BY CLAIRE WHEELER – It has been called a “man-made disaster.”[1] The U.S. mental health system is in tatters. A third of adults with a serious mental illness received no treatment in 2013.[2] With nowhere to turn, the mentally ill end up in our prisons and city streets.[3] “The lucky ones find homes with family. The unlucky ones show up in the morgue.”[4]
It is clear that U.S. mental healthcare is in need of serious reform. A new bill proposes to do just that. On February 26, U.S. Rep. Tim Murphy announced that he would reintroduce the Helping Families In Mental Health Crisis Act in Congress.[5] If passed, it would be “the most comprehensive overhaul of the mental health system since the Kennedy Administration.”[6]
Rep. Murphy (a trained psychologist[7]) is a senior member of the House Energy & Commerce Committee.[8] Murphy introduced the Helping Families In Mental Health Crisis Act over a year ago.[9] But the bill never made it out of the House.[10] Murphy hopes to reach a different result with this Congress.
Murphy’s comprehensive bill would include many reforms, only a few of which I can address in this short blog post. For example, the bill would increase treatment options for children and adolescents.[11] In addition, the bill would create a new Assistant Secretary for Mental Health and Substance Use Disorders within the Department of Health and Human Services.[12]
The bill also provides incentives for states to implement innovative “Assistant Outpatient Treatment” (AOT) programs[13], which is court-ordered mental health treatment without commitment to an institution.[14] Some mental health advocates oppose court-ordered treatment as coercive.[15] But many individuals with a serious mental illness do not recognize they are ill.[16] For this population, following through with a treatment regimen is unlikely at best, making court-ordered compliance the only feasible treatment option. AOT programs, for individuals who need it, allow the court to monitor a patient’s treatment in a less restrictive environment. Furthermore, AOT programs are already authorized in 45 states, and have been shown to be cheaper and more effective than traditional commitment.[17]
Not all of the act’s proposals are positive; for example, the bill proposes to forbid state protection and advocacy programs from engaging in lobbying and class action lawsuits,[18] a dangerous move that decreases the options for advocating on behalf of the mentally ill. But the bill provides a good starting point for getting comprehensive reform off the ground. Overall, the positives outweigh the negatives.
Mental illness is more prevalent than many believe. It is estimated that 10 million adults in the U.S. have a serious mental illness.[19] There is, of course, no cure-all for institutionalized mental health treatment, and no legislation is perfect. Nevertheless, the system as it stands is clearly insufficient, and change must come. The Helping Families In Mental Health Crisis Act will help speed that change along.
[1] Liz Szabo, Cost of not caring: Nowhere to go, USA TODAY, http://www.usatoday.com/story/news/nation/2014/05/12/mental-health-system-crisis/7746535/ (last visitedMar. 5, 2015).
[2] Substance Abuse and Mental Health Services Administration (SAMHSA), Behavioral Health Barometer, 2014 12, available at http://www.samhsa.gov/data/sites/default/files/National_BHBarometer_2014/National_BHBarometer_2014.pdf (hereinafter Behavioral Health Barometer)/
[3] One third of the U.S. homeless population (that’s over 100,000 individuals) has a severe mental illness. U.S. Dep’t of Hous. and Urban Dev., HUD’s 2014 Continuum of Care Homeless Assistance Programs Homeless Populations and Subpopulations (Oct. 7, 2014), available at https://www.hudexchange.info/reports/CoC_PopSub_NatlTerrDC_2014.pdf. In addition, over half of inmates have a mental illness. Doris J. James and Lauren E. Glaze, Bureau of Justice Statistics Special Report: Mental Health Problems of Prison and Jail Inmates 1 (Dec. 14, 2006), available at http://bjs.gov/content/pub/pdf/mhppji.pdf.
[4] Id..
[5] 161 Cong. Rec. H1177 (daily ed. Feb. 26, 2015) (statement of Rep. Tim Murphy)
[6] More Nationwide Praise for Murphy’s “Helping Families In Mental Health Crisis Act,” Murphy.House.Gov, Apr. 4, 2014, http://murphy.house.gov/latest-news/more-nationwide-praise-for-murphys-helping-families-in-mental-health-crisis-act/; see also Memorandum from the Subcomm. on Oversight and Investigations Majority Staff to the Energy and Commerce Comm. Members 1 (May 15, 2014), available at http://energycommerce.house.gov/sites/republicans.energycommerce.house.gov/files/letters/MentalHealth/051514MH-Staff-Memo.pdf
[7] Biography, Murphy.House.Gov, http://murphy.house.gov/biography/ (last visited Mar. 8, 2015)
[8] Oversight and Investigations, EnergyCommerce.House.Gov, http://energycommerce.house.gov/subcommittees (last visited Mar. 8, 2015)
[9] 159 Cong. Rec. H7697 (daily ed. Dec. 12, 2013) (statement of Rep. Tim Murphy).
[10] All Actions: H.R.3717 – 113th Congress (2013-2014) Congress.Gov, https://www.congress.gov/bill/113th-Congress/house-bill/3713/all-actions-with-amendments (last visited Mar. 8, 2015).
[11] Helping Families in Mental Health Crisis Act of 2013, H.R. 3717, 113th Cong. §§ 1121-22, 1131-32 (2014), available at https://www.congress.gov/113/bills/hr3717/BILLS-113hr3717ih.pdf.
[12] H.R. 3717 §101.
[13] H.R. 3717 §103(a).
[14] H.R. 3717 §103(e)(1)
[15] John M. Grohol, The Many Problems with the Helping Families In Mental Health Crisis Act, http://psychcentral.com/blog/archives/2014/04/13/the-many-problems-with-the-helping-families-in-mental-health-crisis-act/. (last visited Mar. 8, 2014)
[16] This is due to the effects of anosognosia, a common symptom of severe psychiatric disorders such as schizophrenia. NAMI Treatment Advocacy Center, Anosognosia (impaired awareness of illness): A major problem for individuals with schizophrenia and bipolar disorder (June 2005), http://www2.nami.org/Content/Microsites86/NAMI_Albuquerque/Home82/Current_Activities/NAMIWalks6/Briefing-anosognosia_%2805%29.pdf
[17] Assisted Outpatient Treatment Laws, TreatmentAdvocacyCenter.Org http://www.treatmentadvocacycenter.org/solution/assisted-outpatient-treatment-laws (last visited Mar. 8, 2015) (providing an overview of the status of AOT programs in the U.S.)
[18] H.R. 3717 §1141.
[19] Behavioral Health Barometer, supra note 2, at 11.
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Claire Wheeler is a 2016 Staff Editor of the Race & Social Justice Law Review.
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