ANALYSES HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT 2015 HR 2646

On June 4, 2015, Rep. Tim Murphy (R. PA) and Rep. Eddie Bernice Johnson (D. TX) introduced the Helping Families in Mental Health Crisis Act of 2015 (“HFMHCA”, HR 2646) which updates the 2013 version which did not pass (HR3717) It contains numerous provisions that will help those with the most serious mental illnesses.

Following is a summary of what Mental Illness Policy Org. considers the most important provisions of HFMHCA and a discussion of others. We did not analyze provisions related to children or technology.

SAMHSA Replaced by an Assistant Secretary of Mental Health and Substance Use Disorders

Background: It is well known that the Substance Abuse and Mental Health Services Administration (SAMHSA) has failed to focus it’s efforts on serious mental illness as mandated in the enabling legislation, use science to develop policy, hire anyone with medical expertise, or focus on reducing important metrics like rates of homelessness, arrest, incarceration, suicide, violence or hospitalization in people with mental illness.

The Helping Families in Mental Health Crisis Act replaces SAMHSA and it’s administrator with Assistant Secretary for Mental Health and Substance Use Treatment who must be a licensed Psychiatrist or Clinical Psychologist. This raises the profile of mental health in the government org chart and ensures that the lead policy official for mental health policy knows something about mental illness. The Assistant Secretary will administer responsibilities formerly administered by SAMHSA.

The Helping Families in Mental Health Crisis Act requires the Asst. Sec to focus on important metrics like rates of suicide and attempts, emergency psychiatric hospitalizations, emergency room boarding; arrests, incarcerations, victimization, and homelessness. The bill dramatically tightens the definition of evidence to be used in determining the efficacy of programs. It establishes a coordinating committee to advise the secretary that includes significant representation from criminal justice.

Mental Health Block Grant Applicants Required to Address Serious Mental Illness

Background: Mental Health Block Grants (MHBGs) are roughly $500 million in federal funds allocated to SAMHSA to distribute as “block grants’ to the states. Both SAMHSA and the Block Grants are supposed to serve people with Serious Mental Illness, but SAMHSA gives guidance to the states to divert the money from people with serious mental illness.

The Helping Families in Mental Health Crisis Act requires states applying for block grants to “include a separate description of case management services and provide for activities leading to reduction of rates of suicides, suicide attempts, substance abuse, emergency hospitalizations, incarceration, crimes, arrest, victimization, homelessness, joblessness, medication” and other important outcomes.

Assisted Outpatient Treatment Programs Receive Modest Funding

Background: Assisted Outpatient Treatment (AOT) allows judges to order a small group of seriously mentally ill who already accumulated multiple episodes of arrest, violence and hospitalization as a result of failing to comply with treatment to stay in mandated and monitored treatment while in the community. This has reduced their incarceration, arrest, homelessness and hospitalization by 70% each and saved money for taxpayers by reducing the use of expensive jails and hospitals. In 2013 Rep Murphy inserted a provision in the 2014 Protecting Access to Medicare Act (a/k/a “SGR” or “DocFix”) that provided $15 million annually for AOT.

The Helping Families in Mental Health Crisis Act of 2015 ups the amount provided to states for AOT by $5 million to $20 million annually and extends the grants through 2018. (20% to existing programs and 80% to new programs.) Further, states with an AOT law on their books will receive a 2 percent increase in their block grant funding. (Roughly $10 million annually split between them)

The Helping Families in Mental Health Crisis Act requires the Asst. Sec to measure outcomes in states with AOT which will help strengthen the evidence for it. Relatedly, states with a need for treatment standard will also receive a 2 percent increase in their block grant funding (about $10 million nationally).

HIPAA/FERPA Regulations Slightly Modified to Allow Helpful Disclosures to Caregivers

Background: Parents who provide case management, housing, income support and other services out of love to their children, are prohibited by HIPAA and FERPA from getting information about diagnosis, medications and next appointments of loved ones. Therefore they can’t make sure prescriptions are filled, transportation to appointments arranged and help facilitate compliance. Doctors and mental health programs also falsely claim that HIPAA prevents them from receiving information from family members.

The Helping Families in Mental Health Crisis Act allows an entity normally required to maintain patient confidentiality to share some  limited information with “caregivers”. HIPPA disclosure is limited to information about the diagnoses, treatment plans, appointment scheduling, medications, and medication related instructions, but does not include any personal psychotherapy notes. The Helping Families in Mental Health Crisis Act does not put a limit on which FERPA-protected information may be disclosed.

