Saturday, January 10, 2015

Treatment Before Tragedy quoted in the Congressional Quarterly!

 Congressional Quarterly 
The Struggle Continues Over Sandy Hook

By Shawn Zeller
Congressional Quarterly

Jan. 12, 2015
The two-year anniversary of the shootings that left 20 first-graders, along with seven adults, dead in Newtown, Conn., passed last month without much fanfare. The hopes of gun control advocates that Congress would do anything in response to it, and other mass shootings, have faded away since the Senate rejected stricter background check rules for gun buyers in April 2013.

But Rep. Tim Murphy hasn’t forgotten. In his office, the Pennsylvania Republican keeps photos of the children killed that day. A Navy reservist and psychologist who helps veterans recover from post-traumatic stress disorder when he’s not legislating, he is not a gun control advocate. “It’s not what’s in their hands, it’s what’s in their minds we have to deal with,” he says.

Since the shootings at Sandy Hook Elementary School, Murphy has held hearings, talked with advocates for the mentally ill and victims of violence, examined federal spending on mental health and proposed legislation aimed at preventing future mass shootings by allowing the government to treat more people with serious mental illness without their permission. It is the GOP’s answer to Newtown.

Bipartisan, his bill stands a chance. But it’s not a sure bet. There’s plenty of opposition among mental health advocates and Democrats in Congress. The head of the lead federal agency on mental health issues, the Substance Abuse and Mental Health Services Administration, doesn’t think much of it. If it gets through Congress, a veto could follow.

Murphy plans to fight for it. He says the mental health system has too long ignored those with the most serious ailments and that the government is largely to blame. The most controversial provision in the bill would require states to treat more people suffering from serious mental illness, such as paranoid schizophrenia, even if those people don’t want to cooperate, by conditioning millions of dollars in existing block grant funding on their willingness to do so.

Half of the states now will only treat someone against his will if he’s an imminent threat to himself or others. Murphy would require states to treat people who have been repeatedly hospitalized or jailed, or whose condition is getting worse and who don’t have the capacity to make a rational decision for themselves.

Murphy suspects that Adam Lanza, the man who fired 154 bullets at children, teachers and administrators at Sandy Hook three Decembers ago, would have been a good candidate.

It makes for a powerful argument. “Those kids are dead and those kids had a right to a future,” Murphy says. “They had a right to be alive.”

Facing Roadblocks

Still, Murphy’s bill hasn’t moved since he introduced it in December 2013. Mental health advocates say Fred Upton, the Michigan Republican who chairs the House Energy and Commerce Committee, wants to see more consensus before he brings it before the panel.

That seems unlikely. Neither Murphy nor his opponents seem willing to compromise. Pamela Hyde, the administrator of the Substance Abuse and Mental Health Services Administration, says Murphy has presented an oversimplified picture of the mental health system and its deficiencies. He also has misplaced priorities, in her view. She says Congress would be wiser to increase funding for early intervention, school-based mental health services and peer supports. “We’re trying to focus on the population of concern and not cast a wide net” that may not get at the problem, she says.

Murphy’s most ardent supporters are the family members of people with mental illness who often feel helpless in their quests to get treatment for relatives. Asra Nomani, an author and former Wall Street Journal reporter, teamed with other family members of people with mental illness after the Newtown shootings to form Treatment Before Tragedy, a group that is advocating for better treatment and services for their relatives.

Thirty years ago, Nomani’s older brother was diagnosed with schizoaffective disorder, a condition marked by hallucinations, delusions, mania and depression. She recalls the “litany of awfulness that families have to go through to get treatment” for their relatives, the 911 phone calls and commitment hearings. “The biggest challenge of this legislation is balancing the rights of families and patients in seeking appropriate care. It can be done. It has to be done for the sake of those with mental illness.”

Nomani credits a state program in West Virginia that required her brother to stay on his medications with helping him. Nearly every state has a similar program now — they try to allow patients to remain in their homes while they are being treated — but Murphy wants to expand them. He proposes to spend $15 million a year for four years on grants to states. A law Congress enacted last March authorized a pilot program along the same lines but the omnibus spending bill, enacted last month, did not fund it.

Families of mental health patients also complain that they cannot get information about a loved one from the doctors and hospitals that treat them because of federal privacy protections. In reality, federal law doesn’t prohibit it and the Health and Human Services Department issued a clarification of the medical privacy rules last February stating so.

But D.J. Jaffe, who founded Mental Illness Policy Org. because of the frustration he had helping to care for a mentally ill sister-in-law, says doctors and hospitals, concerned about violating privacy rights, often lean toward nondisclosure. The result can be infuriating.

