Mental health advocates are encouraged about a mental health bill that makes new investments in prevention and early intervention, advances mental illness research and proposes a White House Office of Mental Health Policy. Despite competition from another proposal introduced five months earlier, advocates remain hopeful that Democrats and Republicans will compromise on comprehensive legislation.
The Strengthening Mental Health in Our Communities Act of 2014 was introduced by Rep. Ron Barber (D-Ariz.) during the National Council for Behavioral Health conference on May 5 in Washington, D.C. (see MHW, May 12). H.R. 4574 is sponsored by Barber along with Reps. Diana DeGette (D-Colo.), Doris Matsui (D-Calif.), Grace Napolitano (D-Calif.) and Paul Tonko (D-N.Y.).
Provisions in the new bill include the reauthorization of important services and programs under the Substance Abuse and Mental Health Services Administration (SAMHSA) and a White House Office of Mental Health Policy that is responsible for developing and implementing a national strategy for mental health. The proposal would ensure collaboration between mental health programs and services across federal, state and local agencies.
Rep. Tim Murphy (R-Pa.) introduced mental health legislation aimed at reforming the mental health system last December. Although those in the field were pleased that the bill includes the reauthorization of suicide prevention programs and Mental Health First Aid, they were not pleased about the bill’s proposal to cut back on the Protection and Advocacy (P&A) program for individuals with mental illness by 85 percent.
Some advocacy groups noted that Murphy’s bill would also expand the use of involuntary treatment and ignore the rights of persons with mental health conditions to make their own decisions concerning treatment. Assisted outpatient treatment (AOT) should be used as a last resort, they said (see MHW, Dec. 23, 2013).
Barber’s legislation, which aims to fill significant gaps in the mental health care system, includes the following provisions:
- Reauthorizes the Garrett Lee Smith Memorial Act for suicide prevention;
- Emphasizes evidence-based practices that have been proven effective through empirical evidence;
- Authorizes mental health awareness training grants to improve mental health awareness;
- Creates a national media campaign to reduce the stigma associated with mental illness; and
- Requires a report on evidence-based mental health practices to better serve older Americans.
Barber said that he received letters from a number of organizations, including the American Psychological Association, about issues the groups felt were important in a mental health reform bill. “That was an important factor in designing the bill,” Barber told MHW.
Barber was wounded along with then-Congresswoman Gabrielle Giffords in the shooting in Tucson in 2011 that left 13 wounded and six people dead. “At least two years prior to the shooting, the gunman, Jared Lee Loughner, displayed symptoms that we now know [revealed] deteriorating problems,” said Barber.
“The police and school saw and no one ever put it together,” he said. “If they had, this might not have happened.” That’s why Mental Health First Aid is so critical, said Barber. The legislation provides $20 million for the public education program.
Barber said he is continuing to seek sponsors for the bill. “We’re hoping the Republicans will join us,” he said. “Any attempt to make this a partisan issue is a mistake.”
Advocates weigh in
“I know that there are some folks who [view] Barber’s bill as an alternative to Murphy’s bill,” Ron Honberg, national director of policy and legal affairs for the National Alliance on Mental Illness (NAMI), told MHW. “We see it a little bit differently. Hopefully, the legislation could be viewed as a potential framework for a compromise or a 'meeting of the minds' among lawmakers," he said.
“To pass a bill in Congress you need Republican and Democratic support,” Honberg said. “The goals of Murphy and Barber’s bills are very much in synch. There are sincere efforts on everybody’s part to improve mental health services in this country. Everyone agrees the mental health system is broken.”
NAMI is very pleased about the proposal to coordinate all levels of federal funding and services, said Honberg. It also expands health insurance technology (HIT) to providers, he said. The legislation extends Medicare and Medicaid reimbursement for the use of electronic health records (EHRs) to mental health professional facilities, and makes mental health and addiction treatment providers eligible for Health Information Technology for Economic and Clinical Health Act technical assistance.
Honberg said he is also pleased about the provision that would eliminate the 190-day lifetime limit on inpatient psychiatric hospital care under Medicare. “It creates an exception to the IMD [Institutions for Mental Disease] rule,” he said. Currently, the IMD exclusion prohibits Medicaid from making payments to IMDs for services rendered to Medicaid beneficiaries aged 21 to 64.
Barber’s legislation is a “very person-centered bill rather than an institutional one,” Debbie Plotnick, senior director of state policy for Mental Health America (MHA), told MHW. The bill emphasizes important provisions for individuals, families and whole communities, she said. “People need a safe place to live,” said Plotnick. “They need coordinated supports and something meaningful to do, such as supported employment, and access to community-based services in a timely manner.”
The legislation also delves further into parity, said Plotnick, citing the provision that requires a Government Accountability Office (GAO) study on mental health and substance use disorder parity enforcement efforts. Additionally, Barber’s bill requires the Secretary of Labor to coordinate with the secretary of the U.S. Department of Health and Human Services (HHS) to prepare annual detailed reports of parity compliance activities in each state.
Individuals with mental illnesses and intellectual disabilities are residing in state institutions because there is no infrastructure for community-based programs and they have to live in restrictive settings, said Plotnick. P&A programs provide a very important function for these kinds of issues, said Plotnick. “It’s very important to P&A to continue to be able to do the exemplary work things been doing,” she said.
“We’re very much in favor of a White House coordinator for all agencies and departments, such as SAMHSA, HHS, HUD [Housing and Urban Development], DOJ [U.S. Department of Justice] and the Veterans Administration, to create an overall strategic plan," said Plotnick.
Barber’s legislation, on the other hand, places an emphasis on peer support, mobile crisis services and other programs for individuals with a mental illness before they reach a point where they’re spending hours in an ER or cycle in and out of prisons and jails, Plotnick said. “Ultimately, everybody hopes that both parties can find common ground,” she said.
DJ Jaffe, founder of Mental Illness Policy Org, told MHW that Barber’s legislation “strips out provisions that help people with a serious mental illness. It’s a mental health bill, not a mental illness bill. It gives more money to the mental health industry without requiring that any of it is spent on people with a serious mental illness.”
Jaffe said families of consumers with a serious mental illness lined up in support of Murphy’s bill. The current bill is probably well intended, he said. “We advocate for people with a serious mental illness. This bill drives funding away from programs that help people with an SMI,” said Jaffe.
“Barber’s bill increases reimbursement rates for marriage counselors, but not for treating people with schizophrenia,” said Jaffe. “The legislation does little for the 4 percent of people with a serious mental illness.”
While some in the mental health field are still split over the merits of two recently introduced mental health bills, the hope is that lawmakers can negotiate one comprehensive bill.