What’s Going on with National Mental
Health Reform?

Spurred to action by a number of mass shooting tragedies, various commissions in Washington were created to seek a solution to the pervasive problem of mass violence in our society. A call to reform the delivery of mental health care was a central component of that effort. As a result of this discussion, members of both the U.S. House and Senate drafted mental health reform legislation. Summaries of the two key bills follow, along with a glimpse at the positions of a couple of mental health advocacy groups.

Highlights of the Helping Families in Mental Health Crisis Act of 2015 (HR 2646)
This comprehensive bill, introduced by Rep. Tim Murphy (R-PA), joined by Rep. Eddie Bernice Johnson (D-TX) as the lead Democrat on the bill, includes provisions that cut a broad swath across mental health care, standards, funding, and practice:

  • Improving community mental health services and integrated mental health and primary care treatment
  • Reauthorizing the Garrett-Lee Smith Suicide Prevention Act, an important federal program providing resources for suicide prevention and postvention
  • Improving access to psychiatric medication for Medicaid and Medicare recipients
  • Increasing resources for research
  • Bi-annually studying best practices for using peer support specialists and certifying peer support specialists
  • Increasing federal funding to states that implement Assisted Outpatient Treatment (AOT) programs
  • Altering the current Medicaid funding restriction for adult psychiatric facilities larger than 16 beds
  • Scaling back authority of legal advocates in areas of representation and discrimination
  • Providing for loosening of HIPPA restrictions for family members

Committee markup of the bill took place in early November. Democrats introduced several amendments, all of which were defeated. Rep. Fred Upton (R-MI), Chair of the House Energy & Commerce Committee (where this legislation originates), noted that both parties had valid concerns and that full committee markup has not yet been scheduled.

What’s Different in the Mental Health Reform Act of 2015 (S. 1945)
This legislation is the Senate’s bipartisan attempt for mental health reform, introduced by Senators Bill Cassidy, M.D. (R-LA) and U.S. Senator Chris Murphy (D-CT). This bill is similar to the House bill but has some notable differences.

  • This legislation addresses lack of resources by reauthorizing existing grants and expanding new grant programs that
    • assist states in identifying barriers to care
    • support intensive early intervention for children
    • bring effective models to scale for adults and children
  • Does not include mandated AOT programs
  • Directs government agencies to conduct audits on Mental Health Parity implementation and issue guidance
  • Makes critical Medicaid and Medicare reforms that allow patients to use mental health services and primary care services at the same location

Rep. Lamar Alexander (R-TN), Chair of the HELP Committee (Senate Health, Labor, Education, and Pensions Committee), has signaled that there will not be any markup on the bill as long as there are budgetary implications.

Seeking a United Mental Health Advocacy Front
Because the bills are so wide-ranging and complex, and mental health advocacy organizations have different interests and priorities, there is not unanimous support for all of the details of the legislation.  Here is a sampling of positions taken by some leading mental health advocates.

NAMI
The National Alliance on Mental Illness (NAMI) issued a press release in early November. Executive Director Mary Giliberti said, “NAMI is thrilled that Congress has taken the first crucial step [by passing the bill in the House Health Subcommittee of the Committee on Energy and Commerce] in moving forward comprehensive, bipartisan mental health legislation. …This historic step responds to the nation’s mental health crisis and seeks to build a modern mental health care system oriented toward early identification of symptoms, effective treatment, and sustained recovery.”

NAMI identified several provisions consistent with their interests and priorities:

  • supporting innovation, evidence-based practices, and early intervention
  • protecting access to psychiatric medications in Medicaid and Medicare
  • scaling back Medicaid restrictions on inpatient psychiatric treatment
  • broadening eligibility for funding to implement Health Information Technology in mental health care
  • balancing the privacy of sensitive health and mental health information while affording families access to information necessary to serve as effective support
  • establishing an Assistant Secretary for Mental Health and Substance Use Services
  • strengthening funding for NIMH research on serious mental illness

NAMI supports S. 1945 as legislation that, in conjunction with HR 2646 in the House, helps advance the process of passing comprehensive mental health reform. NAMI notes that the Senate version

  • does not contain any provisions restricting the activities of Protection and Advocacy for Individuals with Mental Illness (PAIMI) programs
  • does not include the provision in HR 2646 authorizing 2% incentive payments through the federal Mental Health Services Block Grant for states that implement AOT programs
  • does include a provision, also contained in HR 2646, that would extend authority to support AOT pilot programs for an additional two years through 2020.

Mental Health America
MHA, too, issued a statement in early November, prompted by the Health Subcommittee’s passage of H.R. 2646. Prior to that vote, the Subcommittee accepted a manager’s amendment that addressed many of MHA’s concerns with the original proposal. “This is an important milestone for everyone who wants to see balanced, comprehensive mental health systems reform become a reality in America,” said Paul Gionfriddo, MHA President and CEO.

The bill’s emphasis on moving upstream in the process – i.e., on intervening before Stage 4–is a critical step forward toward treating mental illnesses like we treat every other chronic disease. H.R. 2646 focuses on screening and early intervention; community-based systems of care; enhancing the behavioral health workforce; innovation to develop new evidence-based programs; prevention; integration of health and behavioral health care, including measures to facilitate the sharing of health data needed for care integration; enforcement of parity in coverage between health and behavioral health services; and the elevation of behavioral health in the federal government, including increased coordination of services. These are all essential components of a sound care delivery system. Read more at the MHA site.

Significant Opposition
Not everyone is excited about the particulars of these bills. The most controversial provisions include those relating to AOT, “a euphemistic term used to describe involuntary outpatient commitment ordered by a judge, with the threat of involuntary inpatient hospitalization for those who do not comply with their treatment orders;” prioritizing institutionalization over community-based care systems; and reducing privacy protections for individuals with serious mental illness. Another organization objects that the bill emphasizes coercion and institutionalization rather than empowerment and community integration. And the National Disability Leadership Alliance articulated similar objections.

Your Turn

  • Now you know what some others think of this legislation. What about you?
  • What parts of mental health care reform are most important to you, and why?
  • What provisions would you hope to see changed before a final version is enacted?
  • What will you do to make your voice heard on mental health care reform?

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Hope Estheim
Hope Estheim

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