The RLC produces a newsletter each and every month that offers monthly calendars, announcements and articles. Although old newsletters are archived on the website, the articles - often on important advocacy-related issues - run the risk of being buried and difficult to find. In an attempt to make that information more accessible, we still also list RLC-published articles from the newsletter (and other relevant sources) here for your ease and perusal.
On Thursday, June 4, 2015 the Helping Families in Mental Health Crisis Act was re-introduced by Representative Tim Murphy of Pennsylvania. It is also known as H.R. 2646 or, perhaps most commonly, as the ‘Murphy Bill.’ Although it is claimed that the second version of this Bill contains several compromises, it seems just as bad as the first.
In fact, it may actually be worse, and here’s why: The second version of this bill uses toned down language and seems like it’s let go of some of it’s original (and more controversial) priorities. However, most of the ‘toning down’ seems superficial in nature, and so what this actually means is that the Bill is all the more likely to get passed while still essentially allowing for the same setbacks, invasiveness and rights violations to those receiving (or targeted as needing) services in the mental health system.
Ultimately, as with the first time this bill was introduced (2013), it suggests many changes to existing laws and programs that pose a serious risk to our work and movement. Some of the most notable points include:
- Increased Forced ‘Treatment’: The Murphy Bill seeks to loosen restrictions on when force can be used and ties certain types of federal funding to state implementation of Involuntary Outpatient Commitment (IOC) laws (also known as Assisted Outpatient Treatment or ‘AOT’). Although the Bill no longer requires a block on federal funds to a state that does not employ IOC, it still incentivizes it by giving more to states that do. IOC is a particular form of forced ‘treatment’ that allows for forced medication and a number of other requirements and limitations regarding how someone lives their life, sometimes for reasons as simple as the system feeling that that person has been hospitalized too frequently. (For more on IOC, see this article: www.westernmassrlc.org/rlc-articles/214-outpatient-commitment-laws-a-massachusetts)
- It Guts the Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA has and continues to provide funding that many feel is important and highly impactful both for people who struggle with addictions and substance abuse and those who struggle with emotional or mental distress, trauma and psychiatric diagnosis. For example, they provided the initial funding for Second Story Peer Respite in California. They are also responsible for funding peer-to-peer technical assistance centers like the National Empowerment Center in Massachusetts and Peerlink in Oregon, as well as for the funding that helped the Western Mass Recovery Learning Community develop the Handbook on Peer Roles (available here: www.psresources.info). Whatever complaints their may be about SAMHSA, gutting them and moving funds under the control of the Assistant Secretary for Mental Health and Substance Abuse Treatment would inevitably lead to the loss of many supports, particularly in the peer-to-peer realm.
- It Severely Limits How Advocates Can Support People Whose Rights are Being Violated: In the first version of the bill, Murphy sought to gut the budget of the ‘Protection and Advocacy for Individuals with Mental Illness’ (PAIMI) programs (i.e., operating under the Disability Law Centers). This version shifts its tactic from budget reduction to placing limits directly on the authority of such advocates to act on complaints. In the end, the result is the same: Less support and advocacy to people whose rights are being violated.
- It Loosens Restrictions on HIPAA: The Health Insurance Portability and Accountability Act (HIPAA) is what requires medical and mental health professionals to go to great lengths to keep your information private. In this second version of the Bill, Murphy has pretended that he is compromising by no longer okaying the release of psychotherapy notes. However, his new Bill still allows for the release of diagnosis, treatment plans, medication plans, and so on to family and caregivers even when against the person’s will.
- Murphy Pretends to Support Peer-to-Peer Support as a Method to Control and Limit It: In the first version of the Murphy Bill, funding for peer roles was not supported. In what is being marked by some as a ‘concession’ by Rep. Murphy, the new bill encourages funding for peer support. However, the funding comes with a strict definition of what people in peer roles are able to do along with a requirement that they be supervised by mental health clinicians. Should this come to pass, it would devastate the concept of independent peer-run efforts and severely limit some of the most impactful peer supports currently available.
