8 Things to Know About the Recently Introduced Mental Health Care Bill

Rep. Tim Murphy (R-Pa.) introduced a new version of his Helping Families In Mental Health Crisis Act to Congress last Thursday, and it contains compromises aimed at appeasing critics while keeping changes that should please his initial supporters.

I’ve read the 173-page bill twice and have asked for reactions from the top lobbyist of National Alliance on Mental Illness (NAMI), Mental Health America, the Treatment Advocacy Center, the Bazelon Center For Mental Health Law and the National Disabilities Rights Network. I also exchanged emails with DJ Jaffe at MentalIllnessPolicy.org, who testified before Murphy’s subcommittee and has been one of Murphy’s strongest backers. Jaffe was especially helpful in explaining parts of the bill to me.

Here’s a quick analysis of what Murphy, along with Rep. Eddie Bernice Johnson (D-Tx.), have reintroduced. You can also read the bill on your own here.

1. More doctors — and less lawyers — will guide mental health spending.

The new bill will move responsibility for mental health care and funding under an Assistant Secretary for Mental Health and Substance Abuse Treatment within the Department of Health and Human Services. It would require the new secretary be a medical doctor (psychiatrist) or Ph.D. psychologist with practical experience. One of Murphy’s complaints about the Substance Abuse and Mental Health Services Administration (SAMHSA), which currently distributes mental health care funding, is that an attorney, not a mental health expert, runs it.

2. There would be stricter funding criteria for mental health and addiction programs. 

The new bill would tighten funding criteria for mental health programs funded by federal block grants to states. Critics have accused SAMHSA of paying for frivolous programs. Money could only be spent on programs recognized as “evidence-based practices,” as opposed to ones that are popular but not backed by credible evidence.

3. States would be rewarded for implementing Assisted Outpatient Treatment laws.

Under this new bill, states that implement Assisted Outpatient Treatment (AOT) laws will be rewarded with a 2 percent increase in their general mental health/substance abuse funding from the government, but no state would be required to adopt AOT statutes. Under AOT, as it’s known, states can require persons with a diagnosed mental illness to take anti-psychotic medication if that medication has proven to help him/her in the past and he/she has a documented history of violence or repeated hospitalizations.

4. It would make crucial information more accessible to parents and caregivers.

The new bill would modify the Health Insurance Portability and Accountability Act (HIPAA), which deals with patients’ rights to health information privacy, so caregivers, including parents, could obtain information about a loved one who’s hospitalized because of a mental disorder, even if the patient doesn’t want information shared. While it’s important to safeguard privacy, HIPAA has been used in the past to prevent parents from helping someone they love. But the HIPAA modifications would also restrict what information could be shared, whom it could be shared with and when it could be shared. Diagnoses, treatment plans and information about medications — but not personal psychotherapy notes — could be released to a caregiver when it was deemed in the patient’s best interest.

5. Medicaid and Medicare would be accepted at larger inpatient facilities.

Current federal law imposes a 16-bed limit for inpatient beds. This limit was designed to prevent states from re-opening large hospital warehouses. The government then refused to allow Medicare and Medicaid payments to larger-than-16-bed facilities. Murphy’s bill would repeal the exclusion of Institutions for Mental Disease (IMDs), which have more than 16 beds, as long as a facility kept patients less than 30 days. 

6. It would limit the powers of a national advocacy program for individuals with mental illness.

One big change in the bill deals with limiting powers of advocates under the Protection and Advocacy for Individuals with Mental Illness Act (PAIMI programs.) The federal government funds Protection and Advocacy agencies in each state to safeguard the rights of persons with mental illnesses and disabilities. The new bill would limit the powers of PAIMI advocates by restricting their authority. They would only be permitted to investigate cases of abuse and neglect and would be specifically banned from lobbying public officials and from “counseling an individual with a serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of such individual’s caregiver.” That sentence is aimed at William Bruce situations, where a PAIMI advocate told Joe Bruce’s son, William, what to say to be discharged, even though his medical team considered him unstable. William was released and murdered his mother.

7. If you use Medicare, you will no longer have a lifelong limit of 190-psychiatric hospitalization days.  

Murphy adopted a provision from the Democrats’ bill introduced last session to bottleneck his legislation, which would eliminate the 190-day lifetime limit on inpatient psychiatric hospitalizations in Medicare.

8. It would set standards for who qualifies as a “peer” in “peer-to-peer” programs. 

Murphy encourages funding and support for peer-to-peer programs, but his bill would set standards for peers and require a professional mental health practitioner to monitor their work.

Of course, the bill consists of a lot more, including funding programs to prevent suicide among school-age children.

Would this bill effect you or your family? Comment below with your thoughts.

A version of this post originally appeared on Pete Earley’s website.

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