After the school shooting in Newtown, Conn., in December 2012, we saw an unprecedented amount of proposed legislation at both the state and national levels. The legislation was aimed at fixing whatever it is that is broken in our country that either causes or allows a young man to kill more than two dozen innocent people. Some legislators focused on gun control, while others focused on changing the mental health system, with the idea that the shooter’s actions were caused by his untreated mental illness.
Rep. Tim Murphy, Ph.D., has the distinction of being the only clinical psychologist in Congress, so it’s certainly understandable that he would focus on making long-overdue changes to our troubled mental health system. In addition, Rep. Murphy, a Republican from Pennsylvania, has a strong history of voting against legislation that would curb gun rights, and he carries an “A” grade from the National Rifle Association. When Rep. Murphy publicly promised the families of the Newtown victims that he would enact change, it was clear that his passion was for changing the mental health system. In 2013, Rep. Murphy, with bipartisan support, proposed The Helping Families in Mental Health Crisis Act .
The Murphy bill proposed sweeping and complex changes, and the text was 135 pages long. A major component of the bill was to create a position for an assistant secretary for mental health and substance use disorders within the Department of Health & Human Services to coordinate federal programs and ensure that evidence-based treatments were being used.
The bill also called for shifting money from the Substance Abuse and Mental Health Services Administration (SAMHSA) to the National Institute of Mental Health in the wake of recent thought that SAMHSA has become insensitive to severe mental illness and too oriented toward a recovery model that carries a vague antipsychiatry sentiment.
From there, the issues of patients’ rights versus a doctor-knows-best sentiment have influenced the act, as though one can’t be in favor of both. Perhaps the most controversial requirements include a provision that mandates all states to have outpatient civil commitment programs and a provision that says that health care providers may release information to caretakers of patients with psychiatric disorders without the patient’s consent if the information is felt to be necessary for the patient’s safety or welfare.
This last point is likely to be interpreted as suggesting that psychiatric patients don’t have the same right to confidentiality that other patients have, which would be true. It has the potential to be stigmatizing and infantilizing, and there are people who will not seek care because of the perception this creates. In addition, it may create tension between family members who feel the law now entitles them to information and psychiatrists who don’t see this is as necessary or who fear that releasing information will damage the therapeutic relationship.
Many components of the Helping Families in Mental Health Crisis Act have been applauded universally, but the American Psychiatric Association did not formally support the bill, and an opposing bill was proposed in Congress by Rep. Ron Barber, a Democrat from Arizona who took Gabrielle Giffords’ seat after an assassination attempt by a mentally ill man left her unable to serve. Both bills died when the congressional session ended in December, and Mr. Barber lost a re-election bid and has not returned to Congress.
A new Congress has convened, and Rep. Murphy will be re-introducing the Helping Families in Mental Health Crisis Act with numerous changes. Although the APA did not endorse the previous legislation, the association last week announced, with unanimous backing by the Board of Trustees, its support for the Murphy bill.
“We are pleased that Chairman Murphy is refining and reintroducing his comprehensive mental health reform bill, the Helping Families in Mental Health Crisis Act,” APA President Paul Summergrad said in the last week of January. At an event in early February, he said that he intends to add reforms that align well with APA priorities, including boosting the psychiatric workforce and monitoring and enforcement of mental health parity.
“In December the APA Board of Trustees carefully reviewed its strategy, principles and options for reform and unanimously voted to fully support the efforts of Chairman Murphy and his lead Democratic cosponsor, Rep. Eddie Bernice Johnson. Their efforts are historic in scope, and we are hopeful that Congress will through the legislative process act to pass comprehensive mental health reform with the bipartisan support it deserves.”
Still, I heard the news and was terribly disappointed in the APA. The decision to support this sweeping legislation was made without a vote by the Assembly, with the knowledge that some of these issues are quite polarizing. In addition to the HIPAA disqualification, the issue of outpatient civil commitment, in particular, is controversial. Although proponents are quick to point to research that show its benefits – the research has been done specifically on Kendra’s Law in New York, where $125 million was placed into that state’s mental health system to shore up services – we don’t have the research to know if what helps is providing more services or strong-armed coercion. The text of the bill will be released in the coming weeks. At the very least, couldn’t the APA have waited to see exactly what it is we endorsed?
Dr. Miller is a coauthor of “Shrink Rap: Three Psychiatrists Explain Their Work” (Baltimore: Johns Hopkins University Press, 2011).