Family members can’t find out when their relative’s next doctor appointment is, or help her get her medicine. Murphy’s bill states clearly that medical professionals can share information about a seriously mentally ill patient with family members.

When people with mental illness do get to hospitals, there often aren’t beds to treat them. Murphy and his allies blame a rule that dates to the founding of Medicaid in 1965, barring the program, which pays for health care for the poor, from paying for mental health treatment in private psychiatric facilities. At the time, the government was eager to move mentally ill patients out of institutions, where they’d sometimes been warehoused. But the result of Medicaid’s policy is a dwindling number of beds reserved for psychiatric care.

“It’s federally sanctioned discrimination against America’s most vulnerable people,” says Doris Fuller, the executive director of the Treatment Advocacy Center. Murphy’s bill would allow Medicaid to pay for their care at private facilities.

Democratic Resistance

At the heart of the debate is the question of to what degree mental illness is linked to violence. Murphy cites research by Jeffrey Swanson, a professor of psychiatry at Duke University, whose studies have found people with serious mental illness are three to five times more likely to be violent than people without mental illness. Still, mental illness alone contributes little to the overall risk of violent behavior in the population. Swanson’s work, for instance, makes the point that other factors like being young and male, living in poverty, and misusing alcohol or drugs have a bigger impact.

“There is a statistically significant association between serious mental illness and violent behavior,” Swanson says. “But because there aren’t that many people with serious mental illness, and violence is caused by many other things, even if you eliminated mental illness as a risk factor, it’s not going to make a huge dent in the problem of violence.” The vast majority of seriously mentally ill people are not violent, he adds, and the probability that one of them would kill a stranger, as in the mass shootings, is infinitesimal, about 1 in 70,000.

Murphy has proven persuasive nonetheless. Of the 118 co-sponsors of his bill in 2014, 42 were Democrats.

But there’s also resistance on the Democratic side of the aisle.

Former Democratic Rep. Ron Barber of Arizona introduced a rival bill last year that included none of Murphy’s provisions aimed at making it easier to treat people with serious mental illness. Instead, it would seek to raise awareness of mental illness by authorizing an advertising campaign and a new office in the White House.

Barber’s bill would have mostly left the Substance Abuse and Mental Health Services Administration’s work alone.

Barber was defeated for re-election in November. But his Democratic co-sponsors are pledging to continue the fight. They argue that it makes more sense to shore up the existing mental health system by expanding efforts to catch mental illness early.

“We need a system that is welcoming and accessible and available before we discuss expanding involuntary care,” says Paul Tonko, a New York Democrat who was one of Barber’s original co-sponsors.

Agency Opposition

Murphy’s biggest fight, though, is with Hyde and her agency, the Substance Abuse and Mental Health Services Administration, which each year spends $1 billion on mental health grants, research and technical assistance to states, nonprofits and other federal agencies.

Murphy is no fan, accusing the agency of wasting money on programs that not only do little to combat illness, but also discourage people from seeking treatment.

SAMHSA is “funding insulting and absurd programs on songs you can get on the Internet, brochures on how to get in touch with your inner animal, on how to stop taking your medication,” he says. “It’s unethical to tell people that these are not symptoms of a problem.”

He points to a past SAMHSA grantee, the California Network of Mental Health Clients, which lobbied against a 2002 state law providing for involuntary treatment of people with serious mental illness and a proclivity toward violence.

Murphy proposes to strip the agency of most of its authority over mental health policy and give it to a new assistant secretary for mental health at the Health and Human Services Department. His bill would require the agency to reserve 50 percent of the seats on its advisory councils, which help guide agency decision-making, for doctors or psychologists, and require all grants to go to programs evaluated for their effectiveness by people with experience in mental health treatment. A new mental health policy laboratory at HHS would also evaluate the grant spending.

Hyde says the provisions demonstrate a misunderstanding of what her agency does. “Our grant programs require that they either use an evidence-based program or show us what it is they are trying to do to create evidence,” she says.

“Some of our job is to help programs develop new approaches.”

She says that her agency does not fund programs that deny the existence of mental illness or the need for treatment, though she acknowledges that some of the organizations it funds might say those things.

Murphy says he plans no big changes in his bill when he reintroduces it this year, so the fight will continue on. “In the 20 years that SAMHSA’s been around, you’ve had increases in suicide, substance abuse, homelessness, incarceration, unemployment among the mentally ill,” Murphy says. “How is that a report card that’s good? I wouldn’t have put up with that for one year.”
Our voice is being heard! 

Please share the following message with your congressional leaders: "Bipartisan, it stands a chance. Please help Rep Tim Murphy help families like mine in mental health crisis."

No comments:

Post a Comment