Since the mass shooting tragedies of Tucson, Aurora, Newtown, et al., there has been a consensus in Congress that the nation’s mental health treatment system is in need of reform.
Thus, five months ago, Rep. Tim Murphy, a Republican from Pennsylvania, introduced such legislation and has obtained impressive bipartisan support. The bill has 49 Republican and 27 Democratic co-sponsors and has been endorsed by many organizations and newspapers, ranging from the conservative Wall Street Journal to the liberal Washington Post.
Then on May 6, Arizona Rep. Ron Barber, who was shot in the Jan. 8, 2011 mass shooting in Tucson that killed six people and wounded 13, including then-Rep. Gabrielle Giffords, introduced a separate mental health reform bill with only Democratic co-sponsors.
Politico, a newspaper that covers Congress, suggested that partisan politics were behind the bill and expressed “fears that it could hinder progress toward bipartisan reform.”
How do the two bills differ? Both bills include grant funds to the states to strengthen existing programs, and both propose the creation of a mental health authority to coordinate existing federal programs.
However, Murphy’s bill includes several provisions that are aimed at helping individuals with the most severe mental illnesses — people like the Jan. 8 gunman, Jared Loughner. Barber’s bill includes none of these provisions.
One such provision is a proposed reform of the Health Insurance Portability and Accountability Act (HIPAA), implemented in 1996 to protect medical records and patient privacy.
HIPAA has been interpreted so strictly that many officials are afraid to release any information at all, even in circumstances where it should be released.
Families of mentally ill individuals are often unable to obtain even basic information regarding the diagnosis or treatment of severely ill family members. HIPAA reform is badly needed.
Another provision not included by Barber is Murphy’s proposed reform of the federal Institution for Mental Disease (IMD) exclusion for Medicaid payments to state hospitals.
This has been the driving force behind the closure of state mental hospital beds as states attempt to shift costs from themselves to the federal government.
It is a major reason why Arizona ranks near the bottom among states on its number of public psychiatric beds, beds needed to treat and stabilize people like Loughner.
Still another provision in Murphy’s, but not Barber’s, proposed legislation is the reform of state psychiatric commitment statutes allowing hospitalization on a need-for-treatment basis, not just for imminent dangerousness.
In practice, the means than an obviously severely mentally ill individual such as Loughner could be hospitalized for psychiatric evaluation before he had committed a violent act. Arizona has such law, although it was not used for his situation, but half of the other states do not.
Another important provision of the Murphy, but not the Barber, proposed legislation is a grant program to encourage states to use assisted outpatient treatment.
AOT allows severely mentally ill people with a history of dangerous behavior to live in the community only if they are taking the medication needed to control their symptoms.
Multiple studies have proved that AOT decreases hospitalization of, incarceration of and violent behavior by mentally ill individuals. Arizona has such a law but almost never uses it.
There are other differences between the two proposed mental health reform bills, including Murphy’s proposed reform of the federal Substance Abuse and Mental Health Services Administration (SAMHSA), the lead federal agency for mental health issues.
This $3.5 billion federal agency does not even acknowledge the existence of schizophrenia and bipolar disorder in its three-year plan of priorities; whereas Murphy wants to reform the agency, Barber proposes to simply give it more money.
In summary, the Murphy bill focuses on reforms to improve services for the most seriously mentally ill individuals, whereas Barber’s bill omits these provisions and just provides more funding for the status quo. One would have thought that Barber, of all people, would have known better.