The Helping Families in Mental Health Crisis Act defines “caregivers” as “an immediate family member; someone who assumes primary responsibility for providing a basic need of such individual; a personal representative; someone who can establish a longstanding involvement and is responsible with the individual.”

The Helping Families in Mental Health Crisis Act provides that HIPAA protected information may be disclosed only if the patient is over 18 and has “serious mental Illness” diagnosed by a doctor that results in functional impairment of the individual that “substantially interferes with or limits one or more major life activities of the individual.” HIPAA protected information for people without serious mental illness may not be disclosed. FERPA protected information can be disclosed without those limitations.

Disclosure of information can only be made if all the following conditions are met for HIPAA protected information or the first condition only is met for FERPA protected information.

• Such disclosure is necessary to protect the health, safety, or welfare of the individual or general public.
• The information to be disclosed will be beneficial to the treatment of the individual if that individual has a co-occurring acute or chronic medical illness.
• The information to be disclosed is necessary for the continuity of treatment of the medical condition or mental illness of the individual.
• The absence of such information or treatment will contribute to a worsening prognosis or an acute medical condition.
• The individual by nature of the severe mental illness has or has had a diminished capacity to fully understand or follow a treatment plan for their medical condition or may become gravely disabled in absence of treatment.

The Helping Families in Mental Health Crisis Act makes it clear that healthcare providers may “listen to information or review medical history provided by family members or other caregivers who may have concerns about the health and well-being of the patient, so the health care provider can factor that information into the patient’s care.”

IMD Exclusion Slightly Ameliorated to End Discrimination Against Seriously Mentally Ill who Need Hospital Care

Background: IMD’s are “Institutes for Mental Disease” colloquially known as state psychiatric hospitals. Likewise any facility, like an adult homes with more than 50% mentally ill are also IMDs. The IMD provision of Medicaid prevents states from getting reimbursed for people 18-64 who need long-term care in these IMDs. That is why states lock the front door of hospitals, open the back, and kick patients out of the hospitals and into the community where Medicaid will pick up 50% of the cost of care. Many of these individuals cannot live in the community and end up in jail or homeless. Rep. Eddie Bernice Johnson (D. TX), and a former head of psychiatric nursing at a VA hospital has been a stellar proponent of eliminating the IMD Exclusion and helping people with the most serious mental illnesses.

The Helping Families in Mental Health Crisis Act allows states to get Medicaid reimbursement for care of adults in IMDs where the facility-wide average length of stay is less than 30 days. It also provides language preventing residential facilities from being declared IMDs. (CK) I believe this only allows amelioration of IMD is GAO scores it cost neutral. (CK)


PROTECTION AND ADVOCAY (P&A, PAIMI, Disability Rights) Returned to Original Mission of Protecting Mentally Ill from Abuse and Neglect

Background: The Protection and Advocacy for Individuals with Mental Illness (PAIMI/P&A) program was set up by Congress with the noble purpose to establish 50 state organizations to protect institutionalized individuals from neglect and abuse. (These frequently go by name of “Disability Rights [Name of State]). The programs moved beyond that purpose and used other language in the legislation to take on the mission of stopping treatment for the seriously ill, lobbying for laws to close hospitals, kicking people out of adult homes and opposing AOT. Many a state mental health director who has tried to improve care, and families of the seriously ill who have tried to facilitate it have found these federally funded lawyers opposing them.

The Helping Families in Mental Health Crisis Act returns PAIMI to it’s original mission of protecting patients against “abuse and neglect.” Outside the legislation “abuse” and “neglect” are defined.
 42 USC § 10802:
(1) The term “abuse” means any act or failure to act by an employee of a facility rendering care or treatment which was performed, or which was failed to be performed, knowingly, recklessly, or intentionally, and which caused, or may have caused, injury or death to an individual with mental illness, and includes acts such as—
(A) the rape or sexual assault of an individual with mental illness;
(B) the striking of an individual with mental illness;
(C) the use of excessive force when placing an individual with mental illness in bodily restraints; and
(D) the use of bodily or chemical restraints on an individual with mental illness which is not in compliance with Federal and State laws and regulations.

