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Mental Health Legislation: Helping Families in Mental Health Crisis Act

U.S. Congressman Tim Murphy, a Pennsylvania Republican and author of the Helping Families in Mental Health Crisis Act (H.R. 3717), visited Raleigh on Tuesday, August 26, to meet with a panel of experts in the field of mental health care.  Among the panelists were Duke Psychiatry and Behavioral Sciences faculty Jeffrey Swanson, Ph.D., Richard Keefe, Ph.D., and Lisa Amaya-Jackson, M.D., MPH. 

In the United States, an estimated 1 in 4 adults suffer from a mental health disorder or illness, many of whom are unable to access mental health care.  The Murphy bill is intended to fill some of the gaps in mental health coverage.  According to Dr. Jeffrey Swanson, Professor for the Department Psychiatry and Behavioral Sciences at Duke University, Murphy’s proposed legislation focuses on two premises, our need for better and more accessible mental health care and that doctors should be given charge of mental health care, which in theory, will make the system better. 

There are a few factors to consider when talking about mental health care.  First, there is a stigma surrounding mental illness.  In recent years, this stigma has slowly changed, some for the better and some for the worse.  There have been educational campaigns to remove the stigma that mental illness is a personal problem, but rather in many cases it is due to physical changes in the makeup and chemistry of the brain.   Inversely, the stigma that people with mental illnesses are violent has been perpetuated through the violent acts of a small percentage of mentally ill people who have committed mass killings.  This stigma has caused a number of people with mental illness to hide rather than seek treatment. 

An estimated 9.5 million Americans have a serious mental illness (SMI), and an estimated 3.5 million of those with a SMI are not receiving treatment.  Serious mental illness, as defined by the National Institute of Mental Health, is any mental, behavioral, or emotion disorder (excluding developmental and substance use disorders) that results in a serious functional impairment that interferes with or limits one or more major life activities.

After the North Carolina state mental health care reform in 2001, there has been a decline in state funded psychiatric hospital beds and community treatment facilities.  As a result, hospitals are seeing an increase in the number of patients in mental health crisis in the emergency department.  In some cases, patients with a psychiatric illness have to wait up to 5 days for a hospital bed to become available, while patients in rural areas may not have access to psychiatric doctors.

“There’s no question that we need better and more accessible mental health care in America,” says Swanson.  The intent of Murphy’s bill is, among other things, to fill the gaps in the mental health care system by redirecting federal funds to assist in the development and use of new and innovative programs.  One piece of the bill proposes the creation of a National mental health Policy Laboratory with a 5% blog grant dedicated to study and implement innovative mental health delivery systems.   One such innovative delivery system is Daymark Recovery Services, a Raleigh based telemedicine company that provides mental health services to patients throughout the state using video consultation.  

 “There are many things in the Helping Families in Mental Health Crisis Act that have wide support,” says Swanson, “helping mentally ill criminal offenders get treatment, improving the network of services for children exposed to trauma, and increasing the research budget of the NIMH(National Institute of Mental Health).” However, there is controversy over certain pieces of the bill.  A piece of the legislation that has received specific attention from consumer advocacy organizations is outpatient commitment or assisted outpatient treatment (AOT).  Assisted outpatient treatment is mandatory psychiatric treatment for the patient as ruled by a judge.  Research co-authored by Dr. Jeffrey Swanson and Dr. Marvin Swartz, Professor for the Department Psychiatry and Behavioral Sciences at Duke University, and published in the American Journal of Psychiatry, shows that patients who were required by law to receive outpatient treatment had 57% fewer readmissions to the hospital and 20 day less spent in a hospital.  While these results are positive, the controversy surrounding AOT focuses on the civil rights of these patients.

Some controversies revolving around this bill, according to Swanson, include a change in some of the privacy protections for adults in a mental health crisis, reducing funding for programs that protect and advocate for the civil rights of persons with serious mental illness, and the elimination of government support for select programs that provide alternatives to evidence-based psychiatry treatment.

To obtain further information about this bill please visit the website of Congressman Tim Murphy. http://murphy.house.gov/helpingfamiliesinmentalhealthcrisisact

Differing perspectives and op-ed articles concerning this bill are listed below.

Mental Health Group Split on Bill to Revamp Care – The New York Times

The Many Problems with the Helping Families in Mental Health Crisis Act – Psych Centeral

Mental Health Care Reconstruction: Two Visions – North Carolina Health News