RUTHFULLY YOURS

Earlier this month, mentally ill Kyle Odom shot pastor Tim Remington in Idaho because he “knew” the pastor was a Martian. In his untreated delusional state, Kyle then flew to the White House and started throwing his possessions over the fence to get the president’s attention so he could inform him about all the other Martians in government, including Senators Mitch McConnell, Elizabeth Warren, Dick Durbin, Roger Wicker, and Patty Murray.

Congress should learn from episodes like that. Yet at the same time Kyle went on his mission, Senators Lamar Alexander (R., Tenn.) and Patty Murray (D., Wash.) went on theirs. They revealed a discussion draft of their Mental Health Reform [sic] Act of 2016, which is perhaps the worst mental-health bill ever conceived. It is a rudderless hodgepodge of studies, reports, commissions, and added bureaucracy that would do nothing to help people like Kyle.

John Snook, of the Treatment Advocacy Center, an organization focused on improving care for the seriously mentally ill, told Modern Healthcare, “If this were to pass as is, it would be of no benefit to [people with] severe mental illness.” Mental-illness-policy advocate, blogger, and former Washington Post reporter Pete Earley wrote, “The Senate has now set a low standard.”

Alexander and Murray should know better. There are plenty of bills floating around that include useful provisions they chose to ignore. Senator John Cornyn (R., Texas) introduced the Mental Health and Safe Community Act of 2015 (S2002) specifically to reduce violence by the most seriously mentally ill. It encourages states to use assisted outpatient treatment (AOT). Assisted outpatient treatment is only for a tiny group of the most seriously ill who have already accumulated multiple episodes of violence, arrest, homelessness, incarceration, or hospitalization because they refused to stay in treatment. It allows judges to order them into six months of mandated and monitored treatment while they continue to live in the community. It is less expensive to taxpayers and less restrictive and more humane to patients than the alternatives, incarceration and inpatient commitment. It is the only program with independent research showing it reduces homelessness, arrest, incarceration and violence in the 70 percent range.

Senators Alexander and Murray also ignored provisions in the Mental Health Reform Act of 2015 (S. 1945), proposed by Senators Chris Murphy (D., Conn.) and Bill Cassidy (R., Louisiana). That bill would slightly ameliorate the federal proscription on using Medicaid mental-health funds for those who are so seriously mentally ill they need hospitalization. New York City Police commissioner William Bratton recently described the lack of hospital beds as the top difficulty for officers who are called to assist the seriously mentally ill.

More importantly, Alexander and Murray ignored all the extraordinary work of Representative Tim Murphy (R., Pa.) and Eddie Bernice Johnson (D., Texas) in the House. They introduced the bipartisan Helping Families in Mental Health Crisis Act (H.R. 2646), which would eliminate wasteful, counterproductive federally funded mental “wellness” programs and reallocate the savings to programs that are proven to help the most seriously mentally ill. H.R. 2646 would start by defanging the Substance Abuse and Mental Health Services Administration (SAMHSA), perhaps the most useless bureaucracy in Washington. Its own employees rated it one of the worst federal agencies. SAMHSA funds anti-psychiatrists who lobby Congress, encourages states to use federal mental-illness funds on people who don’t have mental illness, certifies as “evidence-based” programs that don’t help the mentally ill, and wastes money. There is no support for it other than from those who receive funds from it. Alexander and Murray would add more bureaucracy rather than taking a scalpel to it.

Alexander and Murray ignored fixing the provisions in HIPAA (the Health Insurance Portability and Accountability Act, 1996) that prevent families that provide housing and case-management services to mentally ill loved ones from receiving the same information that paid providers receive. Families that are prohibited from communicating with doctors cannot ensure that prescriptions are filled or transportation to appointments arranged or take other actions to prevent tragedy. Instead of fixing the problems within HIPAA, Alexander and Murray would layer on new regulations and money, to educate service providers as to what HIPAA is supposed to really mean.

The Helping Families in Mental Health Crisis Act is the best bill in Congress if the goal is to use taxpayer funds efficiently, help people like Kyle, and keep patients, the public, and police safer. Representative Murphy, a psychologist, held extensive hearings, researched the issues, and proposed a bill that keeps its eye on the prize: delivering treatment to adults known to have serious mental illness, rather than all the side shows. The bill has massive support, except from those who want to keep their SAMHSA funding in place and those who defend the right of the psychotic to stay psychotic.

To fix the mental-illness mess, on March 16, when Alexander and Murray will introduce their bill, they should introduce a manager’s amendment to substitute the language in the Helping Families in Mental Health Crisis Act, or in S. 1945 and S. 2002, for their own language. And the House should move too. The Helping Families in Mental Health Crisis Act has the support of 135 Republicans and 50 Democrats. But eleven recalcitrant Democrats are holding up passage, and, to accommodate them, Representatives Fred Upton (R., Mich.) and Joe Pitts (R., Penn.) are so far refusing to let the bill come to a vote in the Energy and Commerce Committee. They should bring it to an up-or-down vote immediately.

While Congress dithers, persons with serious mental illness are going untreated, needlessly suffering, stabbing innocent people in New York, shooting a pastor in Idaho, and throwing foreign objects over the White House fence. Only when H.R. 2646 passes the House and a companion bill passes the Senate will the madness start to subside.

— D. J. Jaffe is executive director of Mental Illness Policy Org., a non-partisan think tank on serious mental illness.