerns.

We applaud Members of Congress for their recognition of the urgent need to reform our mental health system: millions of Americans are living with mental health conditions without access to competent, nonstigmatizing and affordable care. H.R. 2646, however, would do more harm than good. It perpetuates stigmatizing stereotypes about people with psychiatric and developmental disabilities and would strip them of civil rights protections for which disability justice advocates have fought for decades, with particularly dangerous consequences for vulnerable populations such as LGBT communities.

The undersigned organizations therefore stand with numerous other social justice organizations to oppose H.R. 2646, and we encourage you to join a growing number of your colleagues in doing the same.

We welcome the opportunity to discuss the impact of H.R. 2646 on members of the LGBT community. For more information, please contact:

Victoria M. Rodríguez-Roldán
Policy Counsel and Trans/GNC Project Director,
National LGBTQ Task Force Action Fund

Ma’ayan Anafi
Policy Counsel, National Center for Transgender Equality


American Civil Liberties Union
Gay & Lesbian Advocates & Defenders
National Black Justice Center
National Center for Lesbian Rights
National Center for Transgender Equality
National LGBTQ Task Force Action Fund
National Queer Asian Pacific Islander Alliance
Transgender Law Center

ACTION ALERT: “The Mermaid” Film Promotes Stereotypes and Force

sdavidowBy Sera Davidow

It’s Murphy Bill season, and every last article, video and sound bite that’s circling counts in the court of public opinion. Tim Murphy reportedly has admitted that manipulation of information for public consumption is a necessary evil in order to push his agenda. Apparently he feels his self-righteous cause justifies his means. But, the swirl of misguided media leaves the rest of us needing to be all the more attentive to the messages flying around.

Unfortunately, Murphy has plenty of unwitting subjects to further his desired message, and one of them is Italome Ohikhuare who wrote and produced ‘The Mermaid’. ‘The Mermaid’ is a about a young woman and her relationship with her brother who is diagnosed with schizophrenia. It is reportedly based on Italome’s real-life experiences with her real-life brother, for whom she claims this piece is a ‘gift’.

The film is an unfortunate 13-minute advertisement for Involuntary Outpatient Commitment (aka Assisted Outpatient Treatment, AOT, or Murphy’s favorite pet), that attempts to paint itself as a “moving love story about a young woman torn between her blossoming relationship with her boyfriend and her chaotic but endearing relationship with her brother.”

‘Love’ is the furthest thing from my mind as I watch the main character (Sirah) interacting with her boyfriend (Jay) who’s attempting to manipulate her into bed, or her violent and erratic brother (Deji) who she screams repeatedly “just needs his pills.” In fact, this film is troubling at many levels both from a standpoint of racism and psychiatric oppression. Here’s a brief list of the whys:

