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Helping Families in Mental Health Crisis Act of 2013 (Murphy Bill) Is Based on Wrong Premise
 
Passage of the Murphy Bill (HR 3717) without expansion of Medicaid in the Southern states will put an impossible burden on state funding for involuntary outpatient commitment, intensive case management and hospitalization of all those not currently judged disabled by the Social Security Administration, particularly those with co-occurring addiction and mental illness problems.

Bonnie Jo Schell

This article was written by a mental health advocate in Asheville, NC, who has many years of experience, both as a peer provider in California, and an employee of a Managed Care Organization in North Carolina.  Bonnie Schell is now retired.

There is an alternative to passing Rep Tim Murphy's bill.  Democrat Ron Barber of AZ has also introduced a bill that would make many reforms of the present public mental health care system.  It does not have the most objectionable provisions that Murphy would have us rely on.  Rep. Barber has many years of experience working for persons with disabilities in his home state.

The public behavioral healthcare system serves those with the most need and the most limited resources. In NC the average cost per adult with mental illness is $2,405 for Medicaid and $1,302 in state funding. Substance Abuse costs Medicaid $2,102 compared to $48,211 per person per year for those with Intellectual and Developmental Disabilities. A year in prison without treatment costs the government $95,000. Legislators are right to respond not only to the injustice of warehousing people in jails, but also to the costs of this misguided “treatment.”

The Murphy Bill, however, is based on a wrong premise about those who cannot cope with everyday life events. The Murphy Bill portrays the children and loved ones of family members as psychotic, dependent, without insight, unable to care for themselves, and as non-compliant with treatment as patients with diabetes and heart disease are. If this were true, that no one recovered from mental illness or got better, the Medicaid rolls, adding generation after generation, would explode exponentially. The American Psychiatric Association estimates that 50% of Americans will be eligible for a Diagnostic Statistical Manual V label. The Washington based Treatment Advocacy Center estimates that already 40% of those with severe bipolar disorder go untreated and 51% of those with schizophrenia go untreated.
 

The word "Recovery" is not a part of the Murphy Bill. Even before the second generation anti-psychotic medications were developed, a rule of thumb was that, 25% would need services no longer, 25% would get better, 25% would keep their present symptoms, and 25% would deteriorate. Getting better was attributed to communities that supported people who were different with housing and jobs, usually in small towns. Getting better in the last 15 years has been due to Drop In, Peer and Wellness Centers, Wellness Recovery Action Plans, Care Coordination, training in personal and systems advocacy, development of trust in a nonviolent system of care, hope for the future, and psychiatrists, nurse practitioners and case managers who believe in personal recovery.

The Murphy Bill assumes that the best that can be hoped for by those with emotional and behavioral disorders is maintenance and shaky stability, not long periods of remission which is the experience of many. The thought behind the Murphy Bill, following E. Fuller Torrey and D. J. Jaffe is that those who claim recovery were never sick. They believe that mental illness is a brain disease one is born with and not that it is triggered in part by genetics in families, but also by poverty, domestic violence, emotional and physical trauma and abuse. In NC 11 out of every 100 children have a severe emotional disturbance in a given year yet 70 counties do not have a child psychiatrist. 5.4% of NC adults have a severe and persistent mental illness and 7.8% are dependent on alcohol or drugs. Supporters of the Murphy Bill make the presumption that those who say they are in Recovery were never sick.

The Murphy Bill proposes Assisted Outpatient Treatment as a contingency for states to receive federal block grant funds. Outpatient commitment has already been adopted by 44 states, but in many such as NC, seldom used, due to costs and workforce issues. The drain on the mental health system to force treatment on 8-13% of those with the most serious mental illness symptoms will leave up to 87% without adequate community services due to funding allocation.  Under NC Reform only 27% of those with serious symptoms after initial interview were able to have two visits in the next 30 days. Due to a shortage of providers NC is piloting telemedicine in 28 counties without a psychiatrist.

Murphy disparages peer run services provided by trained peer support specialists who have lived experience with mental illness. Not only are these specialists  a cheaper labor pool in a field with dwindling workers, but they alone can share how they remember to take their medication, what it is like to return to college or work, how to get along with landlords, how to manage basic needs on $600-700 a month. Peer support specialists, supervised by credentialed mental health professionals, want to give back to others in appreciation for services they have themselves received. NC has over 900 Credential Peer Support Specialists. Many have college degrees but interrupted lives. Murphy carefully uses the word “scientific” proof for medicalized services instead of “Evidenced-Based” practices which have shown peer provided services to be effective-- as they are with cancer and diabetes patients in a coaching and support role. The VA’s use of peer support over past two years found significant improvements in the perceived ability to actively manage their own healthcare.

The outcomes of treatment envisioned by the Murphy Bill are narrow: staying out of jail and the hospital. The Recovery movement  in the US, Netherlands, Australia,  and Europe envisions an improved quality of life, hope, well- being, keeping housing, having a job or volunteer work, recovering old and developing new skills,  and contributing to society.  Recovery according to William Anthony of Boston University School of Rehabilitation is having a “satisfying, hopeful, and contributing life even with the limitations caused by the illness.”

The premises behind the Murphy Bill’s proposals are false, and its adoption without Medicaid Expansion would bankrupt the states and disrupt people’
s lives.

Bonnie Jo Schell
Asheville, NC
August 25, 2014

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Comment Preferences

  •  Very, very interesting. (3+ / 0-)
    Recommended by:
    worldlotus, Lily O Lady, AnnieJo

    Thank you for this diary. I learned a lot.

