The House is finally moving forward this week on a mental health reform bill, but only after pulling out many of its teeth.
The “Helping Families in Mental Health Crisis Act,” long championed by Rep. Tim Murphy, R-Pa., is slated for a markup at the House Energy and Commerce Committee on Wednesday. Murphy introduced the legislation in late 2013, but it has undergone several revisions as Democrats objected to some of its most controversial, but potentially most impactful, elements.
Most of the disputes have revolved around how to care for the approximately 13 million Americans with serious mental illnesses such as schizophrenia, major depression or bipolar disorder. These Americans are at a much higher risk for unemployment, homelessness and incarceration than others, and more than one-fourth of them lack health coverage.
Lawmakers recognize it’s a pressing problem, but they aren’t united on an approach, with Democrats fearing that mandating treatment for the severely mentally ill or caring for them in psychiatric centers could bring back some of the abuses of the 1960s, when patients were often deprived of their rights.
The latest version, which House Speaker Paul Ryan has said he wants to hold a vote on this summer, strips out or tones down some of the elements Murphy was most excited about initially, although the Pittsburgh Republican insists the bill will still pack a punch if implemented.
“We never compromised our values on this, but we did work towards consensus on this,” Murphy told the Washington Examiner.
Murphy’s bill initially required all states to set up a court-mandated treatment program, known as assisted outpatient treatment, in which a judge is able to order treatment for a seriously mentally ill person. Now, the legislation says only that states with such programs can get extra federal funding.
And instead of changing patient privacy laws to allow family members to more easily get medical records for those with serious mental illness, the bill now directs the Department of Health and Human Services to make the change through the rule-making process to allow for public input.
Murphy also had sought to provide more funding for residential care for the seriously ill, by repealing an old Medicaid rule that prohibited reimbursements to hospitals with more than 16 psychiatric beds. His revamped bill instead codifies a rule released last summer by the Obama administration that eases restrictions on Medicaid reimbursements for mental health facilities.
The legislation does retain some of its original elements, such as creating a new assistant secretary for mental health at HHS, who would be charged with overseeing mental health grants and promoting evidence-based care.
And it still sets up a new panel, dubbed the “Interagency Serious Mental Illness Coordinating Committee,” aimed at streamlining the federal government’s web of mental health program that often don’t coordinate with each other.
The revisions have caused civil rights advocates to rethink their initial opposition to Murphy’s bill. The American Civil Liberties Union told the Examiner on Tuesday it is reviewing the latest version, although the group doesn’t like how it provides extra funding to states with mandatory treatment programs.
Many Democrats have come on board, now that Republicans have conceded to their objections about some elements in the bill, like how it would have immediately changed patient privacy laws. They also succeeded in tacking on some of their own priorities, such as funding for what is known as assertive community treatment.
“Overall, the bill is a good starting point as we work to improve the full spectrum of mental healthcare in America,” a Democratic representative for the Energy and Commerce Committee said. “In the coming days, Democrats will continue to work with Republicans and mental healthcare advocates to ensure that the final bill is as meaningful as possible.”
Yet the stripped-down Murphy bill is frustrating to advocates for the seriously mentally ill, who feel as though the high-need and high-risk patients are generally ignored by the larger mental health community.
D.J. Jaffe, director of the group Mental Illness Policy Org, calls Murphy his “hero” for trying to enact major reforms for those with serious mental illness. Jaffe liked the initial version of Murphy’s bill, but says the latest iteration contains few real reforms.
Jaffe is also displeased with another mental health reform bill from Sens. Chris Murphy and Bill Cassidy, which the Senate Health, Education, Labor and Pensions Committee passed in March and which Senate Majority Leader Mitch McConnell might bring to the floor later this month.
“Both bills are now full of studies, reports, commissions and advisory boards, but little actual solving of problems that have already been identified,” Jaffe said.
Murphy is remaining positive about his bill, though, saying he has been able to retain some of its most important elements and refusing to criticize his Democratic colleagues for their differences of opinion about how to reform the country’s mental health system.
“There’s no doubt in my mind that they feel compassion towards mental illness, and this has been a learning process all the way through,” Murphy said. “So I’m not going to be critical of their understanding of this.”
