Bipartisan Action On Mental Health

Major mental health legislation is finally advancing in Congress, albeit somewhat stripped down to achieve a broad consensus. On June 15, the House Energy and Commerce Committee voted 53-0 to send the Helping Families in Mental Health Crisis Act to the House floor. The full House will probably consider the bill in the fall. It was introduced by Republican Representative Tim Murphy of Pennsylvania, a licensed psychologist, and Democratic Representative Eddie Bernice Johnson of Texas, a psychiatric nurse.

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The Hill has a good roundup of the committee’s work here. Chairman Fred Upton of Michigan said: “Today, this Committee takes a monumental step by advancing a bill that makes real reforms and offers evidence-based treatment for families in mental health crisis. Today we are taking a stand. We affirm that mental illness is not a crime. Mental illness is not a moral defect, it is not a choice, and it is not a joke. Mental illness is just that: an illness.”

Sarah Chamberlain, president of the Republican Main Street Partnership, had a strong piece in The Hill supporting the legislation:

America is in the midst of a national mental health crisis. Over 40 million Americans have a mental illness. Nearly 10 million have a serious psychiatric disorder such as schizophrenia, bipolar disorder or major depression. Millions of people who experience mental illness go without care, and many of them end up in prison or on the streets—or dead. Each year, 41,000 Americans die from suicide and 44,000 from drug overdoses, a number equal to all U.S. combat deaths in Korea, Vietnam, Afghanistan and Iraq combined. Women are particularly impacted by mental illness because they make up two-thirds of all caregivers.

Mental Health America (MHA), which has 950 affiliates across the country, applauded the committee’s passage of the bill. It is one of a number of non-profit advocates that support the legislation.

MHA’s “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.

Read a contrary perspective in Truthout from Oryx Cohen, co-producer of the recent documentary, Healing Voices. He is a member of the National Coalition for Mental Health Recovery and the Campaign for Real Change in Mental Health Policy.

The Violence Myth

A new study published by the leading health policy journal Health Affairs says that the news media’s misrepresentation of the connection between mental illness and violence may undermine public support for mental health policies.

The study, “Trends In News Media Coverage Of Mental Illness In The United States: 1995–2014,” sampled 400 news stories about mental illness, and found that 55 percent of them mentioned violence. By contrast, only 14 percent described successful treatment for or recovery from mental illness.

The study provides some context to the media reporting on whether mental illness was a factor in the mass murder of 49 people at an Orlando gay night club on June 12 by a 29-year-old man, Omar Mateen. In the New York Times, security expert Peter Bergen writes that a New America study found that only one in ten terrorists—below the incidence in the general population—had mental health problems.

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Here’s the full abstract of the study:

The United States is engaged in ongoing dialogue around mental illness. To assess trends in this national discourse, we studied the volume and content of a random sample of 400 news stories about mental illness from the period 1995–2014. Compared to news stories in the first decade of the study period, those in the second decade were more likely to mention mass shootings by people with mental illnesses. The most frequently mentioned topic across the study period was violence (55 percent overall) divided into categories of interpersonal violence or self-directed (suicide) violence, followed by stories about any type of treatment for mental illness (47 percent). Fewer news stories, only 14 percent, described successful treatment for or recovery from mental illness. The news media’s continued emphasis on interpersonal violence is highly disproportionate to actual rates of violence among those with mental illnesses. Research suggests that this focus may exacerbate social stigma and decrease support for public policies that benefit people with mental illnesses.

The Atlantic has a good review of the study here.

An extract:

…[A] consistent and dangerous narrative has emerged—an explanation all-too-readily at hand when a mass shooting or other violent tragedy occurs: The perpetrator must have been mentally ill.

“We have a strong responsibility as researchers who study mental illness to try to debunk that myth,” says Jeffrey Swanson, a professor of psychiatry at Duke University. “I say as loudly and as strongly and as frequently as I can, that mental illness is not a very big part of the problem of gun violence in the United States.”

The overwhelming majority of people with mental illnesses are not violent, just like the overwhelming majority of all people are not violent. Only 4 percent of the violence—not just gun violence, but any kind—in the United States is attributable to schizophrenia, bipolar disorder, or depression (the three most-cited mental illnesses in conjunction with violence). In other words, 96 percent of the violence in America has nothing to do with mental illness.