    "When it's over, I want to say: all my life I was a bride married to amazement." Mary Oliver

    by weezilgirl on Tue Aug 26, 2014 at 07:43:46 PM PDT

  •  Warehousing using outpatient Pharmaceuticals (1+ / 0-)
    Recommended by:
    StargazerNC

    It could be worse if you lived in Idaho. There they spend the least per patient of any state in the country.

    "The Democrats and the Republicans are equally corrupt where money is concerned. It's only in the amount where the Republicans excel." ~ Will Rogers

    by Lefty Coaster on Tue Aug 26, 2014 at 07:51:08 PM PDT

  •  My mother was first committed and "treated" (2+ / 0-)
    Recommended by:
    Lily O Lady, bernardpliers

    in 1951, and she experienced the history of modern psychiatry in the decades since. She grew and adapted to her circumstances constantly, and passed away most lucid and stoic. She also had physical challenges that were brutally punishing. She remained creative and forward looking throughout her life.

    She had many happy years and raised 3 kids and had many grandkids and greatgrandkids. She was everyone's favorite person. She was a "peer" without peer.

    You can't make this stuff up.

    by David54 on Tue Aug 26, 2014 at 08:27:00 PM PDT

    •  What a wonderful tribute to your mom (3+ / 0-)
      Recommended by:
      Lily O Lady, a gilas girl, David54

      Thanks for sharing, David

      One point that needs to be emphasized is the folks who are on meds for mental illness die on average at least 20 years earlier than their non-medicated cohorts.

      •  I believe (2+ / 0-)
        Recommended by:
        David54, AnnieJo

        that the co-occurrence of mental health conditions and chronic diseases are also much higher, which might also account for this.

        Thanks for posting a first diary and joining our conversation here at daily kos today.

        Personally, I'm always interested in hearing what is happening in NC

        Welcome to Daily Kos. If you have any questions about how to participate here, you can learn more at the Community Guidelines, the Knowledge Base, and the Site Resource Diaries. Diaries labeled "Open Thread" are also great places to ask. We look forward to your contributions.
        ~~ from the DK Partners & Mentors Team.

        Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

        by a gilas girl on Wed Aug 27, 2014 at 03:51:22 AM PDT

        [ Parent ]

        •  and neglect. (1+ / 0-)
          Recommended by:
          a gilas girl

          Back in the 50's it was common for (men, esp. ) to divorce their spouses if they were declared mentally ill and committed to the institution against their will.
          My mother begged my Dad to divorce her, out of fear and guilt. We actually got as far as the parking lot of the Edna Gladney Home one dark night, but my Dad wouldn't do it.
          Thanks to the support of our family, Mom pretty much triumphed over her illness and died at 82. Her story is unusual, though.
          Mental illness can be dealt with and overcome, and people can regain their sense of worth. That should be the standard.

          You can't make this stuff up.

          by David54 on Wed Aug 27, 2014 at 07:22:48 AM PDT

          [ Parent ]

        •  Thanks, DK Partners & Mentors (0+ / 0-)

          Actually I posted to Daily Kos before, but I could not log on with my previous profile, so I created a new one.  I am glad you are interested in NC.  

          I usually write on political and government issues.  There is plenty of fodder for future posts on the status of politics here in NC.

        •  Yes and the meds often cause the other conditions. (0+ / 0-)

          i just wrote a letter to the Editor of the Raleigh N&O about this, after they ran a story about the "diabetes epidemic" and how it impacts costs for Medicaid.  There is plenty of info in the research about how meds like Zyprexa and Abilify can contribute to risks for diabetes.

  •  Good article - I think it should be two! (2+ / 0-)
    Recommended by:
    StargazerNC, AnnieJo

    I teach social work in Georgia, and am interested in mental health, and almost didn't click on this article - the title made me think it was really about disproving mental health recovery is possible.

    And since I didn't know about the Tim Murphy bill, it was a little hard to get into the diary.  But I think the wisdom it shares if very valuable -- more of us should think on these things.

    Thanks for posting.

    •  I don't follow your response, can we (0+ / 0-)

      discuss?  Many of my friends are in your field, most at the Jordan School of Social Work at UNC)CH.

      Are you suggesting two articles, one on Recovery, and a second on HR 3717?

      If you will suggest a better title, I can change that easily.  It does make a difference in who reads the column.

      Thanks.  Martha

  •  DJ Jaffe Here (0+ / 0-)

    I always love reading what people say I think. I learn more about me every day. Here's my version of what I think. I don' think we should ignore the seriously ill.  . http://mentalillnesspolicy.org/...

    •  The alternative bill which is not just for famiies (0+ / 0-)

      Strengthening Mental Health in Our Communities Act of 2014
      Sponsored by Congressman Ron Barber (AZ)

      Original Cosponsors: Rep. Diana DeGette (CO), Rep. Doris Matsui (CA), Rep. Grace Napolitano(CA), and Rep. Paul Tonko (NY)

      http://barber.house.gov/...

      Organizational Support:
      American Foundation for Suicide Prevention, Mental Health America, National Association for Rural Mental Health, National Association of County Behavioral Health and Developmental Disability Directors, American Association for Marriage and Family Therapy, American Mental Health Counselors Association, American Association on Health and Disability, National Board for Certified Counselors, Inc. and Affiliates, National Association of School Psychologists, National Coalition for Mental Health Recovery,

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