Legislation aims to improve treatment of serious mental illness

WASHINGTON – A new bill sponsored by Rep. Tim Murphy (R-Pa.) aims to improve the treatment of serious mental illness by providing access and assistance to families and caregivers, improving mental health and substance abuse treatment parity, and encouraging evidence-based mental health care.

H.R. 2646, the Helping Families in Mental Health Crisis Act of 2015, also would increase the number of psychiatric hospital beds for those in acute crisis, allocate funds to mental and behavioral health workforce development, and reform oversight of mental health care delivery.

The bill was originally introduced in the last Congress, after the mass shooting in Newtown, Conn. It is based on the findings of a report commissioned by the House Energy & Commerce Committee’s Subcommittee on Oversight & Investigations, which cited high levels of untreated serious mental illness nationwide.

During a June 16 hearing on the bill, Virginia state senator Creigh Deeds, a Democrat, testified about his son’s serious mental illness. Sen. Deeds said that it wasn’t until after his son had stabbed him multiple times, then killed himself, that the senator learned the details of his son’s treatment for bipolar disorder. Those details might have allowed him to successfully intervene and save his son, Sen. Deeds said. The information he did get often came anonymously, he added, due to providers’ fears of violating HIPAA (Health Insurance Portability and Accountability Act).

“HIPAA prevented me from accessing the information I needed to keep him safe and help him towards recovery. Even though I was the one who cared for him, fed him, housed him, transported him, insured him, I was not privy to any information that could clarify for me his behaviors, his treatment plan, and symptoms to be vigilant about,” Sen. Deeds testified. “I was in the dark as I tried to advocate for him in the best way I could with the best information I had.”

H.R. 2646 would amend HIPAA and FERPA (Family Educational Rights and Privacy Act) to allow family members and other caregivers access to diagnoses, treatment plans, and prescribed medications without patient consent. Release of psychotherapy notes would remain prohibited, however.

Meanwhile, patient privacy legislation (H.R. 2690) introduced by Rep. Doris Matsui (D-Calif.) and considered during the same hearing would clarify and strengthen existing language in HIPAA law by amending but not rewriting it. H.R. 2690 would de-escalate the fears of medical personnel surrounding HIPAA, which Rep. Matsui said was appropriately written but not always applied as intended.

Dr. Jeffrey Lieberman*, chair of the psychiatry department at Columbia University, New York, testified that “simply educating doctors” would not be enough to impact how HIPAA-protected information was shared with concerned families because of “the fear of God placed in doctors by personal injury lawyers who often challenge doctors” even when doctors are doing “the common-sense thing to do.”

H.R. 2646 also calls for medical records and mental health records to be integrated. “If a primary care physician doesn’t know that a patient is recovering from an opiate addiction, that provider might misprescribe the patient an opiate and start that patient into a relapse,” Rep. Murphy said in an interview. “Instead of making the files separate but equal, you make them the same. You can’t treat the brain without treating the body.”

The bill also would change the way Medicaid pays for acute care psychiatric services. Currently, under the institutions of mental disease exclusion, federal Medicaid funds can be used for no more than 16 beds in an inpatient psychiatric facility. According to Dr. Lorenzo Norris, director of inpatient psychiatric services at George Washington University Hospital, Washington, D.C., the result is that state-funded facilities often turn away patients experiencing acute mental health crises. H.R. 2646 would lift the 16-bed limit for inpatient stays of 30 days or less.

Such a change would be “huge. It would definitely increase access to services,” Dr. Norris said in an interview. The bill also calls for the elimination of the 190-day lifetime cap on inpatient psychiatric care covered by Medicare.

The overall aim of the bill, according to Rep. Murphy, is to reinforce existing mental health parity laws and to create more integrated evidence-based interventions for mental disorders, especially serious mental illnesses such as schizophrenia or bipolar disorder. The bill would implement primary care– and community health center–based schizophrenia screening and treatment protocols derived from two projects sponsored by the National Institute of Mental Health: the North American Prodrome Longitudinal Study (NAPLS) and the Recovery After Initial Schizophrenia Episode (RAISE) project.

The bill would increase and consolidate federal oversight of mental health care by doing away with the current top job at the Substance Abuse and Mental Health Services Administration and creating an assistant secretary appointed by the Senate to oversee mental health and substance abuse treatment within the Health and Human Services department. Further, the bill stipulates that the position must be held by a psychiatrist or psychologist. The assistant secretary would administer the current SAMHSA. “I don’t want to eliminate SAMHSA, I want to elevate it,” Rep. Murphy said in an interview.

Several key provisions of the bill have been modified since it was introduced in the last Congress. Previously, Rep. Murphy called for eliminating funds for patients-rights groups, saying they were aligned with the “antipsychiatry movement” that would go as far as advocating people with severe mental illness not take their prescribed medications. Instead, H.R. 2646 would restrict funds to groups that investigate patient abuse and neglect only, which Rep. Murphy said would prevent antipsychiatry activists and others from giving dangerous counsel to those who lack insight into their condition.

