Mental health bill would allow doctors to inform families
A mental health reform proposal from U.S. Rep. Tim Murphy would start to counter a 50-year trend of moving treatment to patients' homes and communities, rather than hospitals.
Introduced as a way to improve patient care and safety, the shift toward community-based programs has gone too far, Murphy told the Tribune-Review.
“This whole grand experiment has failed,” the Upper St. Clair Republican said.
Murphy, a psychologist, co-chairs the Mental Health Caucus and is a founding member of the GOP Doctors Caucus.
A bill he introduced in June, which is gathering support in the U.S. House, aims to increase the number of psychiatric beds for inpatient treatment and boost funding for outpatient programs that judges may order people to comply with, along with a long list of other changes.
Opponents of the bill, including national and local mental health organizations, argue any changes that force people with mental illness into treatment are less effective than those that encourage them to seek treatment themselves, usually outside institutions.
“It would still promote coercive strategies and ignore the gaps in effective community-based services that prevent institutionalization and incarceration,” Jennifer Mathis, director of programs for the Bazelon Center for Mental Health Law in Washington, said in a statement.
Other organizations, including the American Psychiatric Association, support the bill, saying hospitalization and outpatient treatment can benefit people with serious mental illnesses such as schizophrenia and bipolar disorder.
A House subcommittee advanced Murphy's bill, HR 2646, this month in an 18-12 vote. Speaker Paul Ryan said in a recent “60 Minutes” interview he is pushing the legislation as a way to address gun violence.
Murphy started drafting the bill after a review of the nation's mental health system performed after the 2012 shootings at Sandy Hook Elementary School, in which 26 people were killed.
In a report prepared for an oversight subcommittee that Murphy leads, the Government Accountability Office found 112 federal programs meant to support people with serious mental illness in 2013.
Patient overcrowding and staff shortages at mental health hospitals in the 1960s contributed to a view that the hospitals were ineffective and, combined with advances in medicine and other treatments, drove the shift toward community-based care, according to the GAO. Rampant abuse and neglect at the institutions have been cited as another reason for the change.
The number of psychiatric beds in the country dropped from about 500,000 to about 40,000, according to the oversight committee.
That is about 100,000 beds too few, the committee found, linking the shortage with overcrowded jails, homeless populations and emergency room admissions.
“We've traded that hospital bed for the prison cell,” Murphy said.
The bill would change Medicare and Medicaid billing rules to make inpatient beds more accessible.
Many community-based programs supported by state and federal governments aim to help people avoid costly cycles of homelessness, imprisonment and emergency room visits.
Some community-based mental health advocates say the programs need more money to work better.
The Pennsylvania Mental Health Consumers' Association has advocated for closing state mental hospitals and redirecting the money to community-based programs, said Lynn Keltz, the association's executive director.
Keltz said community-based programs are more effective than putting patients in hospitals and stabilizing them with drugs.
Dr. Renee Binder, president of the American Psychiatric Association, said hospitals are better equipped than community-based programs to stabilize someone having a mental health crisis.
Murphy's bill would modify Medicare rules to require hospitals to help mentally ill patients gain access to community-based services after discharge.
The bill includes grants for assisted outpatient treatment, in which judges order patients to complete treatment as a condition of letting them stay outside institutions and hospitals. Forty-five states, including Pennsylvania, use the treatment.
Although voluntary treatment is always better than involuntary treatment, assisted outpatient treatment can help some people avoid prison and repeated hospitalization, Binder said.
“It is one tool that can be used in a very, very small group of patients, but it only works when there are adequate resources given to the whole program,” she said.
Another area of disagreement is a provision in the bill that would allow doctors to share mentally ill patients' information with family members and caregivers when the doctor deems sharing the information necessary for the patient's welfare.
The information-sharing is not permitted under the federal Health Insurance Portability and Accountability Act. The restriction can make it difficult for parents of adult children with mental illnesses and others to take care of patients, Murphy said. Opponents say patients should be allowed to retain the same privacy as people with any physical illness.
Eight federal agencies, including the Departments of Health and Human Services, Defense, and Education, were overseeing the 112 community-based federal programs in 2013, the GAO found, and coordination among them was lacking.
Murphy's proposal would eliminate the federal Substance Abuse and Mental Health Services Administration, tasked with coordinating mental illness programs, and form an assistant secretary for mental health and substance use disorders to take over coordination. The bill would dedicate money to explore ways to screen, diagnose and treat mental illness, with a goal of implementing successful programs more broadly.
Wes Venteicher is a Trib Total Media staff writer. Reach him at 412-380-5676 or firstname.lastname@example.org.