Murphy Holds Hearing to Support Revised Mental Health Reform Legislation
Mental Health Weekly June 22, 2015
The country’s mental health system, particularly for people with serious mental illness, is “badly broken, getting worse and has to be fixed,” said Rep. Tim Murphy (R-Pa.), chair of the House Energy and Commerce Committee Oversight and Investigations Subcommittee, and sponsor of mental health reform legislation, during opening remarks at the Health Subcommittee hearing June 16 to examine “The Helping Families in Mental Health Crisis Act of 2015.”
Murphy and Rep. Eddie Bernice Johnson (D-Texas) reintroduced the legislation, H.R. 2646, June 4. The legislation has been met with praise and criticism from the field on some provisions, including assisted outpatient treatment (AOT), work conducted by Protection and Advocacy (P&A) agencies and the reform of the Substance Abuse and Mental Health Services Administration (SAMHSA) (see MHW, June 15).
“The Helping Families in Mental Health Crisis Act of 2015” was previously introduced in December 2013 (see MHW, Dec. 23, 2013), which also unleashed controversy over some of the aforementioned provisions.
Jeffrey A. Lieberman, M.D., chairman of the Department of Psychiatry in the Columbia University College of Physicians and Surgeons, told lawmakers during the hearing that the mental health crisis is a “solvable problem.” Lieberman told MHW that testifying before the subcommittee was very productive and interesting. “The reintroduction of the bill with some modifications is seeing more bipartisan support than it did when first introduced,” he said.
Lieberman said he was the only physician on the panel of eight with any scientific expertise. “As the only medical representative, that’s a reflection of the fact that Congress has not viewed mental health care as a medical problem,” he said. “There needs to be political will to effect policy change that will facilitate evidence-based practices made available to people and adequate resources provided to support those [treatments].”
Lieberman added, “Murphy’s bill takes a very important step in achieving that goal. I urged full support of the bill.”
Several provisions, said Lieberman, are notable, including the proposal to change the oversight and leadership of SAMHSA, he said. “The resources SAMHSA has and its funding distribution needs to be guided by scientific evidence and not opinion and ideology,” said Lieberman.
The oversight will be at the level of the U.S. Health and Human Services Department cabinet. That person may be a psychiatrist or psychologist, he said. “There will also be an advisory group to review evidence that emerges from searches each year to determine what services are actionable,” Lieberman said. The thrust of it is to use resources currently being spent by the federal government on mental health care in a way that would produce an impact, he said.
The bill’s provision regarding early intervention and prevention is encouraging, added Lieberman. States that receive block grant funds need to put these funds toward the newest and most potentially effective treatment, like the Recovery After an Initial Schizophrenia Episode (RAISE) treatment model, he said.
“RAISE could pre-empt the devastation that psychotic disorders cause people,” Lieberman said.
“The bottom line is that there may be minor issues and aspects of the bill that will cause some difference of opinion,” noted Lieberman.
“Overall, this is an extremely positive bill and a much-needed one. It should rise above the bipartisan disputes.”
Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, Inc. (NYAPRS), said the organization and other recovery advocates have long opposed court-mandated treatment, also known as involuntary outpatient treatment. “It’s a system-failure issue, not a patient-failure issue,” he said.
Murphy’s first bill on mental health reform (H.R. 3717) noted that states would not have access to the $480 million of community block grants set for all 50 states unless officials implement AOT programs. In the current bill, states would receive a 2 percent incentive if they do implement the programs, said Rosenthal, who testified at the hearing.
The revised bill indicates that states would need to have an outreach and engagement program demonstrating that they’re doing something to serve the people with the greatest needs, he said. “For example, I could have an ACT [Assertive Community Treatment] team, peer bridges and mobile crisis services and that would be enough,” Rosenthal said. “You wouldn’t have to have an AOT program.”
Based on the discussions during the hearing, Rosenthal said he is hoping that the next version of Murphy’s bill will include several clarifications.
He said he is hoping for “a clarification that the state eligibility criteria for states to access Community Mental Health Block Grant dollars will be a strong Outreach and Engagement program for underserved individuals that may but will not have to include AOT.”
Protection and Advocacy
Murphy’s initial proposal would have gutted the Protection and Advocacy program, which provides legal-based advocacy services for people with psychiatric disabilities, by 85 percent. In the new bill, that is no longer the case. However, any advocacy by P&A would have to be based on abuse and neglect.
During the hearing, Mary Jean Billingsley of the National Disability Rights Network provided testimony about her 22-year-old son, Tim Costello, who has a disability.
Billingsley said that often issues faced by people with mental illness are not about abuse and neglect but about the problem of human civil rights.
Murphy’s bill would limit advocacy support to abuse and neglect cases even with nonfederal dollars, she said. Had it not been for P&A support, her son would have cycled in and out of institutions, she testified.
Rosenthal said that NYAPRS would like to see a broadening of authority for protection and advocacy lawyers that extends beyond the very narrow abuse and neglect standard that currently is in H.R. 2646 to, at minimum, advocate for more and better services for their clients.
Medicaid IMD exclusion
“Clearly, there’s been a lot of attention paid to the proposal to lift the IMD [Institutions for Mental Disease] exclusion,” said Rosenthal. The IMD exclusion prohibits facilities with 16 or more beds for people with mental illness to receive their federal share of Medicaid funding.
In Murphy’s proposal, a private or state hospital can start receiving Medicaid if on an annual basis, people stay there for no more than 30 days, Rosenthal said. An HHS agreement for Medicaid managed care would allow states to bill Medicaid in the same types of facilities if patients are there for fewer than 15 days, he added.
Rep. Paul Tonko (D-N.Y.) said that while he appreciates Murphy’s continued efforts to improve care for persons struggling with mental illness, he does not support the bill as written. “In addition, I am perplexed by the provisions surrounding the Medicaid IMD exclusion and the Medicare mental health 190-day inpatient limit,” he said in a statement.
“Language in this bill implies that these policies cannot go into effect unless CMS [Centers for Medicare & Medicaid Services] certifies that they will not result in any net spending.”
Tonko added, “Both of these policies have been evaluated numerous times by budget analysts and would clearly imply billions of dollars in increased federal spending.
Because of the ‘no-increased spending’ clause, it is unclear how these policies would ever be implemented under this legislation.… I plan to introduce legislation tackling both of these issues soon.”
Other witnesses who provided testimony included former Representative Patrick J. Kennedy, founder of the Kennedy Forum; Paul Gionfriddo, president and CEO of MentalHealth America; Sen. Creigh Deeds (D-Va.); and Steve Coe, CEO of Community Access