While it's hard to predict whether any legislation will make it through the current Congress, Ingoglia agrees that it has a better chance this year than in previous years. “I have been truly amazed at the bipartisan and bicameral interest in this,” he said.
Key provisions sought by mental health advocates—including early mental health screenings, the HIPAA changes, congressional oversight of mental health parity and efforts to expand the workforce—are likely to be part of the final legislation, Ingoglia said.
One disagreement that caused trouble last year was over court-ordered treatment—known as assisted outpatient treatment, or AOT—for people who are severely mentally ill and meet certain legal criteria. The bills this session incentivize AOT but don't require it.
The bills are closer on other issues as well, including the enhanced profile of mental health in HHS and support for innovation and evidence-based practices, Gionfriddo said. “This year there's enough similarity that the lines have been drawn much more narrowly.”
Although the presidential campaign is likely to mean little gets done in Congress, it might not stop action on mental health. This may be one of the first campaign cycles where candidates are likely to get asked about the issue. In New Hampshire, a recent poll found drug abuse ranked as the second most important problem facing the state. Citizens have asked candidates how they would combat the problem and shared personal stories of struggling in the current system.
The most likely problem is a budget impasse. Legislation that includes new spending usually must also include spending cuts.
Gionfriddo suggests Congress could take the funds from corrections departments, which are providing custodial care to people who need proper treatment. “There's one place it needs to come from where it never should have gone in the first place, and that's jails and prisons,” he said.
The notion of offering people with mental health and substance abuse problems treatment and sentencing alternatives to incarceration has also been attracting strong bipartisan support.
In late July, Sen. Dick Durbin (D-Ill.), Senate Health Committee Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) introduced a bill that supports suicide prevention efforts and promotes integration of behavioral health and primary-care services.
The SAFE Justice Act, also introduced this session, calls for making medication and therapy treatments more available to those who could benefit from it. Other bills push for mental health courts and law enforcement training.
Chris Harris, spokesman for Sen. Chris Murphy, said it's too early to speculate on details about what could pass, even though Murphy's bill has strong bipartisan support. “I think this is mainly an issue of priority, not ideology,” he said.
Recent mass shootings and other tragedies have focused lawmakers on mental health reform, even though the vast majority of people with severe mental illness are not violent.
Sen. John Cornyn (R-Texas) has introduced a National Rifle Association-backed bill that would encourage states to send more information about mentally ill residents to the federal system that performs background checks before gun purchases.
