Federal Mental Health Legislation Home Page 2016-2017 - Mental Illness Policy Org
Federal Mental Health Legislation Home Page 2016-2017 2017-09-14T17:50:20+00:00

federal mental illness legislation

Breaking News: New Federal Serious Mental Illness Committee (ISMICC) gets off to rocky start after great speech by HHS Sec. Tom Price

FEDERAL MENTAL HEALTH LEGISLATION

How federal gov can help seriously mentally ill

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:

  1. Build more psychiatric hospitals (Eliminate the IMD Exclusion in Medicaid)
  2. Make more robust use of Assisted Outpatient Treatment (AOT)
  3. Provide families of the seriously mentally ill relief from HIPPA Handcuffs that prevent them from helping loved ones
  4. Reform or eliminate SAMHSA so federal resources go to the seriously ill and science, not the worried well and pop-psychology.
  5. Reform PAIMI/P&A so families that want care for loved ones don’t have to fight federally funded lawyers.
  6. Build congregate housing with on-site support for seriously mentally ill.
Current Initiatives

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

Rep. Murphy explains vote for ACA reform

Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC)

Sept.-Dec 2017

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.

9/2017 Our Recommendations

9/2017 Our analysis of opening meeting

9/2017 ISMICC membership list

The ISMICC Charter

Source material including membership list

Video: HHS Sec. Tom Price opening speech

Text: HHS Sec. Tom Price opening speech 

ISMICC gets bad advice

Guns for mentally ill bill passes

(1/2016-2/2017)

Bill explanation (USA Today)

Oped opposes guns for mentally ill bill (Jaffe)

Regulations that Congress overturned

Results of roll call vote

Trump pledged to make gun access harder for mentally ill

Mental Illness Policy Org analysis of Obama reg.

Obama Executive Action Congress overturned

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

MIPO response to concerns

Newspaper stories, opeds, editorials

Home page of 2013 version (HR3717)

SAMHSA

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

Our SAMHSA page

Overview: Problems at SAMHSA

SAMHSA funds anti-psychiatry

SAMHSA diverts Block Grants

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

AOT (Kendra’s Law) in NYS

AOT (Laura’s Law) in California

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

Mental Health Court has positive results in DC

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.

HIPAA language in Cures Act

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)

How PAIMII caused death of Amy Bruce

Helping Families in MH Crisis (cont.)

Medicaid/Medicare

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.

Same day billing provisions

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)

Dr. Jeffrey Geller Testimony

IMD legal analysis-detailed

NAMI Policy: IMD Exclusion

NASMHPD Policy: IMD Exclusion

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)

Myths about previous version (HR3717)

Source documents

21st Century Cures Act text

HR2646 text as presented to markup

Text of Democrat substitute bill

Text of HR 2646 as originally introduced (PDF here)

NAMI Harlem endorses

List of 162 cosponsors

Sponsor summary and explanation

Mental Health Reform Act of 2015 (S 1945)

Washington Post Endorsement

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)

PDF of 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

PDF of Mental Health & Safe Communities Act

get the book

Available in all formats at Amazon and Barnes and Noble

Selected Background Papers

Assisted Outpatient Treatment

AOT Results

Department of Justice on AOT

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

5000 mentally ill suicide

1000 Homicides by mentally ill

175000 homeless mentally ill

Cost of homeless mentally ill

Criminalizing mentally ill

Increased criminal justice costs

Mentally ill victimized

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

Overview of Myths

Myths about AOT

Myths about consumers

Myths about medicines

Myths about stigma

Myths about recovery

Myths about antipsychotics

Stigma not important

Myths about coercion

P&A (PAMII/PAIMI) lawyers

Scientology/CCHR

ACLU

Mindfreedom, Scientology, CCHR

Tragedies Reform may have prevented

Aaron Bassler (shot/was shot)

Jenna Ward (sibling)

Peter Earley (parent)

Pat Webdale (daughter murdered)

Morgan Claire (wife)

Karen and James Logan (son shot cops)

Michael Biasotti (police chief)

Brother deinstitutionalization