The Murphy Bills and Beyond
In June of 2015, Representative Tim Murphy of Pennsylvania re-introduced the "Helping Famlies in Mental Health Crisis Act" (HR 2646), better known as the Murphy Bill. A month later, Senator Chris Murphy of Connecticut introduced a very similar bill in the Senate called the "Mental Health Reform Act of 2015" (S2680). Both pieces of legislation threatened to dramatically increase the use of force and dismantle many of the more progressive and healing alternatives that have been developed in recent years. As of November 2016 the fate of both bills remained uncertain.
Meanwhile, another piece of legislation called 21st Century Cures was in development and garnering increasing bipartisan support. A sweeping and expansive healthcare bill, 21st Century Cures was, initially, minimally focused on mental health provisions. Having been stalled in part due to resistance from Senate Democrats' concerns that the bill was dangerously empowering for the pharmaceutical industry, 21st Century Cures also faced an uncertain fate in November. However, the election of President Trump and consequent fears for the bill’s fate prompted a reworking of the bill that also included the absorption of many aspects of HR 2646, “Helping Families in Mental Health Crisis.”
21st Century Cures was passed by the House and Senate on November 30th and December 7th of last year, respectively. On December 13, 21st Century Cures (now including substantial portions drawn directly from HR 2646, "Helping Familties in Mental Health Crisis") was signed into law by President Obama.
- The Murphy Bills and 21st Century Cures: An Update and Overview
- 21st Century Cures: Full legislative text
- Organizations for and against the Murphy Bills
- Archived blogs & articles
The Murphy Bills
Over the past two years, two similar mental health bills--spearheaded by Representative Tim Murphy of (R-PA) and Senator Chris Murphy (R-CT)--garnered substantial bipartisan support. Purporting to establish more effective and efficient mental health care services and to empower families in supporting their loved ones, both bills (especially the bill passed by the House, and to a slightly lesser extent the bill that had not yet passed the Senate) foretold significant violations of people’s rights. Following the passage of the House version of the bill (H.R. 2646, or the “Helping Families in Mental Health Crisis Act”) over the summer, the future of the bills remained uncertain until November.
21st Century Cures
Meanwhile, a massive piece of legislation called H.R.34, or the 21st Century Cures Act (henceforth “Cures”), was in development. The product of a public and nonpartisan conversation with healthcare providers, researchers, and the public, Cures is a massive piece of legislation with a broad goal of “[expediting] the discovery, development, and delivery of new treatments and cures and [maintaining] America’s global status as the leader in biomedical innovation” (Committee on Energy and Commerce, 2016). Among its many provisions, Cures allocates several billion dollars for the advancement of various research initiatives, most notably Vice President Biden’s “Cancer Moonshot” and the BRAIN initiative which investigates diseases like Alzheimer’s. Beyond research funding, Cures aims to advance the development of new therapies by loosening FDA regulation requirements (thus facilitating the expedition of drug approval), incentivizing development of drugs for certain pediatric diseases, and “modernizing” the clinical trial process. Cures also aims to streamline the healthcare deliveryprocess, promoting the use of electronic health record systems to ensure continuity of care and improving education for providers about the latest medical innovations.
Check out Lauren Tenney’s ‘Talk with Tenney’ channel, and listen to the Sunday, August 14 show ‘Updated on Major Mental Illness Bill’ with host Yvonne Smith and guest, Val Marsh of the National Coalition for Mental Health Recovery.
The show gives updates on both the House (Tim Murphy) and Senate (Chris Murphy) ‘Murphy Bills,’ where they currently sit in the legislative process and what to expect next!
Chris Murphy of Connecticut (not to be confused with Tim Murphy, the Representative from Pennsylvania who is responsible for the Murphy Bill discussed above) proposed a gun amendment that targeted “the seriously mentally ill and other dangerous people,” and referred to people with psychiatric diagnoses who have been subjected to forced treatment as “adjudicated as a mental defective.” More importantly, the amendment suggested blocking gun access for anyone who has ever been forced into any kind of psychiatric treatment, no matter how long ago.
While gun control is a worthy discussion, laws that set out to specifically target people with psychiatric diagnoses not only ignore existing research but are discriminatory. Additionally, any legislation that suggests that people with psychiatric diagnoses are dangerous is damaging to our community and likely to lead to increased force and violence against us. Fortunately, this amendment was reviewed and rejected on June 20th, but we will need to keep our eyes open for more like it in coming days!
