Although some in the mental health community applaud provisions in Rep. Tim Murphy’s (R-Pa.) long-awaited revamped mental health reform bill, such as promoting early intervention and prevention programs, research advancement and telepsychiatry use in hard-to-reach populations, and bolstering the federal parity law, others fear that reform of the Substance Abuse and Mental Health Services Administration (SAMHSA) could mean its “dismantling.”
“The Helping Families in Mental Health Crisis Act of 2015” was introduced by Murphy in a different form in December 2013 following a yearlong investigation, including public forums and hearings, to investigate the country’s mental health system. At that time, groups were divided on the merits of Murphy’s proposal (see MHW, Dec. 23, 2013).
Among its provisions, the bill, H.R. 2646 (formerly H.R. 3717), introduced June 4, would reauthorize the National Child Traumatic Stress Network and launch a new early childhood grant program to provide intensive services for children with serious emotional disturbances in an educational setting.
Lawmakers from the Energy & Commerce Subcommittee on Health are scheduled to examine the bipartisan legislation on June 16. The bill is co-authored by Rep. Eddie Bernice Johnson (D-Texas).
Provisions of the new bill would include requiring psychiatric hospitals to establish clear and effective discharge planning to ensure a timely and smooth transition from the hospital to posthospital care and services. It would also advance telepsychiatry to link pediatricians and primary care doctors with psychologists and psychiatrists in areas where patients do not have access to needed care.
Murphy’s legislation is clearly a different bill from what he presented in 2013, said Paul Gionfriddo, president and CEO of Mental Health America. “He didn’t reintroduce last year’s bill,” Gionfriddo told MHW. “We’re treating it as a brand-new bill. The other one no longer exists.”
Gionfriddo said he noted some important changes from the last bill. The earlier legislation tied the receipt of block grants to states adopting assistant outpatient treatment (AOT), he said. Now, states will be incentivized by 2 percent if officials expand community treatment programs, Gionfriddo noted. States will not be penalized, he said, adding that it will remain a state option. “It’s a better approach,” he said.
A provision regarding the interagency coordinating council will enable it to invest more heavily in research, he said. Also, the inclusion of early identification and intervention provisions is “very heartening to see,” Gionfriddo said.
“The legislation [provides] oversight at the federal level with an eye toward elevating and strengthening SAMHSA,” Gionfriddo said.
Murphy spoke about the legislation at the MHA’s annual conference on June 4 in Alexandria, Va., the day the bill was introduced, said Gionfriddo. “We’re still in the early stages of reviewing the bill,” said Gionfriddo. “Clearly, it’s a different bill. It needs to be looked at on its own merit. [The field] should treat it as a brand-new bill and decide how they feel about the provisions of this bill.”
The legislation designates an assistant secretary for mental health and substance use disorders in the U.S. Department of Health and Human Services. The assistant secretary would promote, evaluate, organize, integrate and coordinate research, treatment and services across departments, agencies, organizations and individuals with respect to the problems of individuals suffering from substance use disorders or mental illness.
“This is a great overreach of congressional authority,” Daniel Fisher, M.D., Ph.D., a psychiatrist and founder of the National Coalition for Mental Health Recovery, told MHW. “The first forty-seven pages of the document are designed to dismantle SAMHSA completely.”
The legislation would replace SAMHSA with the new office headed by a government official overseen by Congress, noted Fisher. “It will mean that mental health policy will be driven primarily by Congressman Murphy’s office,” he said. Grant notification, for example, which typically occurs within 48 hours, may now include nearly 60 days of review under the new bill, said Fisher.
Fisher added that such a move would have “dire consequences” for SAMHSA, which focuses on recovery and community integration for people with mental illnesses.
The National Disability Leadership Alliance intends to send a letter to lawmakers expressing their concerns similar to the letter they sent April 23, 2014, to members of the Energy and Commerce Committee and the Health Subcommittee, said Fisher, also a member of the alliance. At the time, they wrote that Murphy’s bill “would weaken current federal efforts to address the unmet needs of people with psychiatric disabilities.…” What remains a concern, however, is the proposed SAMHSA restructuring. “Has there ever been restructuring of another branch of the administration?” he said. “It’s unbelievable.”
At press time, SAMHSA Administrator Pam Hyde was unavailable for an interview. SAMHSA released the following statement to MHW: “SAMHSA appreciates Reps. Murphy and Johnson’s interest in and commitment to addressing issues re services for individuals with mental illness or addiction, and continuing to bring attention to this critically important public health issue. SAMHSA looks forward to working with the representatives to offer technical assistance about the implications of the legislation for current federal programs and for the needs of persons with or at risk of serious mental illness or addiction, and their families.”
MH pilot program expansion
The Excellence in Mental Health Act establishes a two-year demonstration program for eight states to offer a broad range of mental health and substance abuse services that would expand under the reform legislation. The legislation, which certifies behavioral health clinics, passed in 2014.
Under Murphy’s bill, the demonstration program would expand by an additional two years and increase the number of participating states from eight to 10, said Chuck Ingoglia, senior vice president of public policy and practice improvement for the National Council for Behavioral Health. “We’re very happy about that,” Ingoglia told MHW.
“A lot of the provisions are laudable,” said Ingoglia. The legislation includes provisions from the Health Information Technology for Economic and Clinical Health Act, he said. “It would extend meaningful use payments to a variety of mental health and addiction treatment organizations as well as to clinical psychologists,” he said.
Additionally, the legislation clarifies that Medicaid can pay for physical health services and mental health services that are provided at the same time, Ingoglia said. “Right now, in some states the Medicaid program does not allow recipients to receive both a mental health and a substance use service on the same day,” he said. “There is no federal prohibition against this; it’s a state issue. The bill clarifies that would be the expectation.”
Stakeholders have been waiting back as early as January for Murphy to introduce the bill, Ingoglia said. “There’s a lot of excitement about the bill being introduced,” he said. The National Council intends to meet with stakeholders, said Ingoglia. “Obviously we’re looking forward to the hearing and talking with stakeholders as well as staff to understand the next steps,” he said.
Some in the field intend to meet with congressional staff and stakeholders to support the bill and determine the next steps, while others intend to write letters opposing its provisions.