Most of the Congressional proposals that come forward after mass carnage like that at the Navy Yard have been focused on “improving mental health” rather than treating serious mental illness. They are doomed to accomplish nothing. That could be about to change. Yesterday, Representative Tim Murphy (R., Pa.), a former child psychologist, head of the Mental Health Caucus, and founder of the GOP Doctor Caucus announced thoughtful proposals resulting from extensive work by his Oversight and Investigations Subcommittee of the House Energy and Commerce Committee. In a speech on the house floor and an accompanying press release he announced a plan to:
1. Preserve sufficient hospital beds for persons with serious mental illness who need hospital access. Believe it or not, this is controversial. The mental-health industry wants the public to believe everyone with mental illness can function in the community. This is letting wishful thinking trump science. Most can, many cannot. Beds are needed for those who cannot.
2. Increase the use of Assisted Outpatient Treatment (AOT). AOT is specifically and exclusively for the small group of seriously ill who have a history of violence due to non-compliance with treatment. It is a court order that allows them to live in the community in return for a mandated and monitored agreement to accept violence-preventing treatment. AOT reduces the overuse of costly liberty-infringing incarceration and involuntary commitment and thereby saves the taxpayers money, while keeping patients, public, and police safer.
3. Fix “HIPAA Handcuffs”. The Health Information Privacy Act (HIPAA) and Family Education Rights and Privacy Act (FERPA) provide important patient-confidentiality provisions. But some of these provisions prevent parents of persons with mental illness from knowing when their loved ones are being discharged from hospitals, what their medications are, and when the next appointments are. Parents are blamed when something goes wrong, but not given the tools to help them go right. They are given the responsibility to provide care, but not the information needed or the ability to enforce compliance. Small fixes to HIPAA and FERPA can fix that.
4. Eliminate anti-treatment activities within the Substance Abuse and Mental Health Services Administration (SAMHSA). These have been extensively and almost exclusively reported on by National Review and NRO. The lead government agency responsible for reducing the impact of serious mental illness on our communities goes mute after incidents of violence like that at the Navy Yard and funnels money to organizations working to prevent the most seriously ill from receiving treatment.
5. Increase research on serious mental illness — versus ‘improving mental health’ at the National Institute of Mental Health (NIMH). NIMH used to rarely focus on serious mental illness. Under Director Thomas Insel, that problem was fixed and serious mental illness is now the NIMH priority. They deserve and will use well any additional funds.
6. Increase police training. Law enforcement is called in to clean up the mess when the mental-health system fails. The mental-health system shoulddo its own job and help the most seriously ill. But when they won’t, there are tools police can use to defuse situations if they have not yet spiraled out of control. Dr. Murphy’s bill will increase law-enforcement awareness of them.
Citizens should rally behind the proposals of Representative Murphy. President Obama said he would accept good ideas no matter where they came from. These are excellent ideas.
— D.J. Jaffe is executive director of Mental Illness Policy Org., an independent, non-partisan think-tank on serious mental illness.