COMMENTARY

Second Chance for Mental Health Crisis Act

Jeffrey A. Lieberman, MD

Disclosures

February 25, 2015

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Hello. This is Dr Jeffrey Lieberman of Columbia University, speaking to you today for Medscape.

We are getting a second chance. The people of the United States, the mental health care community, Congress, and the government are getting a second chance to do the right thing by bringing a very important piece of mental health care legislation across the finish line.

It is not often that we in the citizenry and in the healthcare community get to applaud, support, and regale in successful healthcare legislation. Apart from the milestones of medicine in American history, more recent milestones include Medicare, Medicaid, the Mental Health Parity and Addiction Equity Act, and now the Affordable Care Act. These have been landmark pieces of legislation that have transformed the landscape of healthcare in this country. In some cases, these efforts have sought to address the inequities regarding healthcare for people with mental illness.

Last year we had a chance to support another landmark piece of legislation. This was the Helping Families in Mental Health Crisis Act of 2013,[1] which was initiated and sponsored by Congressman Tim Murphy from Pennsylvania. Congressman Murphy has emerged as a bright new light and great champion for people with mental illness and for mental health care. He has taken this on as his signature issue and shown the energy and foresight to structure a bill that could have a powerful impact on improving mental health care services.

Unfortunately, this effort was bogged down in partisan politics and ultimately did not move forward. I am sure there were reasons for this, in terms of insurmountable obstacles or mistakes that were made. But it was disappointing that this important legislation never came to fruition. However, what a difference a year makes. Congressman Murphy is back with a retooled bill that is essentially substantively the same, but hopefully with most sticking points smoothed over and an improved political strategy.

This bill will be introduced early in 2015. It is my great hope, and I believe the great hope of most people in the mental health community, that this bill will move forward and be signed into law.

What Is This Piece of Legislation?

This legislation addresses a wide range of areas, including:

Providing care to underserved populations such as rural populations;

Providing ways to prevent individuals with mental illness from needing institutionalization, or if they have committed a criminal act, from being prosecuted as criminals, instead of being treated as people with mental illness;

Promoting the integration of primary care and mental health care in the collaborative care model;

Addressing the shortage of inpatient psychiatric beds in the United States;

Supporting the integration of evidence-based methods of treatment rather than treatments that are favored or preferred by individual providers;

Requiring that services provided in mental health care facilities, that are reimbursed by funding from the government through Medicaid and Medicare or any other sources, have been proven effective through rigorous research.

These policies would be implemented through several mechanisms. A new position of assistant secretary for mental health will be created within the Department of Health and Human Services, reporting directly to the secretary for mental health. The assistant secretary would focus on mobilizing services and research in areas that seem to be the most productive and valuable for the government to endorse and support. The bill also provides additional funding for research through the National Institutes of Health on disorders of the brain that affect mental function and behavior and will facilitate the rollout of research that is ready for prime time, such as the RAISE (Recovery After an Initial Schizophrenia Episode) program. RAISE is geared toward providing specialized first-episode treatment programs with team-based, multielement care for people at the beginning of illness, rather than waiting until the patient reaches the chronic stages of the illness.

Other Long Overdue Reforms

In addition, the bill requires long overdue, badly needed reforms of the Substance Abuse and Mental Health Services Administration (SAMHSA), which is the only federal agency with responsibility for funding that supports direct mental health care. SAMHSA has been a controversial agency in the past. It has not always served what many people, including many psychiatrists, believe to be the interest of the severely mentally ill, or used the most advanced scientific and evidence-based methods. This legislation includes language that places greater requirements on SAMHSA to do so.

This is an opportunity to advance an important piece of legislation that I believe all psychiatrists and others in the mental health care community would see as a great improvement on the existing system of care. We should not let politics impede its progress and ultimate passage. I encourage everyone to read about this, speak out in support of it, and take note of the great work, the courage, and the vision of Congressman Tim Murphy, who has been a much needed champion in this important cause.

Thank you for your attention. This is Dr Jeffrey Lieberman from Columbia University, speaking to you today for Medscape.

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