Lawmakers, for all their ambitious talk about mental health reform, are facing a series of obstacles that may be impossible to overcome this year.
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It’s not that bipartisan support is lacking. In his budget proposal next month, President Obama will ask Congress to allocate $500 million in new mental health funds as well as some policy changes making it easier to keep guns out of the hands of people with severe mental illness.
Republican House Speaker Paul Ryan has said passing mental health reform is a top priority for him this year, and a number of bipartisan bills are brewing in the House and the Senate that aim to improve mental health access and reform the way federal and state programs treat those affected with severe conditions.
And lawmakers of all stripes feel an urgent need to improve access to counseling, medication and other treatment for those with mental illness, as mass shootings, some perpetrated by severely ill people, have multiplied.
But there’s a thorn in the side of all of it: gun control. Democrats are unlikely to work with Republicans on mental health reform unless the GOP agrees to gun control measures. And that’s a nonstarter for most Republicans, especially in an election year.
“I don’t think it would be prudent for us to hold our breath,” said Chuck Ingoglia, a lobbyist for the National Council of Behavioral Health.
Lawmakers also have sharp disagreements over how to reform the mental health system: whether to impose more rules for how states should run their court-ordered treatment programs, and how much to relax patient privacy law so caregivers can get more medical information about those with severe conditions such as schizophrenia or bipolar disorder.
Rep. Tim Murphy, R-Pa., is frustrated that the White House hasn’t appeared more interested in a bill he has been promoting for several years, which eliminates the Substance Abuse and Mental Health Services Administration (SAMHSA) and makes some federal funds contingent on how states run assisted outpatient treatment programs, among other big reforms.
Murphy recently told the Washington Examiner he has tried to engage President Obama and the White House on the issue with little success, although he did meet with Health and Human Services Secretary Sylvia Mathews Burwell about his bill a few weeks ago.
“Um, never,” Murphy said, when asked whether the White House has reached out to him. “A few weeks ago I was at the White House and [told the president] I am the guy who is leading the issue on mental health — I want to talk to you about this.
“He knows it’s me and we’ve been spending years on this,” Murphy said. “We’d love to have his help.”
In addition to Murphy’s meeting with Burwell, White House legislative staffer Don Sisson attended a subcommittee markup for Murphy’s bill in early November.
Asked if the White House plans to get behind Murphy’s bill, White House press secretary Josh Earnest told the Examiner that he “couldn’t speak to all of the conversations between the White House and Congressman Murphy’s office,” but said Murphy’s office would “likely get a phone call.”
Earnest also noted that Obama’s healthcare law gave more low-income Americans access to mental health services through expanding Medicaid and said the president is genuinely interested in doing more.
“And we are certainly willing and ready to work with Republicans who share that priority,” Earnest said.
But lawmakers, both Democrats and Republicans, have their own hangups over Murphy’s bill. Republicans in the House Doctors Caucus are concerned that changes to the law could leave doctors unfairly on the hook if patient records are breached. Members of both parties dislike its focus on court-mandated treatment programs, which are seen by some as another encroachment on patient freedom.
There are concerns about Obama’s proposal, too. While many mental health advocates applauded Obama for including mental health reform among his actions on gun control, some say they would like to hear more details about how he would ensure the $500 million prioritizes support for the severely mentally ill.
Many activists believe that people with illnesses so severe they can’t work and rotate in and out of the criminal justice system aren’t receiving the support they need. The lack of details from Obama is especially a concern for D.J. Jaffe, director of Mental Illness Policy Org.
“That is far too broad,” Jaffe said. “The focus should be people known to have serious mental illness as they are the ones most likely to become violent, arrested, incarcerated, homeless, suicidal and an expense to taxpayers.”
The American Psychiatric Association, which has endorsed Murphy’s bill with a less controversial version of the legislation authored by Sens. Bill Cassidy and Chris Murphy, wants Obama to direct the funds toward addressing the psychiatric workforce shortage, improve enforcement of a mental health parity law and fund early intervention programs.
Obama also called for two changes to mental health policy, by ensuring the Social Security Administration reports information about mentally ill individuals to the national background check system and making it easier for states to report information about people who are prohibited from possessing or receiving a gun for specific mental health reasons.
Lawmakers are making some baby steps toward advancing mental health reform, including a hearing on the Cassidy-Murphy bill last week at the Senate Health, Education, Labor and Pensions Committee and a markup of another bill sponsored by Sen. John Cornyn, R-Texas, scheduled for Tuesday.
But given the various divides, there’s plenty of reason to believe mental health reform will stall this year. Still, American Psychiatric Association President Renee Binder said she’s remaining optimistic. “I think that when Congress gets together, they can focus on things they don’t agree about, or they can focus on things they do agree about. Mental health reform is one of the things people do agree on.”
