Federal Legislation Summary and discussion
Following is an overview and discussion of some of the legislation discussed in detail in columns to the right. Only legislation purporting to get services to adults with serious mental llness are discussed. Mental "health" bills, children's bills and specialized population bills (ex. Veterans) are not.
How federal gov can help seriously mentally ill
On June 4, 2015, Rep. Tim Murphy (R. PA) and Rep. Eddie Bernice Johnson (D. TX) introduced the Helping Families in Mental Health Crisis Act of 2015 (HR 2646 text) which updates the 2013 version (HR3717) which did not pass. Both versions contain provisions that would help those with serious mental illness especially in their reform of SAMHSA, reform of PAIMI programs, and promotion of Assisted Outpatient Treatment. The provisions related to HIPAA, and the IMD Exclusion should be strengthened. Mental Illness Policy Org Strongly Endorses.
On August 5, 2015, Sen. Bill Cassidy (R. LA) and Sen. Chris Murphy (D. CT) introduced the Mental Health Reform Act of 2015 (S. 1945 text). It is billed as a companion bill to HR2646 above. It does a good job of requiring government to invest in programs that are strongly evidence-based, but is missing many of the provisions most important to people with serious mental illness. The bill should be amended to reform SAMHSA and PAIMI, fund Assisted Outpatient Treatment and loosen HIPAA restrictions. Mental Illness Policy Org endorses if ammended
On August 5, 2015, Sen. John Cornyn (R. TX) introduced the Mental Health and Safe Communities Act of 2015 (S 2002 text) which includes important provisions in support of Assisted Outpatient Treatment and Mental Health Courts and others. Mental Illness Policy Org strongly endorses.
On June 9, 2015, Rep. Doris Matsui (D. CA) introduced the Including Families in Mental Health Recovery Act of 2015 (HR 2690 text), which directs HHS to develop HIPAA (patient privacy) regulations that address what information may be shared with families of the seriously ill and allocates $5 million annually to educate health care personnel, lawyers are others about it. If HIPAA was made easier to understand educating the public about it's complexities would not be needed. This bill only has merit if HIPAA itself is amended so parents who provide care out of love, can get the same information about mentally ill loved ones paid providers recieve.
On February 13, 2015, Rep. David McKinley (R. WV) introduced the Examining America's Mental Health Services Act of 2015 (HR 826 text) that would create a study of gaps in services that increase violence by persons with serious mental illness and specifically requires the study to include a study of Assisted Outpatient Treatment.
On April 16, 2015, Rep. Lynn Jenkins (R. KS) introduced the Mental Health First Aid (MHFA) Act of 2015 (HR 1877 text) and on March 11, 2015, Sen. Kelly Ayotte introduced the Mental Health First Act of 2015.(S711 text). Both require SAMHSA to promote MHFA. MHFA is not an evidence based program, has not been shown to help the seriously ill, and has not been shown to improve important outcomes. Mental Illness Policy Org opposes.
On April 30, 2015, Rep. Doug Collins (R. GA) introduced the Comprehensive Justice and Mental Health Act of 2015 (HR 1854 text). Sen Al Franken (D. MN) introduced a companion bill of the same name (S. 993 text). Analysis to come.
Legislative Background on Serious Mental Illness.
The $204 billion US Mental Health budget has been steered towards treating the18% who have any loosely defined behavioral health issues rather than delitvering treatment to the 4% (10 million adults) who are most seriously mentally ill. The mental health industry has driven spending away from programs with strong evidence of efficacy and towards loosely defined, non-evidenced based programs designed to "improve the mental health" of all others.
Focusing resources on delivering evidence based treatments to the seriously ill is the best way to improve care, reduce violence, sucide, victimization, homelessness, hospitalization, incarceration and needless tragedies. It saves money by reducing the use of hospitals and jails to serve people who can live in less expensive community settings.
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. One is run by traditional mental health departments and serves those well enough to volunteer for services. The other mental health system is run by criminal justice and serves those who are too sick to volunteer. The community based mental health industry is unwilling to accept responsibility for this second more seriously ill group. As a result, there are three times as many Americans incarcerated for mental illness as there are in psychiatric hospitals. The traditional mental health system largely ignores the most seriously ill causing their transfer to criminal justice.
SAMHSA is largely responsible
The Substance Abuse and Mental Health Services Administration directs federal mental health policy and is largely responsible for the failure to focus on serious mental illness and the failure to implement evidence based programs. 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,
On the right are several of the more important bills in Congress related to serious mental illness. Many other bills address 'mental health.' Thank you for your support of Mental Illness Policy Org which makes our work possible
Helping Families in Mental Health Crisis Act of 2015 (HR 2646)
The Helping Families in Mental Health Crisis Act is the result of bipartisan effort by Rep. Tim Murphy (R. PA) and Rep. Eddie Johnson (D. TX) both of whom worked in mental health before entering Congress. The bill was originally proposed in 2013 as an attempt to end mission creep in the mental health system and focus it on helping the most seriously ill. It triggered numerous other bills.
