In 2013, Rep. Tim Murphy (R-Pa.) proposed the Helping Families in Mental Health Crisis Act, H.R. 3717, as a response to the tragedy in Newtown, Conn. The legislation did not make it out of committee before the congressional session ended, and on June 4, a revised version of the bill – now H.R. 2646 – was introduced in Congress, cosponsored by Texas Democrat Rep. Eddie Bernice Johnson. The legislation is being framed as sweeping legislation “to fix America’s broken health system.” Those familiar with the original version may recall that controversial portions included a requirement for states to have legislation for outpatient civil commitment or lose funding, and allow caretakers to access information for mental health patients without patient consent. That version also proposed the shifting of funds from the Substance Abuse and Mental Health Services Administration (SAMHSA) to the National Institute of Mental Health (NIMH) to promote research.
The text of H.R. 2646 is 173 pages long, nearly 40 pages longer than the original version of the bill Even those who are well versed in these issues are having trouble deciphering the new proposals.
Let me start with a rather unusual disclaimer for someone writing about a piece of legislation: I haven’t read the bill. Instead, I read the blog of journalist/advocate Pete Earley, after he went to the effort of reading the text, soliciting the opinions of leadership at several organizations, and putting together a list of comparisons between the 2013 and 2015 versions of the proposed legislation. In a piece headlined, “Murphy Introduces Revamped Mental Health Bill: Will It Fly This Time Around?” Earley compares the new 2015 bill to the original legislation proposed in 2013.
I’m going to summarize the differences Earley noted, and I’ll add his caveat that he is not certain that his interpretations are correct; the wording of the bill is confusing, and there is not yet agreement on what the different components of the legislation mean. Because the issues around requirements for outpatient commitment have been so volatile, let me add that Earley did communicate with a staffer in Murphy’s office and confirmed that his understanding of that portion of the legislation is correct.
Earley noted eight main points:
1. Rather than removing funding from SAMHSA and shifting it to the NIMH, the new bill gives oversight for mental health care and funding to an assistant secretary for mental health and substance abuse treatment within the Department of Health and Human Services. The bill stipulates that the position must be held by a psychiatrist or psychologist.
2. In H.R. 2646, this funding would be provided only for programs recognized as evidence-based practices; it does not target specific SAMHSA programs for elimination.
3. States that implement outpatient civil commitment would receive a 2% increase in block funding grants. In the original version, states without this legislation would lose federal funding.
4. The new bill allows psychiatrists to share only specific information with caretakers without patient consent: diagnoses, treatment plans, and information about medications but not psychotherapy notes.
5. Murphy’s bill would repeal the so-called IMD (institutions for mental disease) exclusion for facilities with more than 16 beds as long as a facility kept patients less than an average of 30 days.
6. In the original version of the bill, Murphy wanted to eliminate funding to protection and advocacy agencies charged with protecting patients’ rights. The 2015 version bill would limit the powers of advocates by restricting their authority to the investigation of abuse and neglect, and would forbid these agencies from lobbying and from “counseling an individual with a serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of such individual’s caregiver.”
7. The newer version eliminates the 190-day lifetime cap on inpatient psychiatric hospitalizations in Medicare.
8. H.R. 2646 encourages funding and support for peer-to-peer programs, but sets standards for peers and requires their work to be monitored by a mental health professional.
Obviously, legislation of this length includes much more, but these were the differences Earley identified in his comparison to text of the first version. His Website includes more detail and explanation of these points, and I encourage you to visit PeteEarley.com .
Days after the introduction of the bill, now known as the Murphy-Johnson Act, American Psychiatric Association President Renée Binder and CEO Saul Levin wrote a letter of support for the bill. The letter outlines some of the major issues that the legislation addresses, including increases to the psychiatric workforce. In it, they note: “This is historic legislation that would, for the first time in decades, bring systemwide reforms and improvements to care for our patients and for those who currently lack access to needed treatment.”
A hearing will be held on the bill today.
With thanks to Pete Earley who allowed me to hijack his article.
Dr. Miller is coauthor of “Shrink Rap: Three Psychiatrists Explain Their Work” (Baltimore: Johns Hopkins University Press, 2011). Follow Dr. Miller on Twitter @shrinkrapdinah .