When something terrifying and tragic happens, people want answers. When they want answers, they naturally turn to those seen as being ‘in charge’. Inevitably, those seen as being ‘in charge’ (understandably) feel pressed to ‘do something’. Unfortunately, that pressure can lead those people to ‘do something’ more for the sake of the doing and to settle the public’s nerves, than because it will actually alleviate the problem at hand. In fact, all too often, those actions make the problem worse.
The Helping Families in Crisis Act (H.R. 2646 – also known as the Murphy Bill) is one such action that threatens to send us tumbling down a rabbit hole of extremely costly and regressive policies and protocols. While problematic on many levels, one clear issue is its contribution to the conflation of gun violence and psychiatric diagnosis.
There are several problems with the practice of linking gun violence to psychiatric diagnosis, the most obvious of which include:
1. There is no actual link between gun violence and psychiatric diagnosis
2. Co-existence of gun violence and psychiatric diagnosis is not proof of a causal link
3. There is no evidence that the ‘go to’ interventions proposed by legislation like the Murphy Bill would have stopped most of the recent gun violence
4. The ‘go to’ interventions proposed by legislation like the Murphy Bill violate people’s civil rights in a way that would be seen as flatly unacceptable were any other group to be targeted in that manner
5. Focus on psychiatric diagnosis is often a manipulation to steer us away from a focus on gun control
Read the full article by clicking "read more" below
- Expanding forced treatment in the form of Involuntary Outpatient Commitment (often referred to as ‘Assisted Outpatient Treatment’ or AOT)
- Seeking to control and limit the ability of people working in peer roles
- Seeking to reduce or eliminate funding for anything that is not considered ‘evidence based’ (a status that can be challenging to come by for anyone offering an alternative approach)
- Seeking to exclude the voice of individuals for whom the mental health system has not worked effectively by using language that requires peer specialists and others speaking from personal experience to have been in ‘active treatment for the last two years,’ etc.
Note: This blog is adapted from Sera Davidow's post by the same name on the 'Campaign for Real Change in Mental Health Policy' website.
Senator Chris Murphy of Connecticut (and his legislative co-pilot, Senator Bill Cassidy) released a new ‘Murphy Bill’ this past week. It’s called the ‘Mental Health Reform Act of 2015,’ though it has yet to be assigned an official number. While many words appear in its more than 100 pages, it’s worth noting that the term ‘evidence’ (most often paired with ‘based’ to form the familiar and supposedly scientific phrase, ‘evidence-based’) appears 27 times. Never to be outdone, the almost 200-page House version (‘Helping Families in Mental Health Crisis,’ H.R. 2646) from Representative Tim Murphy uses the same word 38 times.
This makes sense. Why wouldn’t anyone want anything to do with… well… just about anything… to be, you know, based on research and evidence? I mean, evidence is certainly better than wild guesses, right? Apparently, the most commonly used definition for ‘Evidence-Based Practice’ is this:
“The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett et al, 1996).
Most people will hear ‘evidence’ to mean confidence and rigorous standards. They’ll hear that someone has really taken the time to figure things out and get it right. In a most basic way, it (sounds like it) means safety and that inspires trust. Most will read the use of ‘evidence-based’ in these documents in that way, and few will disagree that it’s a good thing, but here’s the problem:
At least in the realm of ‘mental health,’ evidence-based means something more akin to:
The use of current evidence as developed by individuals who had enough funds at their disposal to engage in the bolstering of their own favored ‘best practice’ – often to the exclusion of other evidence to the contrary and commonly more or less in alignment with the dominant paradigm (hence the availability of said funds) – and all too frequently based on research conducted upon such an extraordinarily narrow and contrived group of people and characteristics that it is unlikely to be particularly meaningful or replicable in the ‘real world.’ (Davidow, 2015)
Furthermore, ‘evidence-based’ practice is frequently measured against outcomes that are defined by a clinician or scientist rather than someone whose life is directly impacted. For example, a scientist might interpret reduction in hospitalization as a primary and positive outcome, but ignore the fact that the person no longer hospitalized is so sedated that they have lost their day-to-day ability to function in anything resembling a healthy manner, and will soon begin experiencing medical complications as a result.
Twenty-seven (or 38) uses seems excessive for such a hollow word, particularly in a document that has the potential to change so many lives in such a dramatic way. But, ‘evidence’ is not alone. Alas, there are many words in the Murphy Bills that serve little purpose other than to mislead or fluff up the grand illusion that these legislators are on to something good. Others include (but are not limited to):
- Assisted Outpatient Treatment
- Peer Specialist