“Overwhelming anxiety” On Campus

The online publication Inside Higher Ed has a story about students demanding better access to mental health services. In response, colleges and universities are creating 24-hour hotlines and embedding counselors in residence halls.

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At Pennsylvania State University, where demand for counseling increased 32 percent in the past five years, students took matters into their own hands. The Class of 2016 raised about $400,000 to create an endowment for the university’s Center for Counseling and Psychological Services.

Read the full story here.

IHE‘s snapshot of the challenges:

The mental and emotional health of students has been of increasing concern to colleges in recent years, even as many institutions struggle to find the resources to better address those concerns. More than half of college students say they have experienced “overwhelming anxiety” in the last year, according to the American College Health Association, and 32 percent say they have felt so depressed “that it was difficult to function.”

Nearly 10 percent incoming freshmen who responded to last year’s American Freshman survey reported that they “frequently felt depressed.” It was the highest percentage of students reporting feeling that level of depression since 1988, and 3.4 percentage points higher than in 2009, when the survey found the rate of frequently depressed freshmen to be at its lowest.

The story notes the work of The Jed Foundation, which created a national project called  the Campus Program to help colleges and universities promote emotional and mental well-being. More than one hundred are participating, including Cornell University and SUNY Cortland.

Sadness of Depression

The Mighty is an online community for people facing serious health conditions—and it offers a lively platform for sufferers of mental illnesses to share their experiences. According to The Mighty’s Who We Are page: “We’re creating a safe platform for our community to tell their stories, connect with others and raise support for the causes they believe in. We are stronger when we face adversity together, and we know it.”

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Read a recent post, “What the Sadness of Depression Really Feels Like”:

Imagine you wake up in the morning and you feel as though, overnight, your heart has sunk into the pit of your stomach and stayed there, throbbing, until it becomes a dull but persistent ache that has spread to your entire body. Maybe it’s raining and you have a dentist appointment later that day, or maybe it’s a warm sunny day and you have plans to spend it in your favorite place with your best friends: it doesn’t matter. The entire world looks ominous through the lens of the depression. Whatever lurks beyond the door of the bedroom doesn’t feel safe. Sitting up and swinging your feet out of bed feels insurmountable, not because of the mind-numbing fatigue you feel but because it just hurts inside. Just pushing yourself up to turn off your alarm makes your insides clench with discomfort and fear.

Hard Hats, Not Hard Heads

Amy Morin has a piece in Forbes explaining how the construction industry—to the surprise of many—is becoming a leader in promoting mental health awareness. “They’re doing some incredible work to reduce the stigma attached to mental health and they’re saving lives,” Morin says, encouraging other industries to follow suit.

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Morin’s article cites “Industry Blueprint: Suicide Prevention in the Workplace.” It’s an excellent manual discussing industry risk factors, warning signs, and recommendations. The manual was sponsored by Denver contracting firm RK and produced by The Carson J Spencer Foundation in partnership with the National Action Alliance for Suicide Prevention.

Morin, a psychotherapist and author of 13 Things Mentally Strong People Don’t Do, lists some recommendations of her own:

What You Can Do In Your Organization

—Don’t assume mental health problems aren’t an issue in your organization. The National Alliance on Mental Illness estimates one in four adults experiences a mental illness. Here’s what you can do in your organization:

—Start a conversation about mental health. Talk about issues like stress management in your meetings. Be willing to mention the importance of self-care and living a healthy lifestyle. Your employee’s emotional state has a big impact on their productivity and overall life satisfaction.

—Help employees detect mental health problems early. Many mental health problems go undetected, which causes people to suffer in silence. Encourage employees to access free online screening tools and provide in-service trainings with mental health professionals. Statistics show most people will seek treatment once they recognize they may have a problem.

—Support employee’s efforts to get help. Ensure an employee can get to therapy once a week during work hours and provide the workforce with an employee assistance program. With treatment, 65% to 80% of individuals with mental illness see improvements, so make sure you support people’s efforts to get the help they need.