The new bill has bipartisan support among subcommittee members. “It’s different than we saw last Congress,” Lauren Alfred, policy director for the Kennedy Forum, said in an interview. “Last time it was more about reacting to crisis, this time it’s more about the future. The focus is on what will happen in primary care offices and across the system if comprehensive mental health care reform goes forward.”

Despite that support, there is some dissent.

Rep. Frank Pallone Jr. (D-N.J.), ranking member of the Energy & Commerce Committee, testified that he favors the language on workforce development and parity enforcement but is opposed to predicating community mental health block grant funding on the existence of state treatment standard and assisted outpatient treatment laws, which Rep. Murphy’s proposed legislation would do.

The bill also raised some alarm with references to antiabortion language. Subcommittee member Rep. Jan Schakowsky (D-Ill.) noted that H.R. 2646 would expand existing restrictions on the use of grant funds to pay for abortions by reauthorizing the Garrett Lee Smith Memorial Act, a suicide prevention law. Rep. Murphy dismissed this claim in an interview, noting that to remove the antiabortion language would mean rewriting the existing suicide prevention law. “It’s existing law from a decade ago and we simply reference that whole bill,” he said. “We haven’t changed anything. There’s nothing partisan or sneaky about it.”

[email protected]

On Twitter @whitneymcknight

*Correction, 6/22/2015: An earlier version of this article misstated Dr. Jeffrey Lieberman's name.

WASHINGTON – A new bill sponsored by Rep. Tim Murphy (R-Pa.) aims to improve the treatment of serious mental illness by providing access and assistance to families and caregivers, improving mental health and substance abuse treatment parity, and encouraging evidence-based mental health care.

H.R. 2646, the Helping Families in Mental Health Crisis Act of 2015, also would increase the number of psychiatric hospital beds for those in acute crisis, allocate funds to mental and behavioral health workforce development, and reform oversight of mental health care delivery.

The bill was originally introduced in the last Congress, after the mass shooting in Newtown, Conn. It is based on the findings of a report commissioned by the House Energy & Commerce Committee’s Subcommittee on Oversight & Investigations, which cited high levels of untreated serious mental illness nationwide.

During a June 16 hearing on the bill, Virginia state senator Creigh Deeds, a Democrat, testified about his son’s serious mental illness. Sen. Deeds said that it wasn’t until after his son had stabbed him multiple times, then killed himself, that the senator learned the details of his son’s treatment for bipolar disorder. Those details might have allowed him to successfully intervene and save his son, Sen. Deeds said. The information he did get often came anonymously, he added, due to providers’ fears of violating HIPAA (Health Insurance Portability and Accountability Act).

“HIPAA prevented me from accessing the information I needed to keep him safe and help him towards recovery. Even though I was the one who cared for him, fed him, housed him, transported him, insured him, I was not privy to any information that could clarify for me his behaviors, his treatment plan, and symptoms to be vigilant about,” Sen. Deeds testified. “I was in the dark as I tried to advocate for him in the best way I could with the best information I had.”

H.R. 2646 would amend HIPAA and FERPA (Family Educational Rights and Privacy Act) to allow family members and other caregivers access to diagnoses, treatment plans, and prescribed medications without patient consent. Release of psychotherapy notes would remain prohibited, however.

Meanwhile, patient privacy legislation (H.R. 2690) introduced by Rep. Doris Matsui (D-Calif.) and considered during the same hearing would clarify and strengthen existing language in HIPAA law by amending but not rewriting it. H.R. 2690 would de-escalate the fears of medical personnel surrounding HIPAA, which Rep. Matsui said was appropriately written but not always applied as intended.

Dr. Jeffrey Lieberman*, chair of the psychiatry department at Columbia University, New York, testified that “simply educating doctors” would not be enough to impact how HIPAA-protected information was shared with concerned families because of “the fear of God placed in doctors by personal injury lawyers who often challenge doctors” even when doctors are doing “the common-sense thing to do.”

H.R. 2646 also calls for medical records and mental health records to be integrated. “If a primary care physician doesn’t know that a patient is recovering from an opiate addiction, that provider might misprescribe the patient an opiate and start that patient into a relapse,” Rep. Murphy said in an interview. “Instead of making the files separate but equal, you make them the same. You can’t treat the brain without treating the body.”

The bill also would change the way Medicaid pays for acute care psychiatric services. Currently, under the institutions of mental disease exclusion, federal Medicaid funds can be used for no more than 16 beds in an inpatient psychiatric facility. According to Dr. Lorenzo Norris, director of inpatient psychiatric services at George Washington University Hospital, Washington, D.C., the result is that state-funded facilities often turn away patients experiencing acute mental health crises. H.R. 2646 would lift the 16-bed limit for inpatient stays of 30 days or less.

