More than three years after the tragic shooting at Sandy Hook Elementary School sparked a national conversation on issues related to mental illness and the prevention of violence to self and others, Congress is currently closer than any point in recent history to act on bipartisan, bicameral comprehensive mental health reform legislation that many say would rank along with the Community Mental Health Services Act of 1963 and the Mental Health Parity and Addiction Equity Act of 2008 in terms of historical significance.
After Sandy Hook, leaders of the House of Representatives tasked Representative Tim Murphy, PhD (R-PA) with investigating and providing recommendations on federal mental health policies and priorities. What followed was a bevy of oversight hearings led by Murphy, reports, and stakeholder meetings that resulted in his introduction of the Helping Families in Mental Health Crisis Act of 2013 along with his lead Democrat partner Eddie Bernice Johnson, RN (D-TX). It should be said that both Murphy and Johnson are mental health clinicians (a clinical psychologist and psychiatric nurse practitioner, respectively) with significant real-world experience in these issues outside of their responsibilities as sitting members of Congress.
Though his legislation was held up in Congress in 2013 and 2014, the reintroduced version of the Helping Families in Mental Health Crisis Act (H.R. 2646) has received heightened interest and, as a critical step, passed out of the House Energy and Commerce Subcommittee on Health in November. Companion legislation has now also been introduced in the United States Senate by Bill Cassidy, M.D. (R-LA) and Christopher Murphy (D-CT). The Mental Health Reform Act of 2015 (S.1945) has a number of bipartisan cosponsors in the Senate, and its provisions substantially overlap Murphy’s efforts in the House.
These bills would institute a number of critical reforms to the nation’s fragmented mental health system.
Both bills would establish a new single coordinator for federal mental health resources and research. The duties and priorities of the proposed Assistant Secretary for Mental Health and Substance Use Disorders would emphasize the promotion of science-driven and evidence-based approaches to care. The Assistant Secretary would also evaluate mental health delivery models and disseminate evidence-based strategies to federal grantees and work to modernize and raise the profile of the Substance Abuse and Mental Health Services Administration.
Both bills would address pervasive workforce shortages among psychiatrists and other mental health clinicians. Representative Murphy has undertaken considerable effort to add workforce provisions to his legislation, and Senators Cassidy and Murphy have followed suit. The bills would require the development, implementation, and continuous review of a Nationwide Mental Health Workforce Strategy, among other provisions.
Both bills step up enforcement of the landmark bipartisan Mental Health Parity and Addiction Equity Act (MHPAEA). MHPAEA, and subsequent expansion of parity in the Affordable Care Act, barred most health plans from discriminatory coverage or treatment limitations for individuals suffering from mental illness, including substance use disorders. While the passage of the Parity Act was monumental, much work remains to enforce the parity law so as to realize its vision. These measures would strengthen parity through better coordinating enforcement activities, requiring relevant federal agencies to make important disclosures on compliance investigations, and strengthening oversight on insurers.
Both bills propose to boost financial support for important mental health research within the National Institutes of Health (NIH) related to brain disorders, innovative treatments and technologies, and the determinants of self and other-directed violence. As we know, federal funding supports the vast majority of research conducted by our nation’s medical schools and universities. Unfortunately, appropriations for the National Institute of Mental Health over the last five years have not kept pace with biomedical inflation.
Both bills would support funding for innovative models of care, like the landmark Recovery After Initial Schizophrenia Episode (RAISE) program, which helps individuals with schizophrenia lead productive, independent lives with aiming to reduce financial impacts on public systems. Overall, the bills are substantially focused towards improving care for individuals with severe and persistent mental illness.
The efforts of these mental health champions have enjoyed wide support from the advocacy community. For example, leaders of the House Energy and Commerce recently received a letter urging advancement of comprehensive mental health efforts from groups including American Psychiatric Association, American Psychological Association, the National Alliance on Mental Illness, Mental Health America, the American College of Emergency Physicians, and the National Council for Behavioral Health, among many other signatories.
Comprehensive mental health reform efforts in Congress have also received significant media coverage and editorial endorsements from outlets as diverse as the Wall Street Journal and the National Review to the Washington Post and San Francisco Chronicle. As someone who monitors Capitol Hill health policy coverage daily, I can say with confidence that the attention and coverage of this moment in mental health advocacy history is truly unique when judged by the quantity of blogs, email alerts, and inquiries from the likes of Politico, Congressional Quarterly, and other newspapers that cover the Hill.
Moreover, these bills have widespread bipartisan support among their sponsors’ colleagues. H.R. 2646 has 166 bipartisan cosponsors, and S. 1945 has cosponsors that range from hardline conservatives like Senator David Vitter (R-LA) to liberal stalwart Elizabeth Warren (D-MA). Notably, Paul Ryan, the freshly minted Speaker of the House of Representatives recently remarked that “we need to look at fixing our nation’s mental illness health system – an example, Tim Murphy, Congressman from Pennsylvania, has a bill that is working its way through Committee – I’m sure both parties have lots of ideas in this area, but we should make this a priority.”
This is not to gloss over the fact that clear challenges remain before the President’s signing ceremony for comprehensive mental health reform legislation. Further committee action and floor consideration are required for both H.R. 2646 and S. 1945 in their respective chambers. Though the bills are remarkably similar, any policy differences will need to be ironed out in a bipartisan and bicameral conference. Congress must also not let firearms politics sink the opportunity to substantially improve the nation’s mental health system. Moreover, federal budget and deficit worries frequently necessitate the identification of “payfors” (corresponding cuts or raises in revenue) that would offset any proposed increases in mental health spending. Lastly, the nation and its political infrastructure are moving into the 2016 Presidential election season and all of the associated baggage that entails.
My sincere hope is that this clear momentum for enactment of comprehensive mental health reform translates into action by Congress.