(5) The term “neglect” means a negligent act or omission by any individual responsible for providing services in a facility rendering care or treatment which caused or may have caused injury or death to a [1] individual with mental illness or which placed a [1] individual with mental illness at risk of injury or death, and includes an act or omission such as the failure to establish or carry out an appropriate individual program plan or treatment plan for a [1] individual with mental illness, the failure to provide adequate nutrition, clothing, or health care to a [1] individual with mental illness, or the failure to provide a safe environment for a [1] individual with mental illness, including the failure to maintain adequate numbers of appropriately trained staff.

The Helping Families in Mental Health Crisis Act requires those who get PAIMI contracts to agree to refrain from “lobbying or retaining a lobbyist for the purpose of influencing a Federal, State, or local governmental entity or officer; and “counseling an individual with a serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of such individual’s caregiver.” Importantly, it also adds a grievance process so state mental health directors, family members and consumers who feel PAIMIs are violating their mission and impeding care can be reported to a third party for investigation.

Eliminates Discrimination in Medicare Against Mentally Ill who Need Long-term Care

Background: Medicare discriminates against those with serious mental illness by imposing a 190 day lifetime cap on inpatient psychiatric hospitalizations.

The Helping Families in Mental Health Crisis Act eliminates the 190 day lifetime cap on inpatient psychiatric hospitalization in Medicare.

Requires Medicaid to Allow Two Services Within Same Day

Background: There is a proscription against Medicaid paying for two services in the same day for certain individuals. So those who go to a clinic can’t see their primary physician and psychiatrist on same day, a particularly bothersome provision in rural areas where people have to travel.

The Helping Families in Mental Health Crisis Act allows payment for two services received in a single day.

Bans Medicaid Programs from Discriminating Against Medications Used to Treat Serious Mental Illness

Background: Many treating authorities are trying to move people off expensive treatments and on to less expensive ones without regard to their efficacy.

The Helping Families in Mental Health Crisis Act protects the most seriously ill. For “major depression, bipolar (manic-depressive) disorder, panic disorder, obsessive-compulsive disorder, schizophrenia, and schizoaffective disorder, a State shall not exclude from coverage or otherwise restrict access to such drugs other than pursuant to a prior authorization program” The bill also requires managed care organizations to cover all mental illness medications.


Strengthens Hospital Discharge Procedures

Background: For many seriously mentally ill, the crack is the system. Hospital responsibility ends at discharge, and community programs have no responsibility for patients who don’t show up.

The Helping Families in Mental Health Crisis Act attempts to make the crack smaller, by requiring (medicare reimbursed?) hospitals to prepare discharge plans and facilitate connection with outpatient treatment for patients they are discharging.

National Institute Of Mental Health

Background: Extensive research shows that most mentally ill seriously mental illn are not violent, but that seriously mentally ill who are not in treatment are as a group more violent than others. Historically, the mental health industry has refused to admit this for fear of causing stigma.

The Helping Families in Mental Health Crisis Act provides $40 million annually for four years specifically for NIMH to start studying violence to self and others plus the Brain Initiative.

Increases Minority Mental Health Workforce

Authorizes fellowships to increase the number of culturally competent behavioral health professionals

Creates Suicide Prevention Technical Assistance Center to Focus on those at High Risk for Suicide.

Background: Most investments in suicide prevention are made based on politics rather science. For example, programs aimed at preventing suicide in children are expanded, even though children are the least likely age group to commit suicide.

The Helping Families in Mental Health Crisis Act will provide grants for “prevention of suicide among all ages, particularly among groups that are at high risk for suicide.”

Establishes Interagency Serious Mental illness Coordinating Agency

Background: The federal government has dramatically expanded its mental health efforts by decalring things such as bad grades, bad marriages, lack of jobs, bullying and cyberbullying as mental illnesses and diverting funds to them. Government should help those who need help the most, not least.

The Helping Families in Mental Health Crisis Act establishes this committee to refocus efforts on the most seriously ill. In addition to those responsible for mental health policy, the Attorney General is on it. Other mandatory members include a judge, a law enforcement officer, and a corrections officials.

