With Congress returning from its long summer recess this week, Senate Majority Leader Mitch McConnell could help improve the low standing of the entire institution by allowing a vote on the mental health reform bill that passed the House this summer by a 422-2 margin.
Even though this is an election year and other major issues—including the budget—are on the table, helping people with severe mental health problems is an issue that unites both political parties, the American public, mental health advocacy groups and the nation's criminal justice and healthcare systems.
There is consensus that the deinstitutionalization movement that began in the 1960s has failed. Jails, hospital emergency rooms and the nation's street corners have become the primary settings where too many people with severe mental illness such as schizophrenia or bipolar disorder wind up.
A 2-year-old Government Accountability Office report documented the lack of federal coordination for the more than 100 federal programs designed to help the estimated 10 million people in the U.S. with severe mental illness.
HR 2646, the Helping Families in Mental Health Crisis Act, would create an assistant secretary at HHS to take over the duties of the Substance Abuse and Mental Health Services Administration, which has failed to address the building crisis.
The legislation creates a mandatory assisted outpatient treatment program. It empowers providers to take patients before judges in special courts, who can order them to stay on their treatment plans or face hospitalization. Having a judge tell someone with severe mental disease they must stay on their meds significantly increases compliance.
The bill also includes a nod to increasing the number of available beds by codifying the CMS rule issued this year that will allow state Medicaid programs to pay for up to 15 days a month at mental health facilities. This can be crucial for many people after being treated in a hospital emergency department. A short stay allows time for clinicians to determine if patients have received the right dose of the right medication and can remain on the treatment plan.
In a controversial move, the bill asks HHS to clarify patient privacy rules under HIPAA to explicitly allow caregivers to share patient records with family members. Advocates have long charged that “HIPAA handcuffs” prevent families from even knowing about a love one's diagnosis, medications and living situation.
The legislation is barely a start on what's needed to confront long-term neglect of mental health. No one has articulated a strategy for removing the estimated 350,000 mentally ill people incarcerated in the nation's jails and prisons. A survey of 230 sheriff's departments in 39 states by the Treatment Advocacy Group and Public Citizen found 21% of their jails had 16% or more of their inmate populations with severe mental illness.
And no one is talking about how to fund a sharp increase in the number of long-term psychiatric beds in hospitals and other institutions. They clearly are needed. The average number of psychiatric beds across the advanced industrial member nations of the Organisation for Economic Co-operation and Development is 68 per every 100,000 population. In the U.S., it's 11 beds per 100,000 people.
Last week, Democratic presidential nominee Hillary Clinton called for a major assault on the mental health crisis in the U.S., including a call for $5 billion in additional funding for community health treatment centers. But her plan was limited and noticeably weak on details.
There's a shortage of facilities. There's a shortage of qualified psychiatrists and clinical psychologists. There are issues such as increased stress, opioid abuse and mass violence incidents competing for attention and scarce resources.
By passing and sending the president HR 2646, even in the midst of this weird election year, the Senate can show that our elected leaders are capable of tackling one of the nation's most pressing public health problems.
