The Barber/Pelosi/Waxman Bill appears to be a version of HR-3717 stripped of provisions that help those with serious mental illness and with more spending favored by the mental health industry. (Based on preliminary analysis 5/2/14)
Twenty percent of adults over 18 have “any” mental illness (i.e., some form of depression, stress, anxiety, social phobia, etc.). But only 4.1 percent of American adults have serious mental illness (i.e., schizophrenia, severe bipolar). It is the 4.1% who are most likely to become homeless, suicidal, criminal, arrested, hospitalized, incarcerated and violent. HR 3717, the Helping Families in Mental Health Crisis Act (Murphy and 74 other co-sponsors from both parties) has numerous provisions to address that.
On Tuesday, May 6, 2014, with the encouragement of Nancy Pelosi and Henry Waxman, Rep. Ron Barber is introducing a Democrat Mental Health bill (See Draft). Based on a preliminary analysis of a draft bill the provisions below that address serious mental illness are not in the Democrat bill. We encourage the Democrat Leadership to include them. This is based on a preliminary analysis
1. IMD Reform: The Institutes for Mental Disease Exclusion prevents states from receiving Medicaid reimbursement for the mentally ill who are so ill they need to be hospitalized for an extended period. So states kick the seriously mentally ill out of hospitals to make them Medicaid eligible. Many wind up incarcerated. HR3717 makes small revisions in Medicaid so those who need hospital care can receive it.
2. AOT- HR3717 requires states receiving Mental Health Block Grants to have an Assisted Outpatient Treatment (AOT) law and need for treatment civil commitment standard. AOT is exclusively for those who have a history of multiple arrests, violence, incarcerations or hospitalizations due to going off treatment. It allows judges to order them into mandated and monitored treatment and order the mental health system to provide the care. This ensures the most seriously ill go to the head of the line, rather than the end. AOT reduces homelessness, arrest, hospitalization and incarceration over 70% each. It saves 50% by providing an off-ramp before more expensive and restrictive inpatient commitment or incarceration become needed. 75% of those in the program say it helps them get well and stay well. DOJ certified it as an effective crime prevention program.
3. HIPAA/FERPA Reform- HIPAA and FERPA require doctors to keep parents in the dark absent a specific waiver by the mentally ill individual. Neither James Holmes nor Jared Loughner gave the waiver, hence their parents did not know school authorities identified them as needing help. Parents need the information about their mentally ill loved ones so they can ensure they have prescriptions filled, transportation to appointments, and stay in treatment. HR 3717 writes limited exclusions into HIPAA law so family/caregivers get the same information paid caretakers would receive.
4. SAMHSA/CMHS Reform- This is perhaps the most important reform. Congress created SAMHSA to “target … mental health services to the people most in need”. SAMHSA fails to focus on the seriously ill and funds programs and groups that make care more difficult. Those groups ant to keep their funding. Only four of the 288 programs in the SAMHSA National Registry of Evidence Based Practices are for people with serious mental illness. SAMHSA uses block grant funds to coerce states to replace the medical model with SAMHSA’s recovery model, which requires people self-direct their own care. The most seriously ill, who are psychotic and delusional can not self direct their own care. SAMHSA encourages states to spend on prevention, when there is no way to prevent schizophrenia, bipolar or the other serious mental illnesses. SAMHSA suggests everyone recovers, thereby ignoring those so ill they do not. While accurate diagnosis is key to getting the right treatment, SAMHSA funds 20 Technical Assistance Centers (TAC) and the National Coalition for Mental Health Recovery (NCMHR) which joined the “Occupy Psychiatry” movement by declaring that “psychiatric labeling is a pseudoscientific practice of limited value in helping people recover.” Many NCMHR/TAC leaders do not believe mental illness exists and conduct SAMHSA funded workshops to teach persons with mental illness how to go off treatment. HR 3717 eliminates this nonsense by limiting SAMHSA to funding evidence-based programs and ending their ability to fund anti-medical model advocacy. This has engendered opposition from recipients of SAMHSA funds that do not focus on the seriously mentally ill nor use evidence based practices. This provision of HR 3717 is smart government: replace programs that don’t work with ones that do.
5. PAIMI Reform- PAIMI was founded with the noble purpose of helping to improve the quality of care received by the most seriously ill. It now focuses on ‘freeing’ them from treatment. It has evolved into a lobbying machine that discourages states from spending on the most seriously ill. HR 3717 returns Protection and Advocacy for Individuals with Mental Illness to their original mission of helping persons with mental illness access care and reigns in their ability to use funds lobbying against treatments (ex. hospitals) needed by some of the seriously ill.
6. Create Assistant Secretary- HR 3717 creates an Assistant Secretary for Mental Health to distribute block grants formerly distributed by SAMHSA and help the system address the elephant in the room: getting treatment to people known to have untreated serious mental illness. The Secretary would eliminate non-evidenced based practices, provide better coordination of federal resources, reduce duplication, require the prioritization of the seriously ill, and replace mission-creep with mission control. (Note: Based on preliminary analysis. The Dem Bill does include a White House Office of Mental Health, but the office is not given the responsibility of seeing people with the most serious illnesses are prioritized for services)