Breaking News: New Federal Serious Mental Illness Committee (ISMICC) issues REPORT after getting off to rocky start after great speech by HHS Sec. Tom Price
FEDERAL MENTAL HEALTH LEGISLATION
4 ways federal gov can help seriously mentally ill
Federal Mental Illness Policy Solutions
Mental health legislation generally focuses on improving mental wellness in the highest-functioning. It should focus on delivering treatment to the seriously mentally lll. This page tracks national legislation on serious mental illness.
The Federal government should end ‘mission-creep’ and:
- Build more psychiatric hospitals (Eliminate the IMD Exclusion in Medicaid)
- Make more robust use of Assisted Outpatient Treatment (AOT)
- Provide families of the seriously mentally ill relief from HIPAA Handcuffs that prevent them from helping loved ones
- Reform or eliminate SAMHSA so federal resources go to the seriously ill and science, not the worried well and pop-psychology.
- Reform PAIMI/P&A so families that want care for loved ones don’t have to fight federally funded lawyers.
- Build congregate housing with on-site support for seriously mentally ill.
3/2017: Congress is considering reforming ACA (Obamacare) plan that block grants Medicaid and allows states to not cover mental illness. We oppose.
2/2017: Congress made it easier for certain mental ill to buy guns. This was not a good idea.
2017: Representative Tim Murphy (R. PA) has indicated he will be introducing a bill to reform HIPAA. We support.
12/2016: The 21st Century Cures Act was signed into law incorporating provisions of the Helping Families in Mental Health Crisis Act of 2015 (HR 2646 text) which updated the 2013 version (HR3717). The Senate equivalents were the Mental Health Reform Act of 2015 (S. 1945 text); and Mental Health and Safe Communities Act of 2015 (S 2002 text). We supported most.
Other Recent Legislation
2015. The Including Families in Mental Health Recovery Act of 2015 (HR 2690 text) would have directed HHS to develop HIPAA (patient privacy) regulations and funded HIPAA education.
2015. The Examining America’s Mental Health Services Act of 2015 (HR 826 text) would have studied gaps in services that increase violence and Assisted Outpatient Treatment. Rep. Murphy’s subsequent Helping Families in Mental Health Crisis Act, as well as his amendments to “DocFix” bill addressed these.
2015. The Mental Health First Aid (MHFA) Act of 2015 (HR 1877 and S711) funded and required SAMHSA to promote MHFA. Because MHFA is not an evidence based program, and has not been shown to help the seriously ill or improve important outcomes we opposed. It was subsequently funded in 21st Century Cures Act.
2015. The Comprehensive Justice and Mental Health Act of 2015 (HR 1854 and S. 993) were introduced.
Federal Mental Health Legislation Ignores Serious Mental Illness
The $204 billion US Mental Health budget has been steered towards treating the 18% who have any loosely defined behavioral health “issues” rather than delivering treatment to the 4% (10 million adults) who are most seriously mentally ill. The mental health industry drives spending away from evidence-based programs to non-evidenced based programs.
Solution: Focusing resources on delivering evidence based treatments to the seriously ill would reduce violence, suicide, victimization, homelessness, hospitalization, incarceration and needless tragedies and save money by reducing the use of hospitals and jails.
Put another way, the problem is not that we don’t spend enough, it is that we don’t spend it efficiently.
Criminalization of mental illness by mental health industry
There are now two mental health systems in the United States. The one run by traditional mental health departments serves those well enough to volunteer and the mental health system run by criminal justice serves those too sick to volunteer. There are three times as many Americans incarcerated for mental illness as there are in psychiatric hospitals.
SAMHSA is largely responsible
The Substance Abuse and Mental Health Services Administration (SAMHSA) directs federal mental health policy. See our SAMHSA website for information on SAMHSA funding anti-psychiatry, refusing to focus on the seriously ill, driving mental health block grants to people without serious mental illness, and certifying non evidence based programs as evidence based.
This page only tracks the more important bills and initiatives related to serious mental illness. Many other bills address ‘mental health.’ Thank you for your support of Mental Illness Policy Org.
Reform of Affordable Care Act
March 2017 – ??
Repeal weakens mental health coverage
Treatment Advocacy Center statement
Rep. Murphy criticized for vote on ACA Reform
Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC)
ISMICC was created by CURES Act and includes leaders of HHS, DOJ, DOL, VA, DOD, HUD, DOE, CMS, AG and SSA and 14 public members. ISMICC will report to Congress on advances in SMI/SED research; evaluate SMI/SED programs, and recommend actions.
12/2017 ISCMII report to Congress
9/2017 Our Recommendations
9/2017 Our analysis of opening meeting
9/2017 ISMICC membership list
Source material including membership list
Video: HHS Sec. Tom Price opening speech
Text: HHS Sec. Tom Price opening speech
Guns for mentally ill bill passes
Bill explanation (USA Today)
Oped opposes guns for mentally ill bill (Jaffe)
Regulations that Congress overturned
Trump pledged to make gun access harder for mentally ill
Mental Illness Policy Org analysis of Obama reg.
Helping Families in Mental Health Crisis Act (21st Century Cures)
Late 2016- 2017
The Helping Families in Mental Health Crisis Act (Tim Murphy (R)/Eddie Johnson (D) was proposed in 2013 to focus the mental health system on the most seriously ill. In December 2016 provisions were included in the 21st Century Cures Act and are being implemented in 2017. The bill was not funded when passed, but there was agreement to do so. Rep. Murphy deserves all the praise for this.