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
Home Page Subcommittee markup (ammendments accepted and not)
Text of HR2646 as presented to Markup Committee (11/4/15)
Text of bill Dems wanted to adopt as replacement for HR2646
Text of HR 2646 as originally introduced (PDF Version here)
List of 162 cosponsors
List of members of Energy & Commerce Committee considering bill
MIPO response to concerns of some Democrats
List of some HR 2646 Supporting Organizations
Sponsor's (Rep. Tim Murphy) Summary and Explanation
HR2646 Newspaper stories, opeds, editorials
Home Page of 2013 Version of bill (HR3717)
HR 2646 proposes an overhaul of the mental health system:
Replaces the functions of the inefffective and wasteful Substance Abuse and Mental Health Services Administraion (SAMHSA) with an Assistant Secretary of Mental Health to coordinate all government policy. The Assistant Secretary will be required to promote evidence based programs (as opposed to politically correct or popular) and help ensure adults with serious mental illlnesses are prioritized rather than ignored.
• Overview: Problems at SAMHSA
• SAMHSA funding of antipsychiatry
• SAMHSA diverting Block Grants to non mentally ill
• Lots More on SAMHSA
HR 2646 provides pilot funds for states that want to set up AOT programs. Assisted Outpatient Treatment (AOT) allows judges to order very narrowly defined individuals-only those seriously mentally ill who already have a past histroy 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. It is not an alternative to voluntary treatment, it is only used after that fails. It is less restrictive than the alternatives: incarceration and inpatient commitment.
HR 2646 returns the federal Protection and Advocacy program to its orignal function of protecting persons with mental illness from "abuse and neglect." and stops it from lobbying against programs that help the seriously ill
Problems with PAIMII (Law Journal Article)
Mary Zdanowicz Testimony on PAIMI Problems
Problems with PAIMI (SAMHSA Evaluation of)
How PAIMII caused death of Amy Bruce
HR 2646 takes small step to reform the Institutes for Mental Disease (IMD) Exclusion of Medicaid, which prohibits Medicaid funds from being used for seriously mentally ill adults who need hospitalization. It basically tells states, "if you kick someone with mental illness out of your state hospital, we (the federal government, through Medicaid) will pay half the cost of any community care you provide. So the states lock the front door and kick people out the back to make them Medicaid eligible, no matter how inappropriate the discharge is. HR 2646 makesa narrowly tailored exception to the IMD Exclusion, to remove the federal incentive to provide substandard care.
95,000 psychiatric beds needed
Washington Post: IMD Exclusion
Video: US House of Representatives Hearings on Psychiatric Bed Shortage
Longer psychiatric hospital stays needed
IMD Analysis (short)
Dr. Jeffrey Geller Testimony
IMD legal analysis-detailed
NAMI Policy: IMD Exclusion
NASMHPD Policy: IMD Exclusion
- Train Police and Establish Mental Health Courts
Because the mental health system has largely abandoned treating the most seriously ill, police and sheriffs get called in. Unfortunately, this is often after the person becomes a 'danger to self or others' which can be as dangerous for the patient as it is for police and public. HR 2646 funds mental health courts and CIT Training for police.Mental Health Courts provide mandated and monitored community based treatment in lieu of conviction and sentencing after someone comes into contact with police (AOT provides it before people come into contact with police.) HR. 3717 reauthorizes and funds the Mentally Ill Offencer 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 Heatlh Courts and Police Training have little penetration
Mental Health Court has positive reuslts in DC
"Credentials" peer support. The Helping Families in Mental Health Crisis Act attempts to reign in the excesses of peer support by setting up what will essentially become a credentialing mechanism. It requires those engaged in the practice to understand science, the utility of medications and other aspects. Some think this is a good idea. We are worried that the bill essentially credentials an intervention without evidence it is effective, especially in light of the antipsychiatry advocacy by many of the SAMHSA-funded peer support organizations. We would prefer to see a two-step process. Government should first determine if peer support is effective at improving meaningful outcomes like reducing homelessness, arrest, incarceration, hospitalization and suicide; and if so, after that, establish best practices which HR 2646 does well.
Discussion of peer support provisions of HR 2646
Michigan radio urges Fred Upton to allow vote on unwatered down bill-MP3 (5 minutes)
Washington Post Endorsement
Mental Health Reform Act of 2015 (S 1945)
This bill does a good job of requring 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 activites 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)
PDF of S 1945
Members of Health (HELP) Committee Considering Bill
Mental Health and Safe Communities Act of 2015 (S2002)
This is an important bill because it is sponsored by Sen. John Cornyn (R. TX) Majority Whip and because it will move through judiciary committees rather than health committees (Note: criminal justice system is more interested than mental health system in treating the most seriously ill, because without treatment the seriously lll become a criminal justice responsibility). 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 issues.
Text of S 2002
PDF of Mental Health & Safe Communities Act
Members of Judiciary Considering Bill
Department of Justice (DOJ)
International Association of Chiefs of Police
National Sheriffs Association
National Crime Prevention Council (NCPC)
Agency for Healthcare Research and Quality (AHRQ)
National Alliance on Mental Illness (NAMI)
American Psychiatric Association
American Psychiatric Nurses Association
Mental Illness Policy Org
Treatment Advocacy Center (TAC)
The information on Mental Illness Policy Org. is not legal advice or medical advice. Do not rely on it. Discuss with your lawyer or medical doctor. Mental Illness Policy Org was founded in February 2011 and in order to maintain independence does not accept any donations from companies in the health care industry or government. That makes us dependent on the generosity of people who care about these issues. If you can support our work, please send a donation to Mental Illness Policy Org., 50 East 129 St., Suite PH7, New York, NY 10035. Thank you. For more information,
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