December 2016 TribLive; Mental health advocates say they are encouraged by Congress’ recent passage of far-ranging legislation from U.S. Rep. Tim Murphy to reform the nation’s mental health system, even if the approved changes are imperfect.
“We haven’t been providing adequate services, nor — given the cost — have we been providing adequate research to improve the lives of people affected by mental illness,” said Dr. David Lewis, chairman of psychiatry at the University of Pittsburgh. “A key piece of the legislation, in my mind, is that it brings the need to the forefront, brings it out of the shadows and makes it a national priority.”
The bill’s final version, signed by President Obama last week as part of the 21st Century Cures Act, softened controversial sections regarding patient privacy, involuntary treatment and legal services for people with psychiatric disabilities.
The legislation allots $1 billion for opioid treatment over the next two years but provides no other new funding. If focuses instead on recalibrating existing services under a new federal administrator while aiming to increase flexibility and accountability for the organizations treating people with mental illnesses.
“This has some very significant and substantial changes,” Murphy, an Upper St. Clair Republican, told reporters this week, while acknowledging the bill doesn’t do everything he would like. The bill passed the House in a 422-2 vote in July. The Senate approved it 94-5.
Murphy said he based his reforms on an investigation of the nation’s mental health care system he launched after the 2012 shootings at Sandy Hook Elementary School in Newtown, Conn. The investigation found that the federal government dedicates $130 billion per year toward mental health care and oversees 112 programs intended to address mental illness.
Despite the resources dedicated to it, mental illness often goes untreated, and people with mental illnesses end up in jail or homeless, he has said.
The legislation includes provisions aimed at connecting people with treatment earlier. The bill ramps up services for pregnant mothers, infants, children and adolescents — who start to show signs of mental illnesses that often aren’t treated until their 20s or 30s, said Lewis, the Pitt psychiatry chairman.
The legislation adds new grant programs and increases flexibility for early detection and treatment. It authorizes money for some of the programs — which Congress still needs to affirm before the money is available — and in some cases requires states to pitch in more money as a condition of receiving grants.
The bill aims to link primary care treatment more closely to mental health treatment, including a clarification that hospitals can bill Medicaid for patients to visit a primary care doctor and mental health doctors the same day.
The bill addresses some examples of what Murphy has called barriers to effective treatment, including restrictions on doctors sharing medical information with family members or other caregivers of people with mental illnesses.
That effort met resistance from some groups, such as the Washington, D.C.-based Bazelon Center for Mental Health Law, who say people with mental illness should have the same privacy protections as people with physical illnesses.
The final version of the bill calls instead for the federal Department of Health and Human Services to clarify existing law under the Health Insurance Portability and Accountability Act. The law provides more flexibility for people with mental illnesses than many doctors realize, said Pittsburgh-based HIPAA attorney Bill Maruca.
“There are already exceptions that I think are not very well understood or followed,” Maruca said.
Doctors may disclose personal health information related to mental illness when the patient is a genuine threat to himself or someone else or when the doctor determines disclosing information is in the patient’s best interest and the doctor judges the patient’s condition has incapacitated them.
“There’s probably an overly cautious approach to disclosure, particularly of mental health information, and I think there’s a need for this to be better understood by the mental health community about what they can and can’t disclose in certain situations,” Maruca said.
The legislation supports court-ordered mental health treatment, which some organizations have opposed because they say it is not as effective as voluntary treatment.
The final bill essentially extends an assisted outpatient treatment pilot program, said Jennifer Mathis, Bazelon’s director of policy and legal advocacy, but she still believes it is misguided to use resources on involuntary treatment that could support voluntary treatment.
“Given the dramatic gap in services people need and can’t get … the idea that you would force services on people when you can’t provide the services they want seems silly,” Mathis said.