Such a change would be “huge. It would definitely increase access to services,” Dr. Norris said in an interview. The bill also calls for the elimination of the 190-day lifetime cap on inpatient psychiatric care covered by Medicare.

The overall aim of the bill, according to Rep. Murphy, is to reinforce existing mental health parity laws and to create more integrated evidence-based interventions for mental disorders, especially serious mental illnesses such as schizophrenia or bipolar disorder. The bill would implement primary care– and community health center–based schizophrenia screening and treatment protocols derived from two projects sponsored by the National Institute of Mental Health: the North American Prodrome Longitudinal Study (NAPLS) and the Recovery After Initial Schizophrenia Episode (RAISE) project.

The bill would increase and consolidate federal oversight of mental health care by doing away with the current top job at the Substance Abuse and Mental Health Services Administration and creating an assistant secretary appointed by the Senate to oversee mental health and substance abuse treatment within the Health and Human Services department. Further, the bill stipulates that the position must be held by a psychiatrist or psychologist. The assistant secretary would administer the current SAMHSA. “I don’t want to eliminate SAMHSA, I want to elevate it,” Rep. Murphy said in an interview.

Several key provisions of the bill have been modified since it was introduced in the last Congress. Previously, Rep. Murphy called for eliminating funds for patients-rights groups, saying they were aligned with the “antipsychiatry movement” that would go as far as advocating people with severe mental illness not take their prescribed medications. Instead, H.R. 2646 would restrict funds to groups that investigate patient abuse and neglect only, which Rep. Murphy said would prevent antipsychiatry activists and others from giving dangerous counsel to those who lack insight into their condition.

The new bill has bipartisan support among subcommittee members. “It’s different than we saw last Congress,” Lauren Alfred, policy director for the Kennedy Forum, said in an interview. “Last time it was more about reacting to crisis, this time it’s more about the future. The focus is on what will happen in primary care offices and across the system if comprehensive mental health care reform goes forward.”

Despite that support, there is some dissent.

Rep. Frank Pallone Jr. (D-N.J.), ranking member of the Energy & Commerce Committee, testified that he favors the language on workforce development and parity enforcement but is opposed to predicating community mental health block grant funding on the existence of state treatment standard and assisted outpatient treatment laws, which Rep. Murphy’s proposed legislation would do.

The bill also raised some alarm with references to antiabortion language. Subcommittee member Rep. Jan Schakowsky (D-Ill.) noted that H.R. 2646 would expand existing restrictions on the use of grant funds to pay for abortions by reauthorizing the Garrett Lee Smith Memorial Act, a suicide prevention law. Rep. Murphy dismissed this claim in an interview, noting that to remove the antiabortion language would mean rewriting the existing suicide prevention law. “It’s existing law from a decade ago and we simply reference that whole bill,” he said. “We haven’t changed anything. There’s nothing partisan or sneaky about it.”

[email protected]

On Twitter @whitneymcknight

*Correction, 6/22/2015: An earlier version of this article misstated Dr. Jeffrey Lieberman's name.

WASHINGTON – A new bill sponsored by Rep. Tim Murphy (R-Pa.) aims to improve the treatment of serious mental illness by providing access and assistance to families and caregivers, improving mental health and substance abuse treatment parity, and encouraging evidence-based mental health care.

H.R. 2646, the Helping Families in Mental Health Crisis Act of 2015, also would increase the number of psychiatric hospital beds for those in acute crisis, allocate funds to mental and behavioral health workforce development, and reform oversight of mental health care delivery.

The bill was originally introduced in the last Congress, after the mass shooting in Newtown, Conn. It is based on the findings of a report commissioned by the House Energy & Commerce Committee’s Subcommittee on Oversight & Investigations, which cited high levels of untreated serious mental illness nationwide.

During a June 16 hearing on the bill, Virginia state senator Creigh Deeds, a Democrat, testified about his son’s serious mental illness. Sen. Deeds said that it wasn’t until after his son had stabbed him multiple times, then killed himself, that the senator learned the details of his son’s treatment for bipolar disorder. Those details might have allowed him to successfully intervene and save his son, Sen. Deeds said. The information he did get often came anonymously, he added, due to providers’ fears of violating HIPAA (Health Insurance Portability and Accountability Act).

“HIPAA prevented me from accessing the information I needed to keep him safe and help him towards recovery. Even though I was the one who cared for him, fed him, housed him, transported him, insured him, I was not privy to any information that could clarify for me his behaviors, his treatment plan, and symptoms to be vigilant about,” Sen. Deeds testified. “I was in the dark as I tried to advocate for him in the best way I could with the best information I had.”

