Some are calling it the most ambitious piece of mental health legislation since President John F. Kennedy’s landmark law aimed at shutting down the nation’s notorious “insane asylums” in favor of more humane community-based services — a goal that in two generations was never quite realized.
According to its supporters, the new legislation — quietly making its way through Congress — would take steps toward bringing some of the nation’s mental health laws in line with current science and medical knowledge.
The bill, called the Helping Families in Mental Health Crisis Act, would begin to overhaul a mental health system whose services many criticize as being too little too late.
Local government and mental health officials are hopeful the legislation marks a turning point.
“The whole bill is really huge in terms of addressing the gaps of mental health treatment in America and the crisis that we are facing due to it,” said Sonoma County Supervisor Shirlee Zane, a longtime advocate and supporter of mental health services.
Zane, who says the lack of one-on-one therapy and poor monitoring of psychotropic medications led to the death by suicide of her husband in 2011, argues that mental illness should be treated with the same level of care as health conditions such as heart disease or cancer.
Health care providers are too focused on the “almighty dollar. They make money on cardiac and cancer treatment but not on mental illness … mental health care is a civil rights issue,” she said.
The legislation, authored by Rep. Tim Murphy, R-Pa., a practicing psychologist, is a byproduct of a Congressional inquiry into recent mass shootings, such as the 2012 massacre that left 20 elementary school children and six adults dead in Newtown, Connecticut. Those inquiries focused on the impact of untreated severe mental illness, recognizing that the vast majority of Americans who suffer from conditions such as schizophrenia and bipolar disorder are nonviolent.
But a series of public forums and investigative hearings leading up to the drafting of Murphy’s bill highlighted serious gaps across the entire spectrum of mental health care. In fact, of the estimated 11.4 million American adults who suffer from severe mental illness, 40 percent are not receiving any treatment, according to a House subcommittee investigation into federal mental health programs.
One of the key elements in the legislation is its creation of a high-ranking assistant secretary post that would oversee federal policies addressing mental health and substance-use disorders.
“This is probably one of the biggest pieces of mental health legislation since President Kennedy,” said John Snook, executive director of the Treatment Advocacy Center, a Virginia-based national nonprofit that works to eliminate barriers to treatment for people with severe mental illness.
“For no other illness would we have laws and regulations based on our understanding from the ’60s,” Snook said. “In every other medical illness, the practice, doctors’ requirements and laws for treatment have advanced.”
Among other steps, the legislation would:
Authorize funding for assisted outpatient treatment — court-ordered treatment for people with severe mental illness who do not recognize their condition.
Create a new grant program for suicide prevention.
Expand Medicaid benefits for children who use inpatient psychiatric care.
Strengthen community crisis response and fund grants for the creation of community psychiatric bed databases.
Require the federal Health and Human Services Department to create training programs to educate health care providers and administrators, as well as patients and families, on the proper use of medical privacy rules.
A cost estimate for the bill, called HR 2646, is not yet available, according to the Congressional Budget Office.
One provision of the legislation seeks to get at the nationwide lack of acute inpatient psychiatric hospital beds. The bill codifies into federal law a recent policy rule change to what’s known as the IMD exclusion, which prevents Medicaid dollars from being used for adult patients treated at certain kinds of mental health and substance-abuse treatment facilities with more than 16 beds.
Ideally, the rule change would allow California’s Medicaid program, Medi-Cal, to be reimbursed for treatment in facilities like Santa Rosa’s privately run Aurora Santa Rosa Hospital, which is not affiliated with any local general hospital.
However, Michael Kennedy, Sonoma County’s director of mental health, said the rule change only applies to mental health programs reimbursed by federal Medicaid Managed Care coverage.
In California, he said, the state contracts for mental health services with counties on a “fee-for-service” basis, so the rule change wouldn’t apply.
“With the exception of the IMD exclusion, this bill is a good start,” Kennedy said. “I’d be celebrating right now if it applied to us.”
But Kennedy applauded the federal government’s effort to put greater focus on mental health care, particularly the creation of a sub-Cabinet-level mental health czar.
“I would hope that they really take the time to get out into communities and see what our issues are and advocate strongly for the need of our system,” he said.
Patricia Ravitz, president of the California Association of Marriage and Family Therapists, called the legislation a good first step and said she hoped future legislation would expand access to mental health providers, such as therapists.
Increasing “Medicare beneficiaries’ access to qualified mental health providers, such as marriage and family therapists, would vastly improve the overall mental health of this population,” Ravitz said.
The legislation has raised concerns among some civil liberties organizations, including the American Civil Liberties Union, which objects to such policies as involuntary outpatient commitment and any reduction in patient privacy protections.
Cindy Myers, the interim executive director of Buckelew Programs — which provides behavioral health care and supportive housing for people with serious mental illnesses in the North Bay — said she recognized the careful balance between civil liberties and mental health treatment.
But she praised the federal government’s effort to reform mental health services. The legislation would push “a lot more service availability to the front end of the continuum,” Myers said.
“It’s fairly sweeping,” she said. “How big of a deal it turns out to be once it hits the ground remains to be seen.”
You can reach Staff Writer Martin Espinoza at (707) 521-5213 or firstname.lastname@example.org. On Twitter @renofish.