“Mental illness does not discriminate based on age, class or ethnicity. It affects all segments of society. More than 11 million Americans have severe schizophrenia, bipolar disorder, and major depression yet millions are going without treatment as families struggle to find care for loved ones.”
That is the opening statement of the “Helping Families In Mental Health Crisis Act” (HFIMFCA), a bill proposed by Representative Tim Murphy a U.S. Congressman for the 18th district of Pennsylvania. The bill was suggested after the Energy and Commerce Subcommittee on Oversight and Investigations (ECSOI) completed a top-to-bottom review of the country’s mental health system that began in January 2013.
The findings of the investigation revealed that the way the federal government handles mental health “is a chaotic patchwork if antiquated programs and ineffective policies across numerous agencies,” as stated by the bill itself. The bill goes on to explain that while those who struggle with mental health are no more violent than anyone else, many untreated mentally ill people end up in jail or homeless on the streets. This bill is designed to provide help to those people.
Some of the findings of the Energy and Commerce Subcommittee on Oversight and Investigations are downright terrifying. For example, physicians won’t release information with loved ones about an individual in an acute mental health crisis because of complicated federal rules about communicating with immediate family members.
Can you imagine if your sister or brother were having a psychotic break and the doctors wouldn’t tell you anything because of twisted privacy laws? As an older sister to four brothers, that thought makes me shiver.
Another huge problem: the act plans to empower parents and caregivers by clarifying the Health Information Portability and Accountability Act (HIPAA) privacy rule and the Family Educational Rights and Privacy Act so that mental health professionals can give parents and caretakers the information they need to take care of their loved one who is in an acute mental health crisis.
Another major problem is the severe lack of inpatient psychiatric beds in the USA. Seventy years ago, our country had 600,000 inpatient psychiatric beds for a population that was about half of what it is now; but somehow today, we only have 40,000 beds. This is due to exclusions made under the Institutions for Mental Disease (IMD). Congressman Murphy wants to increase patient access to acute care psychiatric beds by making two narrowly tailored exceptions to the IMD exclusion.
The ECSOI reported that approximately forty percent of individuals with schizophrenia do not know they have a mental illness, and those numbers are similar for many other disorders, making it difficult for those struggling to follow through on a treatment regimen. Think of it this way: what would happen if you broke your leg without realizing it and thus didn’t go to the doctor to get it fixed? You would keep walking on it and it would keep getting worse until eventually you probably wouldn’t be able to walk on it at all. The same thing happens to mentally ill people who don’t get treatment: their brain isn’t working right and they haven’t been to the doctor so they keep using their dysfunctional brain until…until what? Until they’re hospitalized? Until they kill themselves? This is a problem we really need to start thinking about.
The HFMHCA suggests we promote alternatives to throwing the mentally ill into long-term inpatient facilities, such as court-ordered “Assisted Outpatient Treatment” which has already been proven to save money for governments by reducing the rates of imprisonment, homelessness, substance abuse, and costly ER visits.
For people in rural populations who don’t have access to proper healthcare, it is reported that there is an average of 110 weeks between the first occurrence of psychosis and the onset of treatment. Let’s go back to the broken leg example: this time, you know your leg is broken but you know you have to suck it up and deal with it for two years before you can get treated. That’s absurd, two years walking on a broken leg? Imagine trying to go to work for two years with visual schizophrenic hallucinations. When you put it that way, it doesn’t sound so easy, does it? The bill will link psychiatrists and psychologists with primary care physicians in areas where patients do not have access to mental health professionals. That way, people struggling with mental illness can get the treatment they need from their more easily accessible primary care physicians. This is also important because low-income individuals who struggle with untreated mental illness and addiction disorders have higher incidences of cancer, heart disease, diabetes and asthma. Untreated depression alone increases the risk for chronic diseases and can double the cost of healthcare for health disease and diabetes. Primary care physicians can be integrated with behavioral health care by extending the health information technology incentive program to mental health providers so they can communicate and work with primary care physicians.
Out of all the things this bill proposes, I believe the most important one is its proposition to drive evidence-based care by creating an Assistant Secretary for Mental Health and Substance Abuse Disorders within the Department of Health and Human Services. Annually, the federal government spends $125 billion on mental health, but the government does not collect data on how that money is being spent and if those dollars are resulting in positive outcomes, which is atrocious.
How can you expect $125 billion to be spent responsibly if you aren’t overseeing its spending? Well, this new position would coordinate federal government mental health programs and ensure that recipients of the government spending apply evidence-based models of care developed by the NIMH, helping to ensure federal programs are optimized for patient care rather than bureaucracy. In a society where most of the money is being placed into the pockets of the top one-tenth of the top one percent of the population, it is vital to know that the funds being provided to help people struggling with mental illness are really helping those people.