Other Provisions

Reports on Best Practices to Train and Certify Peer Support Specialists

Background: “Peer Support” is a program that pays people with mental illness or substance abuse to guide others with it. Peer support has been shown to be a useful program to address substance abuse. For mental illness, there is solid evidence that those paid like it. According to those paid to provide it, those who receive it feel more hopeful. No independent studies show meaningful improvements in important outcomes like homelessness, arrest, incarceration and suicide. No independent studies compare peer support with non-peer support. And no independent studies of peer support report on the effect on those serious mental illness. There is clear evidence the money SAMHSA historically distributed for peer support goes to organizations that lobby against treatments that help the most seriously ill like the availability of hospitals, AOT and the 2013 version of the Helping Families in Mental Health Crisis Act (HR 3717). I.e, Peer support for mental illness has generally had a negative systemic impact even if those who receive it do receive some benefit.

The Helping Families in Mental Health Crisis Act requires the Assistant Secretary to prepare a biennial report on best practices for “training and certifying peer support and establishing and operating programs using peer-support”. It defines a peer support specialist as someone who has “been an active participant in mental health or substance use treatment for at least the preceding 2 years” and “uses his or her recovery from mental illness or substance abuse plus skills learned in formal training, …to work …with individuals with a serious mental illness or a substance use disorder, in consultation with and under the supervision of a licensed mental health or substance use treatment professional.”

Ask your state mental health director to apply for these federal funds to expand Assisted Outpatient Treatment (AOT)

(June/July 2015)

Thanks to Rep. Tim Murphy, there is new federal funding available that can be used to expand access to assisted outpatient treatment. Following is the draft of a letter you should send your state mental health director, local mental health director and share with anyone who is operating an AOT program in your state encouraging them to apply for the funds.

Name of Mental Health Director

Title

Name of Dept

Street

City, State, Zip

Re: Apply for Federal Certified Community Behavioral Health Clinic Funding and use it expand availability of Assisted Outpatient Treatment

Dear name of state mental health director:

The “Protecting Access to Medicare Act of 2014” (H.R. 4302, 2013-2014) established funding for eight states to create two-year Demonstration Projects allowing Certified Community Behavioral Health Clinics (CCBHCs) to be reimbursed prospectively to help people with serious mental illness. As the result of action by Rep. Tim Murphy, Section 223(d)(4(iii) of the law (P.L. 113-93) states that “preference should be given to those (Demonstration Project applicants) that “will improve availability of, access to, and participation in Assisted Outpatient mental health treatment in the State.” The bill is at http://www.gpo.gov/fdsys/pkg/PLAW-113publ93/pdf/PLAW-113publ93.pdf 

On June 8, SAMHSA is hosting a pre-application webinar to inform you how to apply for funding for the Demonstration Programs. See  http://www.samhsa.gov/sites/default/files/sm-16-001-webinar-notification_0.pdf. Your application must be submitted by August 5, 2015. Comprehensive information on all of this is at http://www.samhsa.gov/grants/grant-announcements/sm-16-001.

We strongly urge you to apply for these funds and to specifically use them to increase the availability of Assisted Outpatient Treatment (AOT) in (name of state).  

Thank you very much.

Name

Cc: Local Mental Health Director

       Local Programs with AOT program

Bills to Help People with Mental Illness in California Pass Mental Health Committee

(April 14, 2015) Several California bills proposed by Assemblymembers Eggman, Waldron and Brown passed the mental health committee today and go to other committees. The first two improve Laura's Law, California's Assisted Outpatient Treatment (AOT) program. It allows courts to order  noncompliant persons with mental illness who have already become violent or needlessly hospitalized as a result of going off treatment, to stay in six months of mandated and monitored treatment while they live in the community. It's been very successful in counties and states that use it. The following summaries are based on bills before they were amended by the committees, so this may not be entirely accurate. Check the actual bills.

• AB1193 (Eggman) eliminates the requirement that counties vote to implement Laura's Law and eliminates the requirement that counties certify that voluntary programs are not being cut. Counties that don’t want Laura’s Law have to vote not to have it, rather than to have it as before. It also allows superior court judges to request a Laura’s Law petition be filed for individuals who come before the court. It extends Laura's Law until 2022. 
• AB 59 (Waldron) supposedly complements AB 1193. I believe it removes the sunset (whereas AB 1193 moved it until 2022, but maybe that was one of the provisions removed during the meeting.) It also removes the requirement that counties certify that no voluntary programs are cut before implementing Laura's Law. That certification requirement basically required counties to maintain failed programs before they could implement Laura's Law. The bill originally would have authorized the court to order a person to obtain assisted outpatient treatment for up to 12 months, rather than 6 months as is now the case. But that provision was removed at last minute. It allows hospitals to petition for AOT for people who are involuntarily committed to inpatient care (5150) and who are being released. That is a good idea as there are people who are involuntarily committed who could leave the hospital if Laura's Law was available to them.