  • The film re-enforces dangerous racial stereotypes: Deji is a young black man *wearing a hoodie* and is repeatedly painted as violent and frightening, particularly toward Jay (who is a white man). There is little that could make this film any less racially sensitive given today’s climate.
  • Except this: Jay (the white, professionally dressed lawyer boyfriend who is physically attacked by Deji) rescues him from drowning at the end of the film.
  • The film promotes significant misunderstandings about how psychiatric drugs work in both the short and long-term: Sirah screams (more than once) that Deji will be alright if he just gets his pills. However, unless we’re speaking of tranquilizer darts (or other heavy sedatives) and unless we’re defining ‘alright’ as ‘incapacitated by sleep’, there is no pill that would have such immediate effect. Furthermore, Sirah’s screechy insistence re-enforces the erroneous belief that psychotropics are the key, ignoring all the research that now suggests that they often lead to little improvement and not infrequently can make things worse.
  • The film promotes the idea that people with psychiatric diagnoses like schizophrenia are scary and dangerous: Although there’s little real-word research to suggest that people with psychiatric diagnoses are at greater risk of violence than the average person, Deji has his hands around Jay’s throat three times within the first five minutes of the Mermaid. This is followed immediately by Jay yelling that he needs to be “Baker Acted” and suggesting that he’s going to “kill someone”.
  • The film promotes hopelessness and perpetuates the idea that people with diagnoses like schizophrenia will forever be tormented and dangerous: Hopeless statistics and propaganda about the schizophrenia diagnosis are tacked on to the end of the film, and the promotional website spouts this little gem at the conclusion of its ‘about’ section: “But the most unexpected moment comes at the end of the film, when they’re all confronted with…the tragic reality that this story, just like schizophrenia, can’t have a happy ending.” (See the film’s full website here: )
  • The film perpetuates the idea that there’s psychiatric drugs and hospitalization or there’s nothing, and that force is an inevitability: Apparently, Sirah’s been trying to support Deji in almost complete isolation, and the film (however unintentionally) paints that and the forced hospitalization he experiences by the end not as two extremes on a fairly broad spectrum, but as point A to point B on a two-point scale. In fact, her boyfriend reassures her that she “did the right thing,” and had “no other choice”. The truth is, though, that there are many choices in how to support people who are going through extreme states, and great harm done through the use of force. Meanwhile, the use of force, while often an act of desperation by otherwise decent people, represents a failure of the system, and not an inevitability of some hopeless ‘brain disease’. This film does a real disservice by failing to represent any of that.
  • As an added bonus, it paints women as shrill and helpless sex objects: Jay seems to be angling to get Sirah into bed at the start of the film. By its conclusion, as Sirah is once again helplessly screaming, Jay must come to her rescue not once (when her brother is drowning), but twice (when she’s crying inconsolably and invites him to spend the night as he’d clearly wanted to do right from the start). Sure, she also has a moment (after Deji is rescued from the ocean by Jay) where she slaps and pins her brother to the ground, but that moment is so unbelievable it’s just plain bizarre.

‘The Mermaid’ is currently being promoted via the Mental health Channel (MHC), as the winner of the Jury Award in their Film Festival. I recently spoke with Managing Director, Harry Lynch, regarding my concerns about the film (among other elements of MHC), and although he said he heard some of my concerns, he didn’t feel that they could take action to remove the film unless they heard from more than just me that it was problematic.

I am hoping that you will hear his words as a call to action and ask MHC directly to remove this film.

Remember, it all counts. Every message going out to the public counts. The messages put forth in ‘The Mermaid’ count (and not in a good way). And, if Harry Lynch speaks truth, so does your voice.

I hope you’ll use it.

You can see ‘The Mermaid’ here: https://vimeo.com/139278058

You can reach the Mental Health Channel here:

Sera Davidow is a mother, an advocate, an activist and a filmmaker who devotes much of her time to the Western Massachusetts Recovery Learning Community (http://www.westernmassrlc.org). She entered the mental health system as a teenager and cites “non-compliance” as part of what saved her from a very different path that surely would not have included the freedom she now enjoys from all psychiatric labels and medications.


A Psychiatrist Opposes H.R. 2646: Here’s Why

Screen Shot 2015-12-05 at 2.50.08 PMDear Congressman Upton:

As a psychiatrist and an American who abhors senseless violations of individuals’ liberty, I implore you NOT to support the Murphy bill or any other legislation that encourages the use of involuntary outpatient commitment for psychiatric treatment. For 9 years, I trained and worked in Wisconsin where involuntary outpatient commitment has been used to force people into treatment for over 30 years, and I can tell you first hand, it does far more harm than good to individuals, it is very expensive, and it does not address the public health and safety issues that people hope it will.

First, let’s be clear about the verbiage that is being put forth to describe involuntary outpatient commitment. The term “Assisted Outpatient Treatment” sounds very humane and appealing, but AOT is neither assisted nor is it treatment. It’s a court order to force people to undergo medical intervention, and primarily that means that they are forcibly medicated. It means that people will be subjected to drugs and procedures that they object to.

Proponents of the Murphy bill will point out that virtually all the states have outpatient commitment laws. However, very few states actually implement them. There are many reasons for this. These laws are impractical, cumbersome for the judicial system and law enforcement, and they entail additional fiscal resources for court process, court-ordered evaluation, and expert testimony. Enforcement of such laws poses difficult practical dilemmas of such magnitude that most states choose to ignore them. For example, if an individual does not come to the clinic for his injection of medications, will police seek him out, apprehend him, and restrain him while he is brought to the clinic and forcibly injected with medications (as is usually specified in outpatient commitment laws)? Do our law enforcement agencies have the resources to assume additional responsibilities with respect to mental health treatment, or feel that it is an appropriate role for them to be, essentially, an arm of the mental health system? In most states, the answer has been a resounding “No.”

