MASS SHOOTINGS AND A MENTAL-HEALTH DISGRACE
THE WALL STREET JOURNAL
Mass Shootings and a Mental-Health Disgrace
The federal bureaucracy is anti-patient, anti-family and anti-medical care. Reform is essential
ByTim Murphy
Mr. Murphy, a Republican, is a U.S. representative from Pennsylvania and a psychologist in the Navy Reserve Medical Service Corps.
Oct .9, 2015
EXCERPT FROM THIS ARTICLE:
In 1955 there were 558,000 inpatient psychiatric beds in the U.S. Today there are fewer than 45,000. The severe shortage is due to the decades-long deinstitutionalization that began in the civil-rights era. But it has been exacerbated by a Medicaid reimbursement rule known as the “institutions for mental diseases exclusion,” which prohibits federal matching payments for inpatient care at psychiatric hospitals with more than 16 beds. My bill moves away from the arbitrary 16-bed cap and establishes a clinical standard for patients with serious mental illness.
These past few months have brimmed with tragedy. Americans are struggling to make sense of horrific acts of mass violence like the August shooting on live television in Roanoke, Va., and last week’s college campus shooting in Roseburg, Ore.
We all know how this plays out in Congress: a moment of silence on the House floor and a fraternal feeling of melancholy when the flag over the Capitol is lowered to half-staff. But that moment of silence will not heal the hearts of those who lost a loved one, and it will not stop the next tragedy. Here and now we need action; we need real change.
That’s why I’ve authored the Helping Families in Mental Health Crisis Act. The bill focuses resources and reform where they are most needed: to foster evidence-based care, fix the shortage of psychiatric hospital beds, empower patients and caregivers under HIPAA privacy laws, and help patients get treatment well before their illness spirals into crisis.
As chairman of the House Oversight and Investigations Subcommittee, I led a congressional investigation into our failed mental-health system after the 2012 Sandy Hook Elementary School shooting. What we found was shocking and disgraceful: a wasteful federal bureaucracy that is anti-patient, anti-family and anti-medical care. The federal government has more than 112 programs that deal with mental health in one way or another, yet a person with serious mental illness is 10 times more likely to be in a prison cell than a psychiatric hospital bed.
In 1955 there were 558,000 inpatient psychiatric beds in the U.S. Today there are fewer than 45,000. The severe shortage is due to the decades-long deinstitutionalization that began in the civil-rights era. But it has been exacerbated by a Medicaid reimbursement rule known as the “institutions for mental diseases exclusion,” which prohibits federal matching payments for inpatient care at psychiatric hospitals with more than 16 beds. My bill moves away from the arbitrary 16-bed cap and establishes a clinical standard for patients with serious mental illness.
We know that families of the mentally ill are the front-line care-delivery team. We also know that those with serious mental illness frequently have chronic diseases like diabetes. Yet federal privacy laws routinely thwart efforts by families to obtain critical information about a sick family member, or even to share that information with the treating physician. This is one reason why the seriously mentally ill die 25 years sooner than the rest of the population. Under my bill, minor adjustments to HIPAA will allow the doctor to share with a known and trusted caregiver the medical diagnosis, prescriptions, and time and place of appointments. Sharing this minimal yet vital information will save lives.
According to the National Institute of Mental Health, those with mental illness in treatment are 15 times less likely to engage in an act of violence than those who go untreated. Many states are adopting court-supervised treatment programs, known as assisted outpatient treatment, for those who, by the very nature of their illness, are unable to voluntarily comply with necessary medical and psychiatric care. A 2005 New York study found that this model reduced rates of imprisonment, homelessness, substance abuse and costly emergency-room treatment for chronically mentally ill participants by upward of 70%. It has also reduced annual Medicaid costs by more than 40% for participants, according to a recent Duke University study. My bill promotes alternatives to long-term inpatient care by helping states fund these innovative approaches to community-based treatment.
Many families who do successfully arrange for care still face federally funded “protection and advocacy” lawyers fighting against their efforts to get their mentally ill loved one to treatment. These lawyers effectively work to get patients out of lifesaving care and abandon them upon release. My bill returns the program to its original function of preventing abuse and neglect of the seriously ill.
This bill also requires psychiatric hospitals to establish clear and effective discharge plans to ensure timely and smooth transitions from the hospital to appropriate post-hospital care and services, emphasizing continuity of care.
It would be impossible to enact meaningful reforms without overhauling the Substance Abuse and Mental Health Services Administration, the relatively obscure federal agency charged with overseeing the lion’s share of mental-health programs. In a scathing report released in February, the Government Accountability Office found that, despite Samhsa and its $3.6 billion annual budget, “coordination related to serious mental illness has been largely absent across the federal government.”
Rather than focus on the millions of Americans with serious mental illnesses such as schizophrenia or bipolar disorder, Samhsa spends billions on “behavioral wellness” programs for those without a mental illness. Incredibly, Samhsa even funds the growing anti-treatment industry, which encourages mental-health patients to stop taking medications.
My bill focuses resources on clinical programs with a proven record of effectiveness, such as the Recovery After Initial Schizophrenia Episode project, an adolescent early intervention program, and the National Child Traumatic Stress Network. The legislation also launches a new early childhood grant program to provide intensive services for children with serious emotional disturbances in an educational setting.
A cornerstone of my reform package is new executive branch leadership. By establishing a new position, an assistant secretary for mental health and substance use disorders, we can ensure that recipients of federal mental-health block grants apply evidence-based models of care, and that dollars are optimized to help patients rather than the bureaucracy.
The Helping Families in Mental Health Crisis Act has been a grass-roots effort. But despite garnering more than 130 bipartisan co-sponsors, as well as support from families and almost every major police, sheriff and mental-health organization in the country, the bill is still blocked by a vocal minority in Congress protecting the failed status quo. No more moments of silence. The time to act is now.
Mr. Murphy, a Republican, is a U.S. representative from Pennsylvania and a psychologist in the Navy Reserve Medical Service Corps.
