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Monday, 11 December 2017

NEW WEBSITE: Campaign for Real Change in Mental Health Policy

A new and comprehensive website has surfaced offering information and ideas on taking action against the Murphy Bill (HR 2646).

The site includes:

You can visit the whole site here.

The text of the Real Change in Mental Healty Policy site's talking points is quoted below the 'read more' link.

Murphy Bill Comprehensive Review Talking Points

The Helping Families in Mental Health Crisis Act (H.R. 2646), introduced by Representative Tim Murphy (R-PA), of Pennsylvania, is a sweeping bill that promises “reform,” but would actually return the nation’s mental health system to many of the failed policies of the past.

Rights

Many of the provisions of the bill would significantly curtail civil rights on the basis of a medical diagnosis.

  • The bill would increase forced treatment by offering states financial incentives to implement Involuntary Outpatient Commitment (IOC) laws (misleadingly referred to in the bill as Assisted Outpatient Treatment or ‘AOT’).
  • Increasing the use of involuntary treatment measures is likely to have a disproportionate impact on people of color, contributing further to disparities in treatment and outcome.
  • The bill would drastically curtail the scope of the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program the federally funded program charged with advocating for and protecting the human, civil and legal rights of individuals with psychiatric diagnoses.
  • The bill weakens the privacy protections of the Health Insurance Portability and Accountability Act (HIPAA) by permitting the release of an adult’s diagnosis, treatment plans, medication plans, and other information to family members against the person’s will.

Science

The bill is inconsistent in a number of ways with current scientific understanding of the etiology and treatment of mental illness and substance abuse disorders:

  • The bill ignores all evidence of the environmental factors that contribute to the development of these disorders, including toxic stress and trauma (especially in childhood) as well as other social determinants of health.
  • The bill is premised on a simplistic, uni-dimensional understanding of mental illness rather than reflecting our current understanding of the complexity of these disorders.
  • Despite a focus on evidence-based practices, the bill effectively precludes many interventions that have been shown to be effective in preventing and treating mental illness and substance abuse disorders.
  • No provision is made for cultural differences known to affect diagnosis, treatment and help-seeking behavior.

Community Supports

The bill uses language that dismisses the possibility of recovery, and effectively promotes institutional services over evidence-based practices in the community.

  • The bill does nothing to encourage the development of community supports that allow many people to live successfully in the community – supported housing, case management, rehabilitation services, job training and placement, social supports.
  • By reinforcing the misperception that people diagnosed with mental illness are more dangerous than others, the bill reinforces the already widespread stigma and discrimination faced by people with these diagnoses. This is likely to contribute to further community exclusion, which has been a serious impediment to the development of appropriate community services.
  • By limiting the scope of the Protection and Advocacy program, the bill will make it harder for people to fight discrimination in housing, and employment, making it more difficult to access existing community services.
  • By creating financial incentives for “assisted outpatient treatment” (AOT), the bill continues to perpetuate the fiction that forcing people into a largely non-existent treatment system will remedy their problems.
  • Several provisions of the bill would serve to undermine independent peer support organizations and activities. In addition, the bill would put at risk federal funding for existing peer-run consumer technical assistance centers and for SAMHSA statewide consumer networking grants.
  • The bill would eliminate a Medicaid funding provision known as the IMD (Institutions for Mental Diseases) exclusion, which prohibits the use of Medicaid financing of psychiatric hospitals and nursing homes larger than 16 beds. This would financially incentivize states to implement re-institutionalization.

Public Health Approach

A public health approach addresses the health and wellness of populations as well as individuals; addresses environmental as well as biological factors contributing to illness; uses social policy as well as programmatic reforms to reduce risk factors and increase protective factors; and provides a balance of prevention, treatment and rehabilitation/support interventions. The bill fails in several significant ways to consider mental illness and addiction as public health problems.

  • The bill explicitly restricts funding for primary prevention programs and features them only in direct relation to the development of severe mental illnesses.
  • No provisions are made for identifying or addressing populations at-risk for developing mental illness and substance abuse disorders, including children growing up with multiple adversities and adults experiencing violence and trauma.
  • Early identification and screening provisions apply only to psychosis, ignoring other prevalent mental disorders, including depression, anxiety, PTSD, and substance abuse disorders.
  • The bill would prevent the federal mental health authority from working to promote wellness and from using social policy levers to reduce risk factors or increase protective factors.

Structural Reform

The bill is constructed on a conceptual framework that ignores progress over the past twenty years. Furthermore, there is little evidence to suggest that the structural solutions proposed will lead to significant improvements in the service delivery system.

  • The bill does little to improve financing for needed services. It focuses almost exclusively on SAMHSA, which comprises a tiny fraction of expenditures for the treatment of mental illnesses, and largely neglects the major federal funder of mental health services, the Center for Medicaid and Medicare Services.
  • The bill sets up a false and dangerous choice between treatment and prevention, when what is needed is to bring them together more effectively.
  • The bill promotes a narrow, professionally-focused and run system of care, diminishing the importance of peer and family voice and control. This is in stark contrast to current thinking in healthcare, which is moving rapidly to implement patient-centered care, shared decision-making, and self-management of chronic conditions.
  • The bill attempts to address a management issue with SAMHSA through legislation. This is a dangerous precedent.
  • A new layer of bureaucracy is created with the formation of a National Mental Health Policy Laboratory (NMHPL).
  • The bill extends legislative authority and oversight to areas that clearly belong within the administrative branch, including approving peer-review groups, reviewing grants and contracts prior to award, and appointing 20% of NMHPL staff.

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