It’s been more than 50 years since the last comprehensive mental health bill passed in the United States.
This fall, Congress may have the opportunity to change that.
Before summer recess, the House of Representatives approved the Helping Families in Mental Health Crisis Act of 2016 (H.R.2646), introduced by Rep. Tim Murphy, Ph.D. (R, Pa.).
The bill was written in 2015 as a response to the Sandy Hook Elementaryschool shooting where 20 children and six adults lost their lives.
It would fund provisions for mental health treatment in the United States.
In June 2016, H.R.2646 received nearly unanimous support by House members.
“We were nonstop with this issue for years,” Murphy, who is a psychologist by training, and works at Walter Reed Hospital in Washington, told Healthline. “There is still a lot to do, but this is transformational.”
The extent of mental illness
Nearly 44 million people in the United States experience mental illness in a given year, according to the National Alliance on Mental Illness (NAMI).
Yet millions have trouble seeking care. Only about a third of the 2 million Americans with schizophrenia receive treatment, according to NAMI.
Experts say that’s because mental healthcare in the United States is a fragmented system of resources. It puts law enforcement — rather than medical professionals — in the role of decision makers when it comes to treating people with mental health issues.
Supporters say H.R.2646 will address these shortcomings through a series of new proposals and programs.
They say the provisions include changes in Medicare billing that allow people with both mental health issues and other physical conditions to be treated at the same location on the same day.
The act also calls for more beds allotted for short-term hospitalization, as well as a new federal administrator position to oversee mental healthcare and create a forward-thinking lab that will delve into best practices for treatment.
The Senate currently has its own version of a mental health bill.
The Mental Health Reform Act of 2016 (S.2680) is similar to the House bill with exceptions. The hope is that the two parties can come up with a bill that satisfies each group, and bring a vote to both floors when they return to Washington this fall.
What the legislation could do
If the bill were signed into law, it would signal a long awaited improvement to the country’s mental healthcare system, according to experts who spoke to Healthline.
“I’d call it foundational,” said Paul Gionfriddo, president and chief executive officer of Mental Health America (MHA). “It’s a good start. It’s not the end of the road, but it’s the right pathway.”
MHA and other mental health advocacy organizations worked with both legislative bodies to help craft the individual bills.
Gionfriddo said at its core, H.R.2646 sets out to fill in the gaps of mental health treatment that make the weblike system a challenge to navigate for those who seek care, and for those who provide care.
One of the most significant proposals is the call for a federal administrator to run the Substance Abuse Mental Health Services Administration (SAMHSA), a branch of the Department of Health and Human Services.
Advocates see great promise in the newly created position — Assistant Secretary for Mental Health and Substance Use Disorders — because it would require the administrator to hold a clinical degree.
Whoever takes the job will be charged with developing a so-called innovation lab to disseminate the most successful mental healthcare treatments currently in practice. With an emphasis on evidence-based care, the lab would give mental health professionals around the country a one-stop-shop for effective models of treatment.
“The provision really sharpens the focus on the federal level,” Andrew Sperling, director of legislative affairs for NAMI, told Healthline.
Other important components include additional beds for patients who need short-term care hospitalizations. Currently private healthcare systems are allotted a specific number of beds for mental health patients, forcing people on to waitlists or into outpatient care, according to Gionfriddo.
The bill would expand that number.
“They’d still have a cap of 15 days,” he said, “but it gives them more flexibility.”
H.R.2646 also takes on mental health parity, requiring more stringent congressional oversight of insurance companies that are in violation.
The bill’s early interventions and education portion for children is also getting a lot of attention. It authorizes an evidence-based program that treats children with schizophrenia.
Another program geared toward children who experience trauma in every day life would also be reauthorized.
Overall, the bill earmarks $450 million for states to serve adults and kids at community health clinics.
“All of these things are missing. [The bill] has them in there,” Gionfriddo said.
Opposition to the legislation
Despite all the programs that H.R.2646 would generate, there are groups opposed to it.
The National Coalition on Mental Health Recovery lists talking points against the bill on their website, and encourages constituents to call their representative to vote “No.”
The American Civil Liberties Union (ACLU) issued a letter earlier this year that called the legislation “outdated, biased, and inappropriate treatment of people with a mental health diagnosis,” and urged congressional members to vote “No.”
One of the ACLU’s greatest concerns in the bill threatens the privacy of mental health patients, as set by the Health Insurance Portability and Accountability Act (HIPAA).
H.R.2646 calls for doctors to freely provide information about a mental health patient to their family members without patient consent.
Murphy wholeheartedly rejected the ACLU’s stance on his legislation.
He said the bill is asking for clarity on the HIPAA rules because when it comes to patients with serious mental illness (SMI) in particular, families need to be in the know.
“Seventy-five percent of SMI patients have at least one other chronic illness,” Murphy said. “Cancer, lung disease, diabetes.”
He argued that these patients usually don’t maintain treatment during bouts of delirium or paranoia. When that happens, doctors should have the freedom to notify family members.
“Our bill tries to clarify that,” he said.
Cara English, D.B.H., director and professor in the Cummings Graduate Institute Doctor in Behavioral Health program, said removing some of the HIPAA communication barriers would be welcomed by many who treat people with mental health issues.
“Because of HIPAA, care providers are afraid to say anything,” she said.
English supports a lot of what she sees in H.R.2646. However, she does have some questions about the bill’s push to shore up integrated care.
SAMHSA calls integrated care “the systematic coordination of general behavioral healthcare,” including “substance abuse and primary care services” to “produce the best outcomes and provide the most effective approach to caring for people with multiple healthcare needs.”
English said in order for integrated care to truly work, medical professionals must receive training in behavioral health conditions and education about specific medications.
“Historically the AMA doesn’t include behavioral health and psychopharmaceutical training,” she said. “So how’s that all going to play out, getting the money for training?”
Gionfriddo, who has worked in mental health for decades and speaks openly about his own son who has schizophrenia, acknowledges that H.R.2646 won’t solve all the problems currently facing the country’s mental healthcare system.
Still, he’s betting on the changes proposed by the bill.
“It’s like we are remembering what we tried to start 50 years ago,” he said.
How it used to be
More than five decades ago, the federal government shifted tactics from holding people with mental health conditions in state-run institutions to providing services through community-based resource programs.
That included outpatient treatment, housing, and job training.
By the 1980s the federal government decided to “step back” from that plan, according to Gionfriddo, and distribute block grants to states. They alone would determine where and how to spend funds on mental healthcare treatment.
That’s when things changed.
“There wasn’t enough money,” he said, and the people who needed help didn’t get it because states weren’t “investing enough in community services.”
The homeless population swelled, Gionfriddo added, as did the shift in treatment.
“Now courts, judges, police decide what going to happen instead of hospitals, doctors, and emergency medical technicians,” he said.
Most media outlets say that there is a chance that a version of H.R.2646 will get a Senate vote, although a few say it won’t receive approval. The potential for a gun control measure to be attached to the bill is the main sticking point, but discussions are still ongoing.
Despite its tenuous status, Sperling thinks a compromise will be reached.
“Neither of these bills are perfect, but we are moving forward,” he said. “We are hopeful we can get it done.”
Murphy is cautiously optimistic.
“I worry about anything that delays this process,” he said. “I hope the Senate will move on it. Nine hundred people a day die [due to mental illness]. Lives are at stake, and every day delayed is more death.”