Proponents of outpatient commitment usually assert its efficacy, but it should be kept in mind that the actual research in this area has shown very mixed results. Most studies do show that you can decrease the use of inpatient services and homelessness using outpatient commitment. But one has to ask – how does it do that? Is it because individuals are effectively treated, less symptomatic, healthier, and recovering? Consumers have been saying for years that this is not the case – that it is because they are overly sedated by medications, incapacitated, and therefore no longer perceived to be “a problem” to others. There are certainly research findings that support their observations. Outpatient commitment has not been shown in any studies to improve social functioning or to increase individuals’ ability to return to work, and some studies suggest that individuals who receive involuntary outpatient commitment are not even less symptomatic than others receiving voluntary services, even if their voluntary participation in treatment is sporadic.

Most of the evidence in support of involuntary outpatient commitment comes from New York state and the implementation of Kendra’s law. The key piece of information that proponents of outpatient commitment omit is that Kendra’s law has shown some positive outcomes largely due to the fact that, at the time the law was enacted, the governor of New York pumped an additional $200 million into mental health services. We know from research that people participate more in treatment and need less acute hospitalization when consumers are offered expanded outpatient treatment options, so it is highly probable that New York achieved these outcomes not through involuntary outpatient commitment but by adequately funding overall mental health services.

Another important consideration is that the National Association of State Mental Health Program Directors (NASMHPD) cautions against enacting outpatient commitment in an environment where there are not robust resources for community mental health treatment. We know that in many states the mental health system has been stripped down to a grossly substandard condition. Consistently, national surveys by NAMI and other mental health advocacy groups grade 27 states’ mental health services as D, D-, or F and NAMI gave the US as a whole a rating of D. Mental health care has never achieved parity with other medical services and state mental health systems face massive gaps in services, inadequate workforce, and insufficient funding. We do not have sufficient resources to provide adequate mental health services to the many citizens who are voluntarily seeking treatment, so what are we really offering the individual who gets “assisted treatment”? I believe the answer is clear. Outpatient commitment for the vast majority of Americans means only one thing – they will be medicated excessively against their will so that they no longer pose an inconvenience to the community. Essentially they are being incarcerated in a chemical jail.

Invariably, those who seek to impose outpatient commitment laws put forward a number of individuals giving personal testimony to the helpfulness of such laws. I do not doubt that these citizens managed to derive benefit from having been forced into treatment, much as some people manage to derive benefit from time in prison. However, I believe we all know that we should not enact law based only upon anecdotal evidence, as it does not represent the full spectrum of the impact of such laws and is easily manipulated. Legislators rarely get to hear first hand from the individuals who are harmed by outpatient commitment because these individuals generally face insurmountable barriers to being able to come forward to present testimony on their own behalf: they are often severely disabled, they are impoverished, they are not supported by such organizations as NAMI or the “Treatment Advocacy” groups, and sometimes they are simply incapacitated by the treatment they are being administered.   I appreciate the personal experience of those who feel that forced treatment was helpful to them; however, I can also say that I have personally known many individuals who felt that forced treatment was dehumanizing and decimated their motivation to pursue recovery due to the overwhelming sense of oppression they felt from being forcibly medicated.  For two of these individuals, the excruciating and permanent adverse effects of these medications were a significant factor in their eventual suicides.

It is also important to realize that many family members of individuals having psychiatric disability harbor the fantasy that “if only we had had a law” their family member would have accepted treatment sooner and had a better life or averted some painful event. In practice this just doesn’t happen. Based upon my lengthy experience with outpatient commitment in Wisconsin, I can assure you that people who are forced to take medications that make them feel horrible do not develop insight about how helpful the treatment is and graduate to voluntary treatment. Instead, they understandably focus on the injustice of the situation, blame family and treatment providers, and do what they can to protest and subvert the treatment process. In most instances, people only gain insight and motivation to stick with these very difficult treatments when they have had the opportunity to make attempts to live without mental health intervention and learn from the outcomes.

