Rep. Tim Murphy (R-Pa.) spoke to a group of mental health advocates today in Cleveland, discussing healthcare policy and drumming up local support for the 2015 version of the Helping Families in Mental Health Crisis Act (H.R. 2646) that he introduced in June.
His overarching message was that the mental health system must be improved, especially for those with serious mental disorders, and that policy must drive a focus on effective treatment.
“We make it the most difficult for those who have the most difficulty,” Murphy said to an audience of about 75 advocates and clinicians.
One of the key points of contention about H.R. 2646 has been the approach to expand assisted/court-ordered outpatient treatment (AOT). The bill offers a 2 percent funding incentive through the federal mental health services block grant to states that have AOT programs. It currently has 105 bipartisan co-sponsors and varying degrees of endorsement in the industry.
“The majority of the bill is phenomenal,” Joyce Roper, LSW, MSW, staff member at the Magnolia Clubhouse, a recovery community, told Behavioral Healthcare. “But some of our members have concerns with the ability of family to mandate treatment.”
Murphy specified that AOT programs apply to only a small portion of individuals with mental health conditions: just 1 percent of 1 percent. Previous versions of the bill mandated AOT programs for states, but this version offers financial incentives—carrots rather than sticks.
“There are some who say nobody should ever have any involuntary commitment, and I don’t agree with that,” he said. “There are some times, by the nature of the illness, that that’s beneficial.”
He believes that if the perpetrators of violent tragedies like Sandy Hook Elementary School and the Aurora, Colo., movie theater had assisted outpatient treatment, the tragedies wouldn’t have occurred. To those who oppose AOT on the basis of personal freedom, he says, “Go talk to the moms from Sandy Hook and tell them that.”
According to Murphy, a person with schizophrenia in treatment, versus someone who is unaware of his own illness and has no treatment, is 15 times less likely to be involved in an act of violence. Mental illness is the tragedy behind the tragedies, and Congress should not ignore it, he said.
According to Murphy, who is a Navy psychologist and currently practices at Walter Reed Hospital in Bethesda, Md., AOT is an evidence-based program that has proven to reduce costs for the justice system and the healthcare system, while also providing satisfaction for the individuals who receive treatment. The alternative would be to send more people with mental health disorders to jail.
“When a judge sentences someone to jail, the state now has to provide for that service,” he said. “When a judge says, ‘you need to be in outpatient care,’ the state has to provide that service. They can’t walk away from it. So there’s a benefit to making sure the services are there.”
Streamlining federal efforts
Additionally, Murphy noted that H.R. 2646 aims to create a new Office of the Assistant Secretary for Mental Health and Substance Use Disorders that would be responsible for getting more out of federal spending on behavioral health. For example, he said, the federal government spends $130 billion on mental health today—mostly on disability payments—meanwhile, its funding is allocated to seemingly bizarre programs that aren’t being tracked for effectiveness, such as fruit smoothies and sing alongs.
At least 112 agencies deal with mental health issues in some way, and they are too often producing uncoordinated efforts that lack accountability.
“The redundancy is massive,” Murphy said. “There are 20 programs for homelessness, which means there are 20 administrators and 20 departments sucking up the money.”
He said legislation for reforming the mental health system for those with the most serious need has been “slow-walked” and that leaders of both parties must stop being passive in addressing the issue.