The White House pick for the newly created post of mental health czar has raised some hackles on Capitol Hill.

President Donald Trump recently announced that Elinore “Ellie” F. McCance-Katz, MD, PhD, a psychiatrist whose career has focused on substance abuse and addiction, was his nominee to serve as nation’s first assistant secretary for mental health and substance use. In 2013, Dr. McCance-Katz served as the Substance Abuse and Mental Health Services Administration’s first chief medical officer. She resigned after 2 years.

The choice does not sit well with Rep. Tim Murphy (R-Pa.), whose landmark legislation , Helping Families in Mental Health Crisis – ultimately passed as part of the bipartisan 21st Century Cures Act – created the cabinet-level post to help end what many have seen as SAMHSA’s poor performance in meeting the nation’s mental health needs.

“I am stunned the president put forth a nominee who served in a key post at SAMHSA under the previous administration when the agency was actively opposing the transformative changes in H.R. 3717, the original version of my Helping Families in Mental Health Crisis Act,” Rep. Murphy said in a statement . “After an intensive investigation bringing to light the many leadership failures across the federal government, but particularly at SAMHSA, I drafted strong legislation to fix the broken mental health system. One of the most critical reforms was restructuring the agency, focusing on evidence-based models of care and establishing an assistant secretary within [the Department of Health & Human Services] to put an end to what the Government Accountability Office termed a lack of leadership.”

Key provisions of the legislation include clearer HIPAA language, expanded access to inpatient psychiatric hospital beds, and a stronger and more streamlined federal commitment to evidence-based practices in mental and behavioral health care delivery.

The American Psychiatric Association, however, endorsed the nomination and called for swift confirmation by the Senate. “We look forward to working with her to improve the quality of care of mental health and substance use disorders,” APA CEO and Medical Director Saul Levin, MD, said in a statement.

Currently, Dr. McCance-Katz is the chief medical officer for Rhode Island’s department of behavioral health care, developmental disabilities, and hospitals. Dr. McCance-Katz, widely regarded as an expert in medication-assisted treatment for substance use disorders, among other addiction-related specialties, also is a former California department of alcohol and drug programs state medical director.

Since leaving her previous post at SAMHSA, Dr. McCance-Katz has been an outspoken critic of the agency she is now being tapped to run. She once editorialized against what she called its poor performance in addressing the needs of people with serious mental illness and its “hostility toward psychiatric medicine.”

Rep. Murphy’s own reported preference for the role was Michael Welner, MD, a forensic psychiatrist upon whom the congressman – himself a clinical psychologist – relied on in part to help craft his mental health legislation. According to mental health blogger Pete Early – who often writes about his son’s struggles with bipolar disorder – the announcement is a surprise to many who expected Dr. Welner to be the pick. On his blog, Mr. Early wrote that Senate sources had told him that Dr. Welner, who publicly supports President Trump, “had a lock on the job.”

Several other names were floated for the position, according to Mr. Early, including John Wernert, MD, who served as head of Indiana’s mental health policy under then-governor, Vice President Mike Pence, and Miami-Dade County, Fla., Judge Steve Leifman , known for his interest in diverting those with serious mental illness from the criminal justice system and into treatment. However, the judge did not have an advanced medical degree, as stipulated by the law , a provision pushed by Rep. Murphy to safeguard against what he said was SAMHSA’s antipsychiatry stance.

In an APA blog post , APA President Maria A. Oquendo, MD, PhD, said Dr. McCance-Katz would “bring a wealth of knowledge in the prevention, treatment, and recovery of substance use disorders” that challenge the United States. “APA strongly supports her appointment.”

Dr. McCance-Katz’s nomination will go before the Senate’s Committee on Health, Education, Labor, and Pensions, which is chaired by Sen. Lamar Alexander (R-Tenn.). His office said the senator “looks forward to learning more about how Dr. McCance-Katz would use her experience in medicine and government to implement the new mental health law passed last Congress to help the one in five adults in this country suffering from a mental illness receive the treatment they need.”

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