We need to keep in mind that involuntary treatment in public health is generally reserved for situations in which the disease is common, communicable, and has a high potential to be lethal, and in which the cause of the disease is known and the legally required treatment is associated with low risk. Examples would be the tetanus or pertussus vaccines for children, or screening for tuberculosis. Mental health diagnoses and treatments simply do not meet this profile.   While many mental health professionals cite “chemical imbalances in the brain” as the cause for psychiatric disturbance and the justification for psychotropic medications, the fact is that such imbalances have never been consistently demonstrated by research. Most recently, a number of alternative theories have emerged that implicate viral genetic material and autoimmune reactions in the central nervous system or generalized inflammation in the etiology of mental illnesses. These novel models of mental illness are promising, but they also call our current treatment practices into question. The fact is, we don’t know what causes mental health disorders, and as a result we don’t know whether the treatments we would force on people are scientifically justifiable or even relevant.

Even more important, the medications that we would require individuals to take are far from benign. Most people who take them experience some degree of fatigue, poor attention, flattened emotion, tremor or restlessness, and gastrointestinal side effects such as constipation and heartburn. More than half experience severe weight gain, which may be in excess of 50 pounds. The antipsychotic medications also commonly cause many other medically serious adverse effects such as seizures, permanent neurological dysfunction, diabetes, heat stroke, heart failure, and other potentially life threatening conditions. One injectable medication has been given special monitoring requirements by the FDA because it can cause sudden unexplained coma. We know that taking these medications over the long term, as many people having psychiatric disability do, erodes people’s health. Due largely to the adverse effects of psychotropic medications, people having psychiatric disabilities have a life expectancy that is 25 years less than the average population.

This is not to say that medications do not help many people. We must ensure that the full range of psychotropic medications is made available in the mental health armamentarium. However, we also need to acknowledge that, generally, the people who get a good response to medications are not the people who are targeted for outpatient commitment. About a third of people will have a significant improvement from medications. They tend to recover, go on to have a full life, and are usually highly motivated to continue treatment. Roughly another third may have a partial response but struggle with significant side effects, and they are understandably ambivalent about treatment. The final third have no significant reduction in their symptoms, though they frequently do have severe adverse effects, and their motivation to pursue treatment with medications is, understandably, very low.   Thus many people who are forced to take medications in outpatient commitment are those who derive very little therapeutic benefit from them, though, from the perspective of social control, others may perceive them to be improved because they are more sedated or chemically restrained.

A serious problem with involuntary commitment statutes is that no safeguards are put in place to ensure that the individual receives quality treatment, rather than being indiscriminately subjected to chemical restraint. It is admittedly difficult to incorporate adequate provisions in legislation to ensure that the mandated services are effective and that risks associated with treatment are adequately managed. To my knowledge, no outpatient commitment law includes a requirement for the treating facility to comprehensively assess the individual’s risk for adverse effects, empirically document an improvement in symptoms and functioning using standardized rating tools, or to examine for and document the intensity of adverse effects. Nor do these laws mandate medical monitoring and treatment for the adverse effects of medications, or specify a threshold for risk. For example, if under involuntary treatment, an individual gains 50 pounds and develops diabetes, the treating facility is under no obligation to modify the treatment approach or to provide the appropriate medical care, even though the treatment is now causing potentially life-threatening adverse effects. Lastly, these laws give no guarantee that the treatment that is forced upon the individual meets generally accepted standards of care. Given that more than half of our state mental health systems are inadequate, with gaping deficiencies in the continuum of care, involuntary treatment obligates individuals to undergo substandard treatment. To me, all of this is simply unconscionable.

