The Helping Families in Mental Health Crisis Act (H.R. 2646), the brainchild of Representative Tim Murphy (R-PA), proposes significant changes to the nation’s mental health care system. The bill has slowly and perpetually gained attention from national media and is pulling modest bi-partisan support. Currently, 47 of the bill’s 168 co-sponsors are democrats (from govtrack.us), and Eddie Bernice Johnson (D-TX) introduced the bill in partnership with Murphy. On November 4th H.R. 2646 was reported out by the House Committee on Energy and Commerce, moving the bill on for further consideration by the full House. Murphy, a child psychologist prior to his life in government, clearly has some in depth knowledge of mental illness, but his proposals are drawing mixed reviews from mental health advocacy groups, media, and professional and peer organizations.
As H.R. 2646 moves closer to possibly becoming law, here’s a look at three of the major proposals in the bill that are currently being debated:
- New Leadership for the Federal Mental Health System
- The bill calls for creation of a new position: the Assistant Secretary for Mental Health and Substance Use Disorders, who would report to the Secretary of Health and Human Services. This individual would oversee the various existing government organizations working within mental health, and would be charged with prioritizing integrated services, early diagnosis, intervention and workforce development. This new position is hailed by some who say it could reinvigorate focus on effective mental health care with the priorities above in mind, and could provide needed oversight for coordinating programs across various agencies (SAMHSA, NIMH and others). The new position would effectively eliminate the SAMHSA Administrator position as the bill explicitly states that the authority of that current position would be transferred to this new position, along with other “higher authority.” Some opponents to this move suggest that the creation of this new position is a way to legislate current SAMHSA Administrator Pamela Hyde out of her job, and that the move is truly motivated by Murphy’s criticism and negative perceptions of Hyde. In any case, this level of oversight could have some real positives with new leadership, but opponents point to inefficiencies that another layer of bureaucracy might present.
- Changes to HIPAA and Medical Information
- Perhaps the most controversial and debated part of H.R. 2646 has to do with changes to the Health Insurance Portability and Accountability Act (HIPAA). The bill proposes allowing educational organizations to disclose mental health information of a student to a caregiver (immediate family member). It also would allow medical providers to disclose information when necessary for health, safety or welfare of the individual or public. The bill’s language emphasizes the release of information to caregivers when there is serious or imminent threat of a patient physically harming self or others, which proponents of the measure hail as a welcome shift that could help prevent violence and ensure better care. But opponents say the measure unfairly limits patients’ privacy rights, and gives healthcare providers too broad of an ability to disclose mental health treatment information. The Bazelon Center for Mental Health Law calls these “discriminatory changes” that would in effect be “reducing the privacy rights of individuals with mental illnesses and discouraging from seeking treatment.” The delicate issue of privacy is at the center of many debates surrounding this bill.
- Changes to Assisted Outpatient Treatment
- Another issue being widely debated concerns the ways in which H.R. 2646 seeks to expand Assisted Outpatient Treatment (AOT), a system that “allows judges to order…those seriously mentally ill who already have a past history of arrest, violence, or needless hospitalization caused by failure to stay in treatment, to stay in mandated and monitored treatment as a condition of living in the community” (from mentalillnesspolicyorg). The bill calls for increased funding for states without these programs to begin pilot AOT programs, and also provides a bump in funding for those states already using this program. Proponents in the AOT model point to significant reductions in the rates of arrest, homelessness and hospitalization for individuals treated by such programs. Opponents say that H.R. 2646 misrepresents AOT as a “community-base” form of treatment and that it is really a kind of forced treatment that is more appropriately referred to as Involuntary Outpatient Commitment (IOC). Groups like the Psychiatric Rehabilitation Association have come out in opposition to H.R. 2646, in part because of the expansion of this controversial program the bill would create. Assisted Outpatient Treatment will continue to be a major point of contention as the bill moves into the consideration of the full House.