Trump needs to choose Asst. Sec. of Mental Health
Summary of provisions with links to bill text
Which Mentally Ill are helped in Mental Health Crisis Act
Summary of Helping Families in Mental Health Crisis Act
Narrative of what’s in HR 2646
Newspaper stories, opeds, editorials
Creates an Assistant Secretary of Mental Health over SAMHSA to force it to focus on serious mental illness, coordinate cross-government policy, promote evidence based programs (as opposed to PC ones) and ensure adults with serious mental illnesses are prioritized rather than marginalized.
Text of Assistant Secretary provisions
Funds pilot AOT programs
Assisted Outpatient Treatment (AOT) allows judges to order very narrowly defined individuals – who already have a past history of arrest, violence, or needless hospitalization caused by failure to stay in treatment-to stay in mandated and monitored treatment as a condition of living in the community.
SAMHSA to award Assisted Outpatient Treatment Grants
Allows and funds courts to use AOT as alternative to incarceration
AOT effectiveness research summary
AOT cuts taxpayer costs in half
Criminal Justice Reforms
Funds mental health courts which allow judges to order treatment in lieu of trial, and Crisis Intervention Training (CIT) to teach law enforcement how to deescalate interactions with mentally ill. The bill reauthorizes and funds the Mentally Ill Offender and Crime Treatment Reduction Act.
Results from Implementing CIT for police
Mental Health Courts reduce arrest and incarceration
Results from implementing Mental Health Courts
Council of State Governments Info on Mental Health Courts
Mental Health Courts and Police Training have little penetration
Tried to reform HIPAA and FERPA
Early versions of the bill tried to free parents of seriously mentally ill from HIPAA Handcuffs that prevent them from getting the info they need to help loved ones, but SAMHSA-inspired opposition stopped meaningful reform from being included. Rep. Murphy has stated he will try again.
Discussion of HIPAA Provisions in Helping Families in Mental Health Crisis Act
Tried to reform PAIMI/P&A
The Protection and Advocacy program was intended to protect mentally ill from “abuse and neglect” but now protects them from being treated. Early versions of bill attempted to fix, but opposition from SAMHSA-inspired groups prevented reform in final bill.
PAIMI/P&A provisions in final bill
Problems with PAIMII (Law Journal Article)
Mary Zdanowicz Testimony on PAIMI Problems
Problems with PAIMI (SAMHSA Evaluation of)
Helping Families in MH Crisis (cont.)
Bill importantly clarified that Medicare can reimburse for mental health and physical health services that are received on same day. (“same-day billing”). Provisions to ameliorate Medicaid’s Institutes for Mental Disease (IMD) Exclusion, which prohibits Medicaid funds from being used for seriously mentally ill adults who need hospitalization were not included in final bill.
95,000 psychiatric beds needed
IMD Exclusion – Jaffe op-ed
Video: US House of Representatives Hearings on Psychiatric Bed Shortage
Integrates physical and mental health
Longer psychiatric hospital stays needed
IMD Analysis (short)
IMD legal analysis-detailed
Non-useful an other provisions
The bill promoted peer-support credentialing, in spite of lack of evidence that peer support improves meaningful outcomes in seriously mentally ill. It funded Mental Health First Aid which lacks evidence it helps mentally ill.
Text of previous version (HR3717)
HR2646 text as presented to markup
Text of Democrat substitute bill
Text of HR 2646 as originally introduced (PDF here)
Sponsor summary and explanation
Mental Health Reform Act of 2015 (S 1945)
Mental Health Reform Act of 2015 (S 1945)
This bill does a good job of requiring programs to be evidence-based and focusing them on reducing homelessness, arrest, incarceration and suicide among those well enough to volunteer for services. It should be amended to include provisions to help those who are sicker. Specifically it should increase the availability of hospital beds, fund AOT, eliminate waste and counterproductive activities at SAMHSA, make meaningful reforms in HIPAA, and certainly reign in antitreatment advocacy by federally funded Protection and Advocacy Programs
Rough Draft Comparison of Senate bill with House bill.
Text of Mental Health Reform Act of 2015 (S 1945)
Mental Health and Safe Communities Act of 2015 (S2002)
The bill contains extensive support for Assisted Outpatient Treatment, Mental Health Courts, training police about mental illness, court supervised treatment for released mentally ill prisoners, forensic assertive community treatment, and other important issues. It is important to note that it is the judiciary committees who are focused on the most important issues that mental health committees have generally ignored.
Text of S 2002
Available in all formats at Amazon and Barnes and Noble
Selected Background Papers
Assisted Outpatient Treatment
International Association of Chiefs of Police on AOT
National Sheriffs Association on AOT
SAMHSA on AOT
Agency for Healthcare Research and Quality
National Alliance on Mental Illness on AOT
American Psychiatric Association
Consequences of lack of treatment
3 million untreated mentally ill
1000 Homicides by mentally ill
Increased criminal justice costs
Mental health systems overwhelmed
Poorer prognosis for mentally ill
Violence and mental illness
Mental Illness tragedies in PA
Mental Illness tragedies in MA
Mental Illness tragedies in OH
Mental Illness tragedies in NY
Mental illness tragedies in MD
Mental Illness tragedies in WV
Plan to reduce violence by mentally ill
63% of mass shootings by mentally ill
Myths that prevent reform
Mindfreedom, Scientology, CCHR
Tragedies Reform may have prevented
Pat Webdale (daughter murdered)
Karen and James Logan (son shot cops)
Michael Biasotti (police chief)