About 350,000 Americans with a diagnosis of a severe mental illness like schizophrenia or bipolar disorder are in state jails and prisons, while the number of psychiatric beds available has shrunk to 35,000, according to a coming analysis by the Treatment Advocacy Center, a nonprofit group that favors expanded access to treatment.
People can disagree. Reasonable people can even disagree reasonably. This all seems to go out the window when discussing the issue of mental illness.
Mental illness scares us for many reasons, mostly because we don't understand it very well. The concept or prospect of losing one's faculties is perhaps the scariest concept imaginable in modern society.
None of us wants to think about not being who we are.
Mental illness has many faces. It can be the homeless person on the street talking to themself.
It can be the world-famous actor and comedian who made us all laugh and cry on numerous occasions.
It can be the teenager that commits horrible acts of violence, sometimes armed.
It can be your mother or your father or your
brother or your sister. Or it could be you.
Recently, I have been forced to do some research on some proposed federal legislation regarding mental health treatment in order to figure out what is happening. I have had to wade through what I consider a lot of weeds to find what I consider the heart of the matter.
I would like to stress at this point that I am a complete novice, just a guy with a screen and a keyboard. I am neither a doctor nor a lawyer, although I have played both on TV.
Two Competing Bills
As with all things Washington, each party has a bill addressing mental health treatment.
There are opinions on both sides about the other, and some are less than polite.
There is some misleading language and happy talk titling.
There are different beliefs about the problems and how to go about fixing them. It seems to me that this is the crux of the disagreements between the two sides. Each bill is trying to fix a different problem.
The two measures reflect a fault line in the mental health community when it comes to caring for people with serious mental illness. Both approaches have champions who feel the other side’s priorities are misguided.
- The Hill
The Republican Version
First there was H.R, 3717, introduced by Rep Tim Murphy (R-PA 18) in December 2013.
from
The Wall Street Journal blog:
The “Helping Families in Mental Health Crisis Act of 2013” is the result of a nearly year-long examination of the nation’s mental health care system by the Pennsylvania psychologist and the [House Energy and Commerce ] subcommittee in the aftermath of last year’s school shooting in Connecticut.
Key Points
- Alter HIPAA and FERPA, allowing physicians to inform families of an "acute mental health crisis"
- Alters the Institutions for Mental Disease exclusion to reimburse for facilities larger than 16 beds
- Promotes things like Assisted Outpatient Treatment and other "alternatives" to hospitalization
- Reform the Substance Abuse & Mental Health Service Administration (SAMHSA)
- Create Assistant Secretary for Mental Health and Substance Use Disorders within the Department of Health and Human Services
Here's the thing that gets most people upset with this bill, Assisted Outpatient Treatment is also called outpatient commitment by critics. They claim that these provisions allow judges to force treatment on those with repeated histories of hospitalization or with violent offenses.
The Democratic Version
Then Rep Ron Barber (D-AZ 2) introduced "The Strengthening Mental Health in Our Communities Act of 2014" in May 2014.
from
azcentral.com:
Rep. Ron Barber, D-Ariz., the sponsor of the Democratic bill, understands this [issue of mental illness and violence] on a visceral level.
Barber and his former boss, Gabrielle Giffords, were among the 13 wounded when [Jared] Loughner killed six people in Tucson in 2011.
Key Points
- Increase mental health funding for active and retired military
- Create "mental health first aid" programs in schools and communities
- Create a White House Office for Mental Health Policy (think Drug Czar)
- Eliminate the 190-day lifetime cap on inpatient psychiatric care under Medicaid
Beyond Partisan Lines
As I quoted earlier in the diary, the competing bills reflect competing visions of mental healthcare in the US.
From The New York Times, in reference to Murphy's bill:
“It’s the most comprehensive mental health bill we’ve seen in a long, long time, and that in itself is an accomplishment,” said Keris Myrick, chief executive of the Project Return Peer Support Network and president of the board of the National Alliance on Mental Illness, which supports some parts of the bill. “I think almost everyone sees things in the bill that are long overdue, but also things they’re very concerned about.”
Among those opposing the bill because of its involuntary treatment provisions is the Bazelon Center for Mental Health Law, whose president, Robert Bernstein, said, “Many serious organizations seem to have an ‘any port in the storm’ mentality, supporting this bill even though it includes dangerous provisions.”
from
USA Today, also in reference to Murphy's bill:
"Mental health advocates disagree about the balance between respecting patient privacy and helping people who don't realize they're sick; whether scarce financial resources are better spent providing community care or hospital beds; and whether to promote general mental health or concentrate resources on those with the most severe mental illnesses, such as schizophrenia, says D.J. Jaffe, executive director of MentalIllnessPolicy.org. And some people with mental illness reject all treatment, viewing psychiatry as the problem, rather than the solution."
What It Boils Down To
The issue boils down to one of treatment, even if forced, versus one of civil rights. I believe that Murphy believes that his bill is the right approach to solving some important problems facing society. I also believe that the bill's opponents believe that the civil rights issues are of paramount importance.
I am in the defense of civil rights camp myself. However, I also agree with Jaffe on this point. Severe mental illness, not the one in five but the one in twenty, is difficult to recognize in yourself. Take my word for this, please. Many people, with and without mental illness, view the medical mental health profession as the problem, or at least part of it.
And that's where the problem lies. Maybe, just maybe, the answer is not either/or but some of both/and. That "and" being to increase funding for mental health care treatment, awareness and research. If we can find the money to hospitalize and jail the mentally ill then maybe we can use some of that for research and treatment. Maybe we can find some more on top of that. Of course, I'm a "tax and spend" liberal, so there's that.