Serious mental illness – including such afflictions as schizophrenia and bipolar disorder — directly affects less than 5 percent of the American public. But these illnesses are in part responsible for some of our most incorrigible social problems, and their consequences are evident in our prisons and on our streets.
Next Wednesday, Representative Tim Murphy’s Helping Families in Mental Health Crisis Act (H.R. 2646), which aims to refocus our wasteful, woefully misdirected federal mental-health bureaucracy on serious mental illness, is scheduled for markup in the House Energy and Commerce Committee. His colleagues should send the full House the strongest possible version of the bill.
The agencies responsible for setting federal mental-health policy — the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Mental Health Services (CMHS) — have long focused on treating the many millions of Americans suffering mild mental illness (low-level depression, anxiety, “trauma,” and other, sometimes nebulously defined, conditions) rather than the severely mentally ill, many of whom are dangers to themselves and to their fellow citizens. Murphy, a Pennsylvania Republican and Congress’s only psychologist, first conducted a multi-year investigation of the federal mental-health bureaucracy and then crafted a bill that aims to reverse those priorities.
At its heart are two transformational — and commonsensical — changes. For years, SAMHSA has distributed money to grantees without imposing any meaningful requirement that they provide independent evidence of improved outcomes. It has made no difference to SAMHSA whether a program actually makes a difference in reducing suicides or homelessness or repeated hospitalization. The Murphy bill would create a National Mental Health Policy Laboratory that would establish objective outcome measures, so that policymakers could know which programs are actually serving the seriously mentally ill.
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Murphy’s bill would also install, at or near the head of the federal mental-health apparatus, an Assistant Secretary for Mental Health and Substance Use Disorders, who would be an actual medical professional with psychiatric experience. The federal mental-health agencies inexplicably remain the only federal medical agencies not led by qualified medical professionals.
There is widespread support for Murphy’s legislation from the medical community and from law enforcement.
These two changes alone would do much to overhaul a failed, unaccountable bureaucracy. But Murphy’s bill features other important reforms as well. The bill would force the Department of Health and Human Services to revise the overly restrictive privacy rules, written under the authority of the Health Insurance Portability and Accountability Act, that keep family members of people with serious mental illness from being able to obtain crucial information about their loved ones; it would help to rectify the widely acknowledged shortage of psychiatric beds by revising Medicaid funding rules for institutions for mental diseases, or IMDs, which are stand-alone psychiatric treatment centers; it would encourage and increase funding for assisted outpatient treatment, which has proven effective in reducing rates of violence, substance abuse, and incarceration; and much more.
The chief opponent of these changes is the mental-health industry, which has many reasons to maintain the status quo, not the least of which is financial. The legions of easy-remedy programs are staffed by legions of public employees; many people are invested in keeping the government’s funding streams flowing to them. It’s likely that the bill’s opponents will try to steer the appropriations toward the usual quarters and, by doing so, neutralize its reforms.
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But they’ll face stiff headwinds. There is widespread support for Murphy’s legislation from the medical community — the American Psychiatric Association and Mental Illness Policy Org. back the bill — and from law enforcement, it being an indisputable fact that our prisons have become de facto mental institutions. The National Sheriffs’ Association, the International Association of Chiefs of Police, and many others have endorsed Murphy’s bill.
The Helping Families in Mental Health Crisis Act has 191 sponsors – hailing, notably, from both parties — and the full support of Speaker Paul Ryan. The Energy and Commerce Committee should send him the most vigorous version of Murphy’s bill that they can, then help him get it onto the president’s desk. This bill is not a panacea; no bill would be. But it is a crucial, long-overdue step toward reforming a bureaucracy that, competently run, could be a key resource in alleviating the suffering of millions of Americans, and in mitigating some of our most pressing social problems.