Two other bills, not related to Laura's Law, but that help the seriously ill also passed the mental health committee and move to other committees.

• AB1194 (Eggman) allows courts to consider past history when deciding when to 5150 (involuntarily commit) someone. Past history is best predictor of future behavior (l,e someone who went off meds in past, and became violent is more likely to become violent again if they again go off meds). AB1194 now goes to appropriations.  
• AB 1237 (Brown) passed mental health committee and goes to next committee. It requires state hospital system to create pool of psychiatrists to evaluate people who are found mentally incompetent to stand trial or who has been found to be insane at the time he or she committed the crime. 

Darrell Steinberg Report on California Mental Health Services Act (MHSA) Wrong

Darrell Steinberg and the California Mental Health Directors who distribute Mental Health Services Act funds just released their own MHSA report saying MHSA is working fine and they are doing a good job. It got press in SacBee and LA Times and others.

MHSA does help some people with serious mental illness. But following was what was left out of the report

• 100% of the funds go to the mentally ill who are well enough to recognize they are ill. The homeless psychotic screaming at voices and eating out of dumpsters are not. 
• There was no info about the diagnosis of those being served in the report. MHSA is legislatively limited to helping those with “serious mental illness”. The funds are going to others who are easier to serve, hence the good numbers.
• There was also no mention of the MHSA waste and how Mental Health Services Oversight and Accountability regulations divert  Prevention and Early Intervention funds to those without serious mental illness. 
• There was no mention of oversight regulators diverting MHSA funds to their own programs.
• There was no mention of funds being given to groups that want to sue to stop counties from using Laura's Law to help people with serious mental illness.

It is not surprising that the Behavioral Health directors who distribute the funds came up with a report saying they are doing a good job. But independent sources say that is not true. The California State Auditor report, Associated Press investigation, Little Hoover Commission, and Mental Illness Policy Org investigation all found they are not. But those organizations don't have the $11 million PR budget those who run MHSA have. How did they get the $11 million? They diverted MHSA funds to it.

Learn about Laura's Law at http://mentalillnesspolicy.org/states/lauraslawindex.html

Learn about waste and fraud in Mental Health Services Act at http://mentalillnesspolicy.org/states/california/mhsa/mental_health_services_act_mhsa.html

Learn about serious mental illness at http://mentalillnesspolicy.org

Re: NYPD Shootings: Cuomo Should Sign "Prisoner Mental Health Discharge Bill" Today

Even after mentally ill ex-prisoner Ismaaiyl Brinsley shot New York Police Department officers Liu Wenjin and Raphael Ramosa, New York State Governor Cuomo is refusing to sign a bill (S7818) that passed both houses and is on his desk right now. 

The “Prisoners Mental Health Discharge Planning Bill”  would require prison officials to make sure prisoners with mental illness who are being released are 

• given a discharge plan, 
• an appointment with a community program, 
• and enough medications to last until the appointment. 
• It also adds parole officials to the list of people who can refer someone with a mental illness to a hospital for evaluation. 

Ismaaiyl Brinsley was reported by his mom to be mentally ill, and reported to have been previously institutionalized and incarcerated. While Brinsley was not released from a New York prison, this bill would help improve care and prevent violence by those with mental illness who are. Cuomo should sign it today. 

Supporters

Mental Illness Policy Org.  

NYS Association of Chiefs of Police 

National Alliance on Mental Illness of NYS  

Sponsors 

Senator Catharine Young (Senator representing Kendra Webdale’s parents district in Buffalo)  

Assemblyman Danny O’Donnell (NYC)  

We also note that Mayor DeBlasio's Task Force on Mentally Ill at Riker's failed to include expansion of Kendra's Law in their recommendations. Kendra's Law reduces homelessness, arrest, violence and incarceration by the mentally ill prisoners who are enrolled by keeping them in mandated and monitored community treatment.

In both Albany and NY officials are ignoring the most seriously ill. 

Finally, we thank Rep. Tim Murphy (R.PA) for introducing HR 3717, The Helping Families in Mental Health Crisis Act which addresses serious mental illness rather than ignoring it.

(This was written quickly. Sorry for any typos). 

Visit http://mentalillnesspolicy.org for science based info on serious mental illness intersecting with violence.

