Murphy Bill Comprehensive Talking Points

The Helping Families in Mental Health Crisis Act (H.R. 2646), introduced by Representative Tim Murphy (R-PA), of Pennsylvania, is a sweeping bill that promises “reform,” but would actually return the nation’s mental health system to many of the failed policies of the past.

Rights

Many of the provisions of the bill would significantly curtail civil rights for a group of individuals with psychiatric diagnosis.

• The bill would increase forced treatment by offering states financial incentives to implement Involuntary Outpatient Commitment (IOC) laws (misleadingly referred to in the bill as Assisted Outpatient Treatment or ‘AOT’).
• The bill would drastically curtail the scope of the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program, the federally funded program charged with advocating for and protecting the human, civil and legal rights of individuals with psychiatric diagnoses.
• The bill weakens the privacy protections of the Health Insurance Portability and Accountability Act (HIPAA) by permitting the release of an adult’s diagnosis, treatment plans, medication plans, and other information to family members against the person’s will.

Science

The bill is inconsistent in a number of ways with current scientific understanding of the etiology and treatment of mental illnesses and substance use disorders:

• The bill ignores all evidence of the environmental factors that contribute to the development of these disorders, including toxic stress and trauma (especially in childhood) as well as other social determinants of health.
• The bill is premised on a simplistic, uni-dimensional understanding of psychiatric disorders rather than reflecting our current understanding of the complexity of etiology, expression, and treatment of these conditions.
• By focusing almost exclusively on severe mental illnesses, the bill effectively ignores the most prevalent conditions, including substance use and depression.
• Despite an expressed preference for evidence-based practices, the bill focuses on a narrow range of interventions to the exclusion of many other interventions that have been shown to be effective.
• No provision is made for cultural differences known to affect diagnosis, treatment and help-seeking behavior, or for the lack of evidence-based practices for differing cultural, linguistic or ethnic groups.

Community Supports

By prioritizing institutional and mandatory services, the bill implicitly conveys the message that healing and recovery are unlikely, and that community services and supports are ineffective.

• The bill does little to encourage the implementation of the evidence-based community supports that allow many people to live successfully in the community – supported housing, case management, rehabilitation services, job training and placement, and peer supports.
• By highlighting problems in living experienced by a tiny minority of individuals, the bill reinforces the widespread prejudice and discrimination faced by people with these diagnoses.  This characterization is likely to contribute to further community exclusion, which has been a serious impediment to the development of appropriate community services and recovery.
• By limiting the scope of the Protection and Advocacy program, the bill will make it harder for people to fight discrimination in housing and employment, making it more difficult to access existing community services.
• By creating financial incentives for “assisted outpatient treatment” (AOT), the bill continues to perpetuate the fiction that forcing people into a largely non-existent treatment system will remedy their problems.
• Several provisions of the bill would serve to undermine independent peer support organizations and activities. The bill would put federal funding for existing peer-run consumer technical assistance centers and for SAMHSA statewide consumer networking grants at risk.
• The bill would eliminate a Medicaid funding restriction known as the IMD (Institutions for Mental Diseases) exclusion, which prohibits the use of Medicaid financing for adult psychiatric hospitalizations and residential facilities larger than 16 beds. This would financially incentivize states to re-institutionalize people in segregated settings.

Public Health Approach

Public health addresses the health and wellness of populations as well as individuals. Public health approaches focus on environmental as well as biological factors; use social policy as well as programmatic reforms; and provide a balance of prevention, treatment, and rehabilitation/support. The bill fails in several significant ways to address mental health, mental illness and addiction within a public health framework.

• The bill explicitly restricts funding for primary prevention programs and primarily features them in direct relation to the development of “severe mental illnesses.”
• No provisions are made for identifying or addressing populations at-risk for mental disorders or addiction, including children growing up with multiple adversities and adults experiencing violence and trauma.
• Early identification and screening provisions apply only to psychosis, ignoring other prevalent psychiatric diagnoses, including depression, anxiety, PTSD, and addiction.
• The bill would prevent the federal mental health authority from working to promote wellness and from using social policy to reduce risk factors or increase protective factors.

Structural Reform

The bill is constructed on a conceptual framework that ignores substantial progress in the field over the past 20 years. There is no evidence to suggest that the structural solutions proposed will lead to significant improvements in the service delivery system.

• The bill does little to improve financing for needed services. It focuses almost exclusively on SAMHSA, which comprises a tiny fraction of mental health expenditures, and largely neglects the major federal funder of mental health services, the Center for Medicaid and Medicare Services.
• The bill fails to integrate treatment and prevention, the core of a public health approach.
• The bill promotes a narrow, professionally-focused and run system of care, diminishing the importance of peer and family voice and control. This is in stark contrast to current thinking in healthcare, which is moving rapidly to implement patient-centered care, shared decision-making, and self-management of chronic conditions.
• The bill attempts to address a management issue with SAMHSA through legislation. This is a dangerous precedent.
• A new layer of bureaucracy is created with the formation of a National Mental Health Policy Laboratory (NMHPL).
• The bill extends legislative authority and oversight to areas that clearly belong within the executive branch, including approving peer-review groups, reviewing grants and contracts prior to award, and appointing 20% of NMHPL staff.