H.R. 2646 would amend HIPAA and FERPA (Family Educational Rights and Privacy Act) to allow family members and other caregivers access to diagnoses, treatment plans, and prescribed medications without patient consent. Release of psychotherapy notes would remain prohibited, however.

Meanwhile, patient privacy legislation (H.R. 2690) introduced by Rep. Doris Matsui (D-Calif.) and considered during the same hearing would clarify and strengthen existing language in HIPAA law by amending but not rewriting it. H.R. 2690 would de-escalate the fears of medical personnel surrounding HIPAA, which Rep. Matsui said was appropriately written but not always applied as intended.

Dr. Jeffrey Lieberman*, chair of the psychiatry department at Columbia University, New York, testified that “simply educating doctors” would not be enough to impact how HIPAA-protected information was shared with concerned families because of “the fear of God placed in doctors by personal injury lawyers who often challenge doctors” even when doctors are doing “the common-sense thing to do.”

H.R. 2646 also calls for medical records and mental health records to be integrated. “If a primary care physician doesn’t know that a patient is recovering from an opiate addiction, that provider might misprescribe the patient an opiate and start that patient into a relapse,” Rep. Murphy said in an interview. “Instead of making the files separate but equal, you make them the same. You can’t treat the brain without treating the body.”

The bill also would change the way Medicaid pays for acute care psychiatric services. Currently, under the institutions of mental disease exclusion, federal Medicaid funds can be used for no more than 16 beds in an inpatient psychiatric facility. According to Dr. Lorenzo Norris, director of inpatient psychiatric services at George Washington University Hospital, Washington, D.C., the result is that state-funded facilities often turn away patients experiencing acute mental health crises. H.R. 2646 would lift the 16-bed limit for inpatient stays of 30 days or less.

Such a change would be “huge. It would definitely increase access to services,” Dr. Norris said in an interview. The bill also calls for the elimination of the 190-day lifetime cap on inpatient psychiatric care covered by Medicare.

The overall aim of the bill, according to Rep. Murphy, is to reinforce existing mental health parity laws and to create more integrated evidence-based interventions for mental disorders, especially serious mental illnesses such as schizophrenia or bipolar disorder. The bill would implement primary care– and community health center–based schizophrenia screening and treatment protocols derived from two projects sponsored by the National Institute of Mental Health: the North American Prodrome Longitudinal Study (NAPLS) and the Recovery After Initial Schizophrenia Episode (RAISE) project.

The bill would increase and consolidate federal oversight of mental health care by doing away with the current top job at the Substance Abuse and Mental Health Services Administration and creating an assistant secretary appointed by the Senate to oversee mental health and substance abuse treatment within the Health and Human Services department. Further, the bill stipulates that the position must be held by a psychiatrist or psychologist. The assistant secretary would administer the current SAMHSA. “I don’t want to eliminate SAMHSA, I want to elevate it,” Rep. Murphy said in an interview.

Several key provisions of the bill have been modified since it was introduced in the last Congress. Previously, Rep. Murphy called for eliminating funds for patients-rights groups, saying they were aligned with the “antipsychiatry movement” that would go as far as advocating people with severe mental illness not take their prescribed medications. Instead, H.R. 2646 would restrict funds to groups that investigate patient abuse and neglect only, which Rep. Murphy said would prevent antipsychiatry activists and others from giving dangerous counsel to those who lack insight into their condition.

The new bill has bipartisan support among subcommittee members. “It’s different than we saw last Congress,” Lauren Alfred, policy director for the Kennedy Forum, said in an interview. “Last time it was more about reacting to crisis, this time it’s more about the future. The focus is on what will happen in primary care offices and across the system if comprehensive mental health care reform goes forward.”

Despite that support, there is some dissent.

Rep. Frank Pallone Jr. (D-N.J.), ranking member of the Energy & Commerce Committee, testified that he favors the language on workforce development and parity enforcement but is opposed to predicating community mental health block grant funding on the existence of state treatment standard and assisted outpatient treatment laws, which Rep. Murphy’s proposed legislation would do.

The bill also raised some alarm with references to antiabortion language. Subcommittee member Rep. Jan Schakowsky (D-Ill.) noted that H.R. 2646 would expand existing restrictions on the use of grant funds to pay for abortions by reauthorizing the Garrett Lee Smith Memorial Act, a suicide prevention law. Rep. Murphy dismissed this claim in an interview, noting that to remove the antiabortion language would mean rewriting the existing suicide prevention law. “It’s existing law from a decade ago and we simply reference that whole bill,” he said. “We haven’t changed anything. There’s nothing partisan or sneaky about it.”

[email protected]

On Twitter @whitneymcknight

*Correction, 6/22/2015: An earlier version of this article misstated Dr. Jeffrey Lieberman's name.