We also need to critically examine our motivations in enacting outpatient commitment laws. As is the case with the Murphy bill, proponents of outpatient commitment often cite public safety issues and roll out the rare but dramatic examples of situations where individuals having psychiatric symptoms engaged in heinous homicidal acts in response to psychotic beliefs. Such incidents are vanishingly rare though they receive a lot of publicity. Homicides precipitated by psychosis constitute a minute percentage of homicides in the US. Nor is it clear that forced outpatient treatment would have prevented these tragedies. In some instances, the individuals who perpetrated these crimes were already mandated to receive outpatient psychiatric services and this was ineffective, as was the case for Seung Hui Cho at Virginia Tech in 2007. In other cases, the individual had never been identified to need psychiatric intervention. In the case of Adam Lanza of the Sandy Hook shooting, which is one of the incidents prompting the Murphy bill, treatment was recommended when he was a minor, but was declined by his mother, and no evidence of psychosis or incipient violence had been identified during an extensive psychiatric evaluation. We know that mental health professionals cannot predict future behavior.  We know that treatment with medications does not eliminate the possibility that an individual can have a recurrence of symptoms or, like any other citizen, become violent for other reasons.   Also, we have laws that allow for involuntary commitment in the event that a person is a danger, and past behavior can be factored into the determination that the individual meets criteria for dangerousness. In view of all this, it should be obvious that outpatient commitment laws, no matter how they are worded, are ineffective tools for improving public safety and add nothing to our current tools for intervening in the event of dangerousness.

Another common motivation for supporting outpatient commitment is the belief that such laws reduce mental health expenditures for individuals who are frequent hospital recidivists or who otherwise consume a disproportionate amount of public resources. However, when one examines the bigger picture, most studies have found that outpatient commitment drains funds from mental health to pay for court mandated evaluations, court process, expert testimony, and other expenses associated with the legal process.  Further, in many cases, hospital recidivism is not caused by consumer non-compliance, but, rather, results from poor coordination of care, lack of timely access to care, a lack of community support services, and inadequate treatment options. Forcing medications on individuals will not resolve recidivism due to these deficits in the system of care. However, it is likely that many of these individuals will be unfairly labeled as treatment failures and inappropriately subjected to outpatient commitment when, in fact, the system of care has failed them.

Outpatient commitment is a simplistic way to give the false impression of “doing something” to solve complex and disconcerting social problems. The core clinical problem is simply that we don’t have effective and easily tolerated cures for mental disorders. But neither will outpatient commitment address the prevailing social concerns surrounding mental health treatment. From a public health perspective, at the risk of being provocative, if the goal of such legislation is really to reduce the incidence of aberrant public behavior, what we need instead is a law that prohibits the consumption of alcohol; if the goal is really to reduce healthcare costs, what we need instead is a law to force diabetics to comply with recommended treatment; if the goal is really to decrease the risk of gun-related deaths, what we need instead is a law to keep firearms out of the hands of males. Obviously few people would ever consider legislating these violations of people’s rights even though these changes would make a significant impact on these important public health problems. I would put it to you that the reason we are even considering violating the rights of individuals having psychiatric disabilities is because they constitute a small, highly stigmatized, and vulnerable group who will generate little push-back.

Lastly, we need to consider the devastating impact of involuntary outpatient commitment on our ability to provide people mental health care. The single most important therapeutic tool that mental health professionals have is the trusting relationship we have with our clients. People need to be able to tell us their innermost thoughts and fears, and trust that we will treat them in a fair and respectful manner. In my experience, the threat of involuntary outpatient commitment undermines that relationship and deters people from seeking the help they need.

In summary, I sincerely hope you will reject any legislation that seeks to expand or incentivize outpatient commitment for psychiatric treatment. Forced outpatient treatment is never the short-cut to recovery that proponents claim it will be. Forcing someone to be injected with medications does not promote insight, improve functioning, improve quality of life, save money, or promote public safety.  Most of the proponents of this bill are individuals and professionals who have had very limited, if any, experience with the actual implementation of involuntary outpatient commitment. It is understandable that the concept sounds appealing to them; however, the issues are just not that simple and, as a result, involuntary outpatient commitment is not the tool they imagine it will be. Involuntary outpatient commitment is harmful, not helpful to the goals of getting people into treatment, fostering recovery, promoting safety, and containing mental health costs. If we truly wish to assist citizens having refractory psychiatric concerns, we must fund mental health adequately, ensure that all state mental health systems meet the prevailing standard of care, and encourage strengths-based, individualized approaches to recovery that de-stigmatize mental health concerns.

Sincere thanks for your attention to this issue,

Coni Kalinowski, MD
Medical Director, Mojave Adult, Child, and Family Services
University of Nevada School of Medicine