The Top 10 Facts About The Mental Health Reform Legislation in the 114th Congress
Myths and Facts About H.R. 2646 (The Helping Families in Mental Health Crisis Act) and S. 1945 (The Mental Health Reform Act)
1. The bills are not the same as earlier ones, and there are some important differences.
While much of the debate on both sides appears similar to a year ago, the underlying legislation has changed, and this session’s proposals take a more balanced approach to mental health reform than did past proposals, emphasizing both stage 4 crisis response, as well as prevention, early intervention, and care integration.
2. The bills do not mandate forced treatment.
While H.R. 2646 offers an incentive and funding for states to implement Assisted Outpatient Treatment (AOT), it does not mandate any additional AOT. It also does not change any existing state laws that do not penalize people if they refuse AOT. States will continue to be free to spend their current block grant dollars as they wish, and also be free to choose any evidence-based programs to support with their new federal demonstration grant dollars, and any promising programs to support with their new federal innovation grant dollars.
3. Nothing in either bill will prevent mass shootings. But they will prevent tragic outcomes and the progression of mental illnesses from Stage 1 to Stage 4.
That should be our top “prevention” priority. Mental health care is not a solution to gun violence, because the correlation between mental health conditions and gun violence is modest. But people with mental illnesses do lose 25 years of life expectancy for a variety of reasons – violence, suicide, and complications from other diseases among them. Early identification and intervention is the way to prevent many of these tragedies, and these proposals move us in that direction.
4. These proposals do not diminish SAMHSA, but elevate mental health in the federal bureaucracy.
That should be our top “systems” priority. SAMHSA has done a great job promoting recovery and the innovative services that make it possible during the 23 years since the agency was created. But SAMHSA has never been given the authority it needs to make sure other federal agencies are really addressing mental health. In their present form, neither bill cuts funding to SAMHSA, or repeals any of its statutory authority to promote recovery.1 Instead, both bills add in a new Assistant Secretary and an Interagency Serious Mental Illness Coordinating Committee, and leave federal law guiding SAMHSA in effect. In one approach, SAMHSA as an agency will report to the Assistant Secretary. In the other, the people of SAMHSA will be led by the Assistant Secretary. But a fair reading of both bills is that they ensure that in the future SAMHSA will play an even bigger role in helping the rest of the federal government better serve individuals with mental health conditions.
5. For those whose mental illnesses have already reach crisis stages, the bills will move mental health treatment and services (and maybe even dollars) out of our jails and into treatment and service programs in our communities.
That should be our top “treatment” priority. In fact, in its current form, H.R. 2646 calls on the federal government to create a plan to end the incarceration of nonviolent offenders with mental illness within ten years and use the savings to support community services for people with mental illnesses. That alone could finally empty our 21st century asylums (jails and prisons), echoing the efforts of our founder, Clifford Beers, a century ago. Even more importantly, both proposals call for millions of dollars of additional federal spending on a wide range of community-based programs – where new infusions of dollars are badly needed.
6. The bills are grounded in a sound public health approach.
In public health policy, we recognize the importance of the prevention, early intervention, services integration, and recovery. We work to prevent premature disability and death from chronic disease. And we focus on making communities, as well as individuals, healthier. These bills are not “wellness only” or “non-medical” responses to mental illnesses. On the contrary, they move in the direction of treating mental illnesses as health, not safety, concerns, the same way we treat other chronic diseases, and focus on the causes, not just the effects, of mental illnesses – and provide money in innovation and demonstration grants for this work.
7. If these bills pass, people will get more than just triage when they go to the hospital, but not held for years.
Some people think the bills – by opening up more funding for hospitals, too – will return individuals with mental health conditions to asylums. The bills do allow for some additional inpatient stays, which are often necessary for proper diagnosis and treatment plan development. But they do not allow for lengthy custodial institutionalization. Recovery must be the goal of all treatment and services, and we should support efforts – even modest ones – to make sure that people get the amount of inpatient care they need at the time, and afterwards they get access to the community services they need to prevent another hospitalization and thrive in the community.
8. Integrating health records as proposed in these bills will not let the police or your employer access your health information or diminish the legal rights of individuals.
The bills allow for the sharing of substance use information in integrated health care systems. This sharing will not allow employers and police to see your health information and use it against you – the privacy rule in HIPAA already protects against this. Allowing information sharing is essential for safety and ensuring that individuals can get access to the care they need.
9. The bills will not force peers to be supervised by clinicians.
The bills contain a report that examines best practices in training and credentialing peer support specialists who work in clinical settings. This report will be an important first step in ensuring that health plans will reimburse for peer services. Nothing about either bill forces peers outside of clinical settings to work under clinicians.
10. The bills will not be the end of mental health reform, but they do represent an important beginning to addressing structural issues and building out a continuum of care.
The mental health system is deeply broken and underfunded. While these bills lay a foundation for reform, they are still only a beginning. Congress will need to build on them with subsequent legislation to ensure that our mental health system is most effective. It will still need to look at education and employment supports, for example. While it can be argued by both sides that the bills do not go far enough, we need to acknowledge that they go further toward large-scale reform than other bills have in a generation, and that “starting over” from here is just a euphemism for “doing nothing,” yet again.