Thursday, 24 September 2020

The Murphy Bills and Beyond

In June of 2015, Representative Tim Murphy of Pennsylvania re-introduced the "Helping Families 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. 



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The Murphys Have Their Way With Words

sdavidow 1Note: 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
  • Recovery

Read more: The Murphys Have Their Way With Words

Senate Releases It's Own Murphy Bill

Representative Tim Murphy of Pennsylvania has been promoting some version of the ‘Helping Families in Mental Health Crisis’ Act (HR 2646) for some years.  His most recent version was released in June, and although somewhat toned down, it continues to push forced treatment, decreased privacy rights, diminished access to advocates and more. 

Following not far behind, Senator Chris Murphy of Connecticut (along with Senator Bill Cassidy) released a Senate version in early August.  This version, called the ‘Mental Health Reform Act of 2015,’ (S. 1945) is different in spots but often identical to the House Bill.

Both threaten our movement in a multitude of ways including (but not limited to):

  • 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.

Want to know more about the new Senate Murphy Bill?  Here are a number of sources of information:

  1. Listen to the Talk with Tenney Radio Show, "Reading the Cassidy-Murphy Bill" here.
  2. Listen to the Talk with Tenney follow-up show, "Further Analyses of Current Mental Health Legislation" here.
  3. Check out Lauren Tenney's Blog, "Senate bill 1945: The New Fraud - Getting into the 'Mental Health Reform Act of 2015'" posted here on Mad in America.
  4. Check out Sera Davidow's Blog, "The Murphys Have a Way with Words" posted here on the Campaign for Real Change in Mental Health Policy.

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.

Read more: NEW WEBSITE: Campaign for Real Change in Mental Health Policy

The ‘Murphy bill’ (H.R. 2646) fails its own home inspection

scomstockBy Scott Bryant-Comstock (Originally posted here)

When I printed out the text of the Helping Families in Mental Health Crisis Act of 2015, H.R. 2646 (all 173 pages of it) I had to fight the temptation to jump to the particular areas of most interest to me (AOT, HIPAA, among others) and instead, read it the way you would read a novel, from beginning to end, no skipping ahead to look for the good parts, just one page at a time. I encourage all of you to do the same. If you do, you will get a better sense of the tone of the bill, the overall direction of the bill. In effect, you get a feeling for the foundation that the bill is built upon, and it is the foundation that is most critical to the success or failure of any legislative proposal.

Operating from good intentions It is important to underscore that Congressman Murphy and the architects of the Helping Families in Mental Health Crisis Act of 2015 (H.R. 2646) are working with the best of intentions. I have had the honor of meeting with the Congressman, and there is no doubt that he cares deeply about this issue. The tragedy at Sandy Hook propelled him to take on mental health reform as a defining issue for his legacy in Congress, and for that, one must applaud him. Members of his staff were incredibly helpful to us early on in our dialogue series by encouraging us to meet with and talk to some of their most ardent supporters. We welcomed the opportunity and after meeting their suggested contacts, have developed some enduring friendships and mutual respect.

Developing relationships with ardent supporters of the Murphy bill underscores the importance of “getting it right” when it comes to the language in this bill. Their stories, along with the stories of the equally passionate individuals who have come out in opposition to the Murphy bill, require us to be vigilant in our assessment. We must analyze it far beyond the sound bytes of political expediency so that both supporters and detractors of the Murphy bill can see movement toward comprehensive mental health reform. Here is the little secret about "divisiveness" between mental health advocates that politicians don’t want you to know. When you get advocates in a room together, away from the political spotlight, more often than not, they are in agreement about the need for a spectrum of mental health supports and services, not one end of the continuum versus the other. We need federal mental health reform legislation to reflect that same continuum approach at the state, tribal and local level.

This bill, as currently written, does not do that. However, don't be deterred, Network faithful. In this post, I will discuss several serious issues with the bill. Make no mistake, while there is plenty that is wrong with the bill, this is also the time for us to rally and share our ideas for how to make the bill better. Take solace in the fact that in a recent meeting between family organization leaders and Congressman Murphy, he was quoted as saying that "this is the time to send in language for improvement." Let's take him up on his offer!

Now is the time to get involved in this discussion. Share your ideas for improvement, and together, we can make this a stronger bill that can lead the way to meaningful mental health reform in America.

Warning: I am forceful in my commentary on the bill. I do so, because, as it is currently written, everyone loses. Network faithful who are Murphy bill supporters lose. Network faithful who are Murphy bill opponents lose. Consider my blunt critique a wake-up call to all of us. What we at the Children's Mental Health Network know better than most is that both supporters and opponents of the Murphy bill need to win if we are going to achieve meaningful mental health reform in America.
Let the tough love begin.