Mental Health Advocates versus Mental Illness Advocates

Excerpts from Speech to NAMI/NYS Convention

By DJ Jaffe

Exec. Dir. Mental Illness Policy Org.

November 15, 2013

I am supposed to talk on legislation here and in Washington, and I would be glad to talk about that. But before beginning I want to make clear that like most of you, I am not a mental health advocate. 

Like most of you, I am a mental illness advocate.  I think we need less mental health spending and more mental illness spending.  It is the most seriously ill not the worried-well, who disproportionately become homeless, commit crime, become violent, get arrested incarcerated or hospitalized. 360,000 are behind bars and 200,000 homeless because we are now focused on improving mental health, rather than treating serious mental illness.

My number one message is that we have to stop ignoring the most seriously ill. Send them to the front of the line for services rather than jails shelters prisons and morgues.  I’ll talk about how mental health advocates ignore the seriously ill, followed by how the debate between mental health and mental illness is being reflected in legislation in Washington and Albany.

Now before beginning, I admit the boundary between mental health and mental illness is debatable, but the extremities are clear. 100% of the population can have their mental health improved. 20% have some sort of illness that can be found in DSM, mainly minor illnesses like anxiety. And most of the illnesses in DSM are minor. But only 4.2% have a serious mental illness like schizophrenia, treatment resistant bipolar, major severe depression or another illness that prevents them from functioning.

Historically, people with serious mental illness were a priority because our budget was spent on the hospitalized. But mental health advocates have changed our focus. The federal government spends $130 billion mental health dollars, much on improving the mental health of all Americans-or as former NYS OMH Commissioner Michael Hogan argued, “to create hope filled environments where people can grow”

I say we stop ignoring the seriously mentally ill.

That distinction between mental health and mental illness is the main debate going on today around the country and is certainly at the core of the two bills Congress is now considering and was at the core of some bills being considered in New York like the SAFE Gun Control Legislation.  NAMI/NYS is one of the few groups doing both.  They have always done a stellar job at trying to improve the mental health of the 20% and they also advocate for the 4%. So if someone asks me, “Where do I stand” it is with NAMI/NYS. Although I should add, my comments today are mine, not theirs. 

Let me talk about how mental health advocates drive care away from the most seriously ill. 

Mental "health" advocates claim everyone is well enough to volunteer for treatment. That is simply not true. As Congressman Murphy-who is also a psychologist, mentioned last night, some have anosognosia: They are so sick, they don’t know they are sick because the brain is impaired so insight is lacking. When you see someone walking down the street screaming they are the Messiah it is not because they think they are the Messiah. They know it. Their illness tells them it is so.

We have to stop ignoring the seriously ill  

Other mental "health" advocates claim mental illness affects everyone and claim all mental illness is serious. They are wrong. All mental illness is not serious. Many people I worked with including myself, have had or have depression, anxiety, have trouble sleeping, take Zoloft or Prozac, or nothing and do quite well.  We don’t need funds diverted from the seriously ill to the highest functioning.

Mental "health" advocates claim everyone recovers. That is False. Some do not. They actually hide those who don’t recover. You won’t see the homeless and psychotic in their Mental Health Awareness Week PSAs because they want everyone to believe all mentally ill are high functioning. Trying to gain sympathy for mental illness by only showing the high functioning is like trying to end hunger in Africa, by only showing the well-fed.

We have to stop ignoring the seriously ill

There are two trade associations here in Albany that do some good work for the high functioning, but claim to speak for those with serious mental illness. They want OMH to close hospitals that serve the seriously ill and turn the money over to them.  That would be wrong. We are short 95000 hospital beds, nationwide and 4000 in NY, even if we had perfect community services.  When hospitals go down incarceration goes up. There are so few hospitals, today it’s harder to get into Bellevue than Harvard and once in you’ll be discharged sicker and quicker. Here in Albany last week Desmond Wyatt was released from the Capital District Psychiatric Center and killed his mother the next day.  His brother told police Desmond was hearing voices but that didn’t stop the hospital from releasing him.

We have to stop ignoring the seriously ill.

Mental health advocates work to convince the public that violence is not associated with mental illness. That may be true for the high functioning but violence is clearly associated with untreated serious mental illness. To convince the public mentally ill are not more violent, mental health advocates quote studies of the treated. Those studies prove treatment works, not that the untreated are not more violent than others. Or they quote studies of the 20% with any mental illness not the 4% with serious mental illness. Their studies are of those in the community and therefore exclude the violent: those in jails, in prisons, involuntarily committed, or have completed suicide.

