Federal mental health bill offers a chance at ‘historic’ reform

This week, a House committee advanced major mental health legislation that was introduced in the wake of another mass shooting — the 2013 Newtown massacre. The much-delayed Helping Families in Mental Health Crisis Act, or H.R. 2646, would overhaul the current federal system, focusing on people with the most serious mental illnesses and directing more resources before, during and after a crisis.

“Today, this committee takes a monumental step by advancing a bill that makes real reforms and offers evidence-based treatment for families in mental health crisis,” said bill sponsor Tim Murphy (R-PA), in his opening statements Wednesday. “… What we are doing is historic: No Committee has ever tackled the issue of serious mental illness like we are today.”

The Affordable Care Act represented a major step forward for mental health care by calling for preventative services and mental health treatment for individuals that is supposed to be equivalent to physical health care. This bill addresses broader, system-level reform. It would fix “the nation’s broken mental health system by refocusing programs, reforming grants and removing federal barriers to care,” according to Murphy’s statement.

The bill creates an assistant secretary in the Department of Health and Human Services (HHS), who will have mental health credentials. This position would help coordinate programs across agencies and promote effective, evidence-based programs. The act also establishes a National Mental Health Policy Laboratory that would drive innovative care models, and develop evidence-based standards for grant programs. And, it dedicates funding for brain research.

On the hospital side, the measure aims to improve the transition of patients from the hospital to post-hospital care and services. It provides more psychiatric hospital beds for those in acute mental health crisis. The bill also provides incentives for states to provide community-based alternatives to institutionalization, such as Assisted Outpatient Treatment, for those with serious mental illnesses.

The legislation would also focus on the mental health workforce, requiring the assistant secretary to devise a national strategy for increasing the number of mental health providers nationwide. It also seeks to help underserved and rural populations by linking pediatricians and primary care doctors with psychiatrists and psychologists via telemedicine.

Even before this week’s mass shooting, advocates were heralding the measure as a much-needed transformation of the country’s mental health system.  

“We have a mental-health crisis in this country 365 days a year, every year,” wrote Orlando Sentinel guest columnist Dottie Pacharis just days before Omar Mateen shot 49 people at an Orlando nightclub. “We only hear about the mass shootings that make the national news; yet tragedies involving untreated mental illness occur daily throughout this country and will continue to do so until Congress passes meaningful mental-health reform legislation.”

If Congress approves the measure, the results could be transformative, writes psychiatrist Sally Satel in a comprehensive Forbes piece, explaining “a solid groundwork for improving the nation’s mental health system will be laid.”

But, she points out, the current version of the bill is a softened version of the original legislation, according to Satel. And the debates surrounding the legislation is telling:

The controversy it has generated sheds light on pre-existing tensions surrounding ideas about the nature of the forces (psychological, biological, and social) that lead to psychopathology – and, in turn, the most appropriate forms of treatment and intervention. This clash of cultures explains much of why our federal mental health system is so troubled in the first place.

Here are some other good primers on the bill, its potential impact and the controversy and revisions it has undergone:

1. Pete Earley, a former journalist, an author and mental health advocate takes a look back at the original proposal and compares it the version debated this week. One difference: Murphy initially proposed modifying the Health Information Portability and Accountability Act (HIPPA) so that caregivers could receive information on a loved one who is hospitalized because of a mental disorder — even if the patient refuses to share that information — if it’s deemed in the patient’s best interest. That language was later removed, and the current version simply requires HHS to “review HIPAA privacy regulations and take steps to clarify the law and better educate those impacted by HIPAA about what can and can’t be made public.”

2. The Huffington Post offers a personal look at the possible impact of the legislation. Blogger Jessica Gimeno tells stories of how mental illnesses such as schizophrenia impact individuals and their loved ones. The common thread among those she interviews is a lack of awareness that one is ill, which is not uncommon among individuals with severe mental illness.

3. This March letter from a coalition of 200 national groups offers insight on why the bill is controversial. Critics say the proposed bill would “will function to eliminate basic civil and human rights protections for those with mental illness.” Some are concerned that the bill would end newly created programs and reduce privacy protections.

For more background on the latest behavioral health research, check out this month’s Health Affairs, which focuses on mental health studies. Among the reports is a study documenting how mental health disorders top the list of most-costly conditions in the United States, as well as the Affordable Care Act’s role in establishing mental health parity, which should improve access to behavioral health care.

Health Affairs’ Editor-in-chief Alan R. Weil writes: “With a raging opioid abuse epidemic under way and renewed concerns over rising suicide rates and underdiagnosed maternal depression, mental health and substance abuse are garnering increased attention in the health policy sphere and the public at large. Yet a vast gap remains between the role behavioral health plays in defining the well-being of the population and the resources dedicated to understanding and addressing behavioral health needs.”

This new legislation, however, still has some big hurdles to clear. House leadership is tentatively planning to bring the bill to the House floor in September, according to Energy and Commerce Committee Chairman Fred Upton, R-Mich., as reported in The Hill.

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