There’s a great deal more to this Bill and if you’re interested in reading it for yourself, you can do so here: http://docs.house.gov/meetings/IF/IF14/20150616/103615/BILLS-1142646ih.pdf
A hearing on the Bill was also held on Tuesday, June 16 and should be available for viewing on the Energy & Commerce Committee’s website here: http://energycommerce.house.gov/hearing/examining-hr-2646-helping-families-mental-health-crisis-act#video
You may also be interested in reading Harvey Rosenthal’s written testimony for the June 16 hearing below.
Harvey is the Executive Director for the New York Psychiatric Rehabilitation Association Services (NYAPRS) as is a longtime outspoken advocate against Involuntary Outpatient Commitment.
Also of note, Doris Matsui has proposed an alternate Bill, ‘The Including Families in Mental Health Recovery Act.’ While many feel this Bill does not go nearly far enough, others are choosing to support it as a much preferred alternative over the Murphy Bill. You can view this alternate Bill here:
BUT MOST IMPORTANTLY:
Call your state Representatives and Senators and tell them you oppose the Murphy Bill (HR 2646) and are asking them to do the same!!!!!
You can find out who your State Representative is here: http://www.house.gov/representatives/find/
You can find out who your State Senator is here: http://www.senate.gov/
The life of a Bill is unpredictable and so it’s not clear how long the Murphy Bill might take to pass or be dismissed, but we hope that you’ll join us in staying on top of what’s happening and what we can do to stop the Murphy Bill. In an effort to support that, we will be launching a ‘Stop the Murphy Bill’ webpage on our website by mid-July to help everyone stay up-to-date. Stay tuned for more!
Massachusetts is one of the last states (alongside our neighbors in Connecticut) to not have a formal ‘outpatient commitment’ law (often referred to as ‘AOT’ or Assisted Outpatient Treatment in the media). These laws can be extremely far reaching in how they applied.
For example, a person can be ‘sentenced’ to this kind of forced treatment when they get in legal trouble or simply because others feel they’ve been hospitalized too frequently. As a part of this kind of forced treatment, they can be required to do anything from taking particular psychiatric drugs to attending therapy and/or day programs to living in a particular area and so on. And, when they fail to comply, that can be grounds for them to immediately be picked up and incarcerated in a hospital (even if they are doing well overall in the community and simply based on the theory that something might go wrong for them because they are not complying with the order).
Overall, Massachusetts has resisted Outpatient Forced Commitment laws in spite of ongoing pushes from legislators like Senator Ken Donnelly and Representative Kay Khan along with the national Treatment Advocacy Center. However, in the last year, proponents of this kind of forced treatment were successful in pushing through a $250,000 pilot program. The pilot program is currently underway at Eliot Human Services based in Lexington. This pilot is dangerous even if Eliot finds a 'nicer' and more 'progressive' way of implementing it (which could, more than anything, lead to a dangerous blending of force and choice-oriented approaches that ultimately only serves to distort the concept of 'person-centered' and 'self-determination').
This pilot program is extremely problematic for a number of reasons including:
- It’s a slippery slope: Although the door is not fully open to widespread Outpatient Forced Commitment in the state, this pilot is like a ‘foot in the door.’ The longer it is allowed to continue, the more likely it becomes that this sort of forced treatment will shift into a full Outpatient Forced Commitment law.
- Eliot is employing people in peer roles in this program: Peer-to-peer support is absolutely inconsistent with the use of force. Employing someone working in a peer role as a primary team member of a program built around the concept of Outpatient Forced Commitment is an abuse of the peer role. Some are even calling for the individual working in that peer role to have to give up their certification as a ‘Peer Specialist’ because this represents a violation of the Certified Peer Specialist Code of Ethics. To allow this to continue will do a great deal of damage, including to the integrity of the peer role itself.
- Eliot is using Pat Deegan’s Commonground as a part of this program: Commonground is a computer program that supports informed choice and full participation for people when they are meeting with their psychiatrists. It is based on the concept of person-centered and person-driven care and the wisdom that comes from living your own life and knowing what is right for you. It is dishonest and disingenuous to employ this tool in an environment that is based on the concept of Outpatient Forced Commitment. It was also put in place as a component of this program without the knowledge of Pat Deegan (who herself was once diagnosed with schizophrenia and has gone on to build a full life, including the development of this program).