Because many people who struggle with mental illness don’t have insurance and don’t have access to proper care, many patients in acute mental health crisis end up in the ER. There, they receive adequate treatment, but end up facing the same problems when they are discharged. This act proposes that it is crucial to stabilize psychiatric patients beyond the ER by protecting certain classes of drugs commonly used to treat mental illnesses so those on Medicare and Medicaid can be prescribed the correct medicine by primary care physicians.
The National Institute of Mental Health regularly measures public health outcomes to develop appropriate medical models for care. For example, the Recovery After Initial Schizophrenic Episode (RAISE) project demonstrated that earlier intervention with treatment for a patient at risk for developing schizophrenia allows those people to lead normal, functional lives. Without this kind of research, physicians would not know what treatments were most successful in helping psychiatric patients. However, the NIMH lacks the financial research to further pursue their medical research.
This bill proposes the NIMH be authorized to participate in President Obama’s Brain Research Through Advancing Innovative Neurotechnologies (BRAIN) initiative ($300 million in public and private investments); this would encourage the agency to undertake additional research projects on self-directed violence and other manifestations of mental illness.
Back to the broken leg example: say you finally make it to the hospital after two years of walking on a broken leg and the doctor tells you that you need surgery, but he doesn’t know what kind of surgery because he can’t afford to do research on what surgery would be most effective in healing your leg.
Obviously, the government would sanction funds to help that kind of research, so why won’t they pay for the NIMH to do research on more effective treatments for mental illness?
Now let’s say you’re meeting a friend downtown while you’re walking on your broken leg and you park at a parking meter because it is the spot closest to the meeting point and you’ll have to do less walking. However, you can’t afford the meter fare. You decide to risk it anyways and leave your car parked at an expired meter. When you and your broken leg return to your car, you find yourself under arrest for parking at an expired meter. You were just trying to help yourself out because your leg was hurting so bad! Now you’re stuck in jail where half of the inmates also have various broken bones.
Replace broken limbs with mental illness and you’re looking at a real statistic: between twenty and fifty percent of the incarcerated system inmates have a mental illness. Congressman Murphy suggests that if the Department of Justice (DOJ) were required to collect more data on interactions between the police and the mentally ill, less psychiatric patients would be thrown in jail and the overall population of incarcerated persons would subsequently decrease. This DOJ reform would also authorize the Byrne Justice Assistance Grants to be used for mental training for law enforcement and corrections officers.
As someone who struggles with mental health, I can’t even begin to describe the stigma I face every day, whether it’s from my teachers, my boss, even some of my friends. Because mental illness is so stigmatized and so misunderstood, people judge me so harshly for struggling with it. Do you think those same people would judge me for having a broken leg? Probably not, because we all know what it means to have a broken leg. The bill suggests that the best way to end the stigma mental illness is to start with providing a better understanding to children and teens at school. If this legislation were to pass, mental health stakeholders would work with the Department of Education to undertake a national campaign aimed at reducing the mental health stigma in schools. The Garrett Lee Smith suicide prevention program would also be reauthorized in order to screen grants to schools for suicide prevention efforts.
It is no secret that mental health clinics are always suffering a severe staff shortage. Clinicians and healthcare professionals can volunteer at federal free clinics, but not at community mental health clinics because of federal legal barriers and the high cost of medical malpractice insurance.
Why don’t we revisit the concerns of how that $125 billion budgeted for mental health programs is being spent: is it not a little suspicious that physicians are only allowed to volunteer at FEDERAL clinics, but not community clinics? The HFMHCA wants to increase physician volunteerism by eliminating federal legal barriers created by the Federal Tort Claims Act the prevent physicians from volunteering at community health clinics and federally-qualified health centers
The substance abuse problem in our country keeps growing. More and more patients are being checked into rehabilitation facilities and even more people are being thrown in jail for drug related crimes. For the last decade, the Substance Abuse and Mental Health Services Administration has been unauthorized and lacked mission focus. Their grant programs are not evidence-based and are not guided by the best available medical science.
Does that sound like a program that’s really helping anyone? Would you want your broken leg to be treated by a facility whose treatments were not evidence-based and did not use the best available science to design treatment plans? Certainly not. So why are we sending substance abuse patients into such programs? The bill plans to fix this problem by emphasizing evidence-based treatments, sunsetting unauthorized programs, and strengthening congressional oversight of all federal behavioral health grants.
If you look at all the misconduct occurring in our government in the treatment of mental illness through the lens of the treatment of a broken leg, our system is clearly a broken one.
With a population of 321 million people, what would you do if only 40,000 people with broken legs could be treated? Or what if you couldn’t afford health insurance so you went to a community health clinic to have your broken leg treated, but there weren’t enough doctors to help you? How would you survive if everyone around you thought you were entirely incapable of leading a normal life because of your broken leg? These are entirely real issues that people, like me, who struggle with mental illness face every day.
The Helping Families in Mental Health Crisis Act provides some very legitimate strategies to fix these problems, and I am in full support of Congressman Murphy’s proposals.