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Treatment providers face off against patient advocates over AOT: Part 1

April 21, 2014
by Alison Knopf
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Rep. Tim Murphy

Mass shootings have led to calls for improved access to mental health treatment. The school shootings in Newtown, Connecticut led to the Now is the Time initiative by President Obama that included many new programs and expanded funding for mental health treatment, which the field supports. At the same time, mental health advocates also point out that people who need mental health treatment are no more likely than the rest of the population to be violent. Representative Tim Murphy (R-Pennsylvania) developed H.R. 3717 in response to Newtown

Otherwise known as the Helping Families in Mental Health Crisis Act of 2013, H.R.3717 was introduced by Rep. Murphy last December and had a hearing on April 3 by the Subcommittee on Health of the House Energy and Commerce Committee. Although the bill has the slimmest of chances even getting out of committee, the ideology behind it has the strong support of mental health advocates, with one divisive exception: assisted outpatient treatment (AOT), known by opponents as forced treatment or court-ordered medication.

Meanwhile, another bill, the Access to Medicare Act (H.R. 4302), which passed in the Senate on March 31 and was signed the next day by President Obama, includes AOT provisions. The comprehensive legislation that makes numerous changes to the Medicare system and delays the implementation of ICD-10 also includes expanded funding for outpatient mental health treatment and institutes a pilot for AOT.

The Washington, D.C.-based Bazelon Center for Mental Health Law and other patient advocates oppose H.R. 3717 because of the AOT provisions. Other groups support it because it expands mental health treatment--but wish it didn’t have the AOT provisions. And this is the tension in the mental health treatment community that has been growing in the wake of mass shootings.

The line of scrimmage

Patient advocates are almost universally opposed to any kind of involuntary, coerced treatment. Yet, they need more resources, more treatment, and more access. On the treatment side, there is also agreement that more resources are needed, but for some providers, they also see the need to coerce treatment. This is where the “line of scrimmage” is formed. Patient advocates are not opposed to medication as long as it’s voluntary. But the mainstream of psychiatric providers seem to say that unfortunately, there are some patients who need some element of coercion.

The mental health field is walking a fine line between advocating for funding and explaining that people with mental illness aren’t violent. “Everybody is walking the same line,” said Brian Altman, legislative affairs director for the Substance Abuse and Mental Health Services Administration (SAMHSA). The Now is the Time Initiative, proposed by President Obama in early 2013, was comprehensive, with multi-pronged approaches, he said. The point of that initiative was to identify individuals who need help early, irrespective of whether they will become violent, he said.

Rep. Murphy has historically chided SAMHSA for not focusing on people with serious mental illness—and pointedly cut some of the funding for SAMHSA in H.R. 3717. He E. Fuller Torrey, M.D., founder of the Treatment Advocacy Center in Arlington, Va., sides with Rep. Murphy in criticizing SAMHSA and in promoting AOT.

Last year, Torrey, a longtime critic of SAMHSA, was the star witness at a hearing on SAMHSA held by the House of Representatives Subcommittee on Oversight and Investigations, which ischaired by Murphy. After grilling SAMHSA Administrator Pamela Hyde, J.D., Murphy introduced Torrey, who launched into a line-by-line critique of SAMHSA’s lack of focus on people with serious mental illness.

Continue the story here.

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