Read more: The ‘Murphy bill’ (H.R. 2646) fails its own home inspection

The Murphy Bill: Old Wine in New Bottles





 By Andrea Blanch and David Shern (Originally published here)

In June, the Helping Families in Mental Health Crisis Act of 2015 (H.R. 2646) was introduced by Reps. Tim Murphy (R-PA) and Eddie Bernice Johnson (D-TX).  Several groups have applauded the bill for focusing attention on the need for strengthening the nation’s mental health system.  Unfortunately, the bill proposes very little new, contains provisions that could prove harmful to the very people it is intended to help, and ignores significant scientific advances in our understanding of the causes and treatment of mental illnesses.

Others have criticized in detail the bill’s emphasis on institutional and coercive approaches to treatment rather than on effective, voluntary community-based services; the elimination or drastic reduction in important programs overseen by the Substance Abuse and Mental Health Services Administration (SAMHSA); provisions that would curtail or limit enforcement of civil and privacy rights; and structural problems with proposed changes in federal mental health administration.  Here, we want to focus on another failing of the bill – the lost opportunity to build on what science has taught us during the past twenty years.

The Science.  There is now little doubt that mental illness and substance abuse result from a combination of genetic and environmental influences.  Some people are genetically predisposed to these conditions, and may develop symptoms even in the absence of other risk factors.  Others people are propelled down this path by traumatic events or adverse experiences, especially in childhood.  While the science is still evolving, it is clear that when children experience multiple risk factors –particularly in the absence of protective factors - the stress response system is overloaded and a “cascade of risk” is triggered.  These experiences can become ‘biologically embedded’ in the developing brain, causing a spectrum of behavioral health problems which, in turn, predispose a variety of general health and social problems.

These findings have important implications for the field. Clearly, an integrated public health approach is required - one that is person/family centered, addresses the social determinants of health, and powerfully combines primary prevention with treatment and rehabilitation.  Ignoring any of the components of public health is short-sighted.  For example, recent meta-analyses suggest that if major forms of childhood adversity were eliminated, a significant percentage of new cases of both child and adult psychosis could be prevented.  Similarly, the premature mortality of people with severe mental illnesses – a shocking statistic that has recently garnered national attention - underlines the multiple co-morbidities, disability and mortality associated with mental illness and illustrates the need for better access to care.

The Murphy bill nominally seeks mental health reform but fails to capitalize on these recent scientific advances and, in fact, is regressive in its approach.  There are fundamental flaws in the bill’s approach to treatment and rehabilitation as well as to prevention.

Read more: The Murphy Bill: Old Wine in New Bottles

The Murphy Bill: People are Afraid

nhunterBy Noel Hunter (Originally published here)

Recently, the Murphy Bill in the United States Congress has resurfaced as a tangible threat to the civil liberties of individuals labelled "seriously mentally ill." As many others might relate, my reaction was one of rage, sadness, and utter bafflement. Usually when I become incensed I am inspired to write. But, how much more can be written on this topic? Although I have a decent amount of knowledge regarding this bill, the deceptive ideals contained within it, and the actual evidence base that should give reason for extreme caution to those considering supporting this bill, people far more competent and knowledgeable than I have already done the work of refuting the rhetoric with facts and figures and offering alternative solutions and methods of action. (see: http://www.ncmhr.org/downloads/NCMHR-Fact-Sheet-on-Involuntary-Outpatient-Commitment-4.3.14.pdfhttp://www.ncmhr.org/press-releases/12.12.13.htmhttp://www.bazelon.org/News-Publications/Press-Releases/12-12-13-Murphy-PR.aspxhttp://www.madinamerica.com/2015/03/eugenics-2014-murphy-bill/;http://www.madinamerica.com/2014/04/murphy-bill-violates-civil-rights-increases-government-intrusion-ignores-scientific-research/;http://www.madinamerica.com/2013/12/tim-murphy-mental-health/; and http://www.madinamerica.com/2014/04/mental-health-social-justice-issue/)

Yet, here we are. Having defeated the bill once, it is back like herpes. After my frustration and anger dissipated a bit, I pondered this and was hit with a "duh" moment. Politics is not about facts; politics is about power, money, and playing on the emotions of society. I realized that it is imperative that we understand and tease apart the issues in society that not only allow such a bill to sustain attention, but seemingly needs such a bill to exist. Perhaps if we can come to a better understanding, then we might be able to offer alternatives that simultaneously honors human dignity and assuages the fears and concerns of the larger public. While putting forth the rational argument of research and evidence, which is on our side, we need to also understand that this is not a rational game. It is an emotional one, and so we need to come back on that same level; though not in the way we want (Hey, folks on Capitol Hill! I've been hurt and you're hurting me more!). In our efforts to fight back and prevent a return of the dark ages, it might behoove us all to attempt to address the fear, the helplessness, the need to scapegoat, the genuine concern, and/or the natural human selfishness that people have which might lead them to support the bill in the first place.

People are Afraid

Read more: The Murphy Bill: People are Afraid



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