This program must be stopped. Unfortunately, the Senate Ways & Means Committee just earmarked $250,000 for the pilot program to continue. However, before the budget becomes final, the Senate and House must form a joint council to review the differences in their budget recommendations and come up with a joint plan to submit to the Governor.
TAKE ACTION: You can help stop this effort by contacting own Senators and Reps (wheredoivotema.com) along with leadership of the Ways & Means Committee today. Consider saying something like, “Forced Outpatient Commitment (also known as AOT) is harmful. It has been proven ineffective and a waste of resources by a number of studies (for details: ncmhr.org/downloads/NCMHR-Fact-Sheet-on-Involuntary-Outpatient-Commitment-4.3.14.pdf). Please oppose the earmark for the continuation of the AOT Pilot in Massachusetts.”
To find the contact information for members of the Ways & Means: malegislature.gov/Committees/Joint/J39
Forced Outpatient Commitment (commonly referred to as ‘Assisted Outpatient Treatment’ or ‘AOT’) is a type of law allowing for individuals to be forced to take psychiatric medications, attend therapy, etc. against their will, even when living in the community. Massachusetts is currently one of only a small handful of states that have refused to implement this type of law. However, in a devastating blow to local advocates, an ‘AOT Pilot’ was ordered. The decision read as follows:
“The department shall expend not less than $250,000 to develop and implement an assisted outpatient treatment pilot program to treat residents who suffer from serious and persistent mental illness and experience repeated interaction with law enforcement or have a high rate of recurring hospitalization due to their mental illness, either through a voluntary agreement with the resident or by court order mandating that the resident receive the treatment described in this program; provided further, that the department shall report not later than June 1, 2015, to the house and senate committees on ways and means and the joint committee on mental health and substance abuse the progress and results of the pilot program and any identified barriers and challenges to treatment for the aforementioned treatment group.”
In Massachusetts, there is a law called the ‘Five Fundamental Rights'. This law was implemented in 1998 as an amendment to the existing Massachusetts mental health laws. These rights are applicable to all residences and facilities that are operated, licensed or contracted by the Department of Mental Health (all psychiatric hospitals and residential programs, etc.).
For the last several years, advocates have also been pushing for a sixth fundamental right, often called the ‘Fresh Air’ bill. This bill has circled through the legislative process multiple times, but was finally signed into law by Governor Deval Patrick in January of 2015, just before he left office. This bill, and related advocacy, have focused on the importance of access to the outside and fresh air, even while hospitalized in an inpatient setting. The text of the amendment adding in the sixth fundamental right reads:
People who have experienced psychiatric diagnosis, been hospitalized, or overcome other major life challenges and who now work or are connected to peer support communities often see themselves as a part of a movement. We’ve heard that movement be called everything from a ‘peer movement,’ to a ‘recovery movement’ to a ‘consumer’ or ‘c/s/x movement.’ (c/s/x stands for ‘consumer/survivor/ex-patient.’) However, all of these frames fall a little bit short.
Our work is a part of something bigger than all that. Yes, our work is about personal healing and moving toward a better life as individuals.
But it is also about oppression, choice, rights and the interconnectedness of all of our human spirits. It is difficult to imagine personal healing without consideration of how others are being treated, or hurt or supported (or not) to have full lives. In fact, much healing has happened in our community precisely by being connected in that way and calling on each other to stop hurting one another and raise each other up.
In truth, our movement is a human rights movement.
What does this mean? It means we not only stand with others who have experienced psychiatric diagnosis, trauma and so on, but also with people who have been wounded and oppressed because of the color of their skin, their gender expression, their sexuality, income, physical abilities and so on. It means our movement seeks to move toward healing and wholeness for anyone who has struggled or been hurt for any reason, not just those who have been challenged by emotional and/or mental distress and/or received services within the mental health system. This is true whether we ourselves have felt good or bad about our experiences (or a mix thereof) in the system, and whether we see our problems as coming from within or outside of our bodies.
It means that when juries failed to indict Darren Wilson or Daniel Pantaleo for the deaths of Michael Brown and Eric Garner, we all were wounded in some way. It means that, on November 20th—the national Transgender Day of Remembrance in recognition of all those who have been killed as a result of transphobia—we all were called upon to stand together. These are just two examples of the many.