They argue even talking about violence causes stigma. Talking about violence is a prerequisite to reducing it. It is violence by the small minority that tars the non-violent majority. Their failure to admit to violence is preventing us from implementing policies to reduce it.

We have to stop ignoring the seriously ill.

Current laws prevent people from getting treatment until after they become danger to self or others. That’s ludicrous. Laws should prevent violence not require it. Think seatbelts. But mental "health" advocates want civil commitment to be even more difficult. They argue involuntary treatment is bad without recognizing jail and prison are worse. They argue against medications and restraint and as the NY Times pointed out on Monday that is causing hospitals to become dangerous places. Patients can’t be restrained so hospitals call police. Mental health advocacy is causing seriously mentally ill patients into prisoners.

We have to stop ignoring the seriously ill.

Mental Health Advocates are working to stop Assisted Outpatient Treatment (Kendra’s Law). AOT is the most successful treatment for the small group of the most seriously ill who already accumulated multiple incidents of violence, arrest, incarceration, or needless hospitalization because of their refusal, actually their inability, to be well enough to volunteer for treatment. Kendra’s allows courts to order six months of mandated and monitored community treatment.  It is less restrictive than the alternatives: inpatient commitment and incarceration. It reduces arrest, suicide, hospitalization and violence among people with serious mental illness over 70% each and cut costs in half creating more funds for services for all.

Peer support may do something. But it is not proven to do anything like what Kendra’s Law does. But mental health advocates want to replace Kendra’s Law with peer support.

We have to stop ignoring the seriously ill

Mental "health"  advocates encourage government to spend more on prediction and prevention. As we heard in multiple sessions yesterday, we don’t know how to predict or prevent serious mental illness because we don’t know what causes it.  They argue we should focus our spending on children because half of all mental illness begins before age 14.  But the statement is only true if you include substance abuse. The study the claim is based on actually EXCLUDED serious mental illnesses like schizophrenia and bipolar. Serious mental illness begins in late teens and early twenties and continues after that. That’s where we have to focus our attention.

Mental "health" advocates argue mental illness is associated with bad grades, poverty, single parent households, and their latest cause, bullying and cyberbullying so we should divert funds meant to help the seriously ill to improve grades, end poverty, improve marriages and address cyberbullying.  Those are worthy social services issues but are not mental illnesses. Spending mental health funds on those diverts attention from mental illness.   Mental "health" advocates claim trauma is a mental illness. Trauma is not a mental illness. PTSD is. It can be extreme or mild.

Stop Diverting the Money!

Mental  "health" advocates blame police when something goes wrong, and want more CIT training as do I. But police only step in when one condition has been met: The mental health system failed. And mental health advocates fail to recognize that as their diverting funds to the tangential rather than the consequential is largely responsible for the system failing. As mental 'health" advocates abandoned advocating for the seriously ill, criminal justice has stepped up: Largely thanks to Chief Biasotti, the International and NYS Associations of Chiefs of Police, Dept. of Justice, National Sheriffs Association, and others have become the leading voices on how to improve care for the seriously ill.

Now I’d like to turn to how this debate between mental health and serious mental illness is playing out in New York and Washington.

What is interesting to me, is that generally it is Republicans, not Democrats who are helping the seriously ill.  I am a left wing Democrat so it pains me to say, but my party is generally oblivious to the fact that throwing more money at mental health does not improve treatment for people with serious mental illness. Democrats have been captured by mental health advocates and therefore ignore unpleasant truths like not everyone recovers, sometimes hospitals are needed; and left untreated a small subset of the most seriously ill do become violent.  

For example, in NY, when Governor Cuomo said he was going to pass legislation requiring therapists to report potentially dangerous mentally ill to criminal justice so they could be banned from owning firearms, there was no way to stop it. But Republicans inserted provisions requiring the reports to go through county mental health directors rather than directly from therapist to criminal justice. Why? Because that was a way to force county mental health departments to become aware of seriously mentally ill who live in their counties. The hope was they would offer treatment not just take guns away.  Directors fought the provision, preferring to keep their heads in the sand.  They called it an ‘unfunded mandate’. Helping the seriously ill is not an unfunded mandate, it is their mandate.

Much of the rest of the speech was dedicated to explaining the provisions of the Helping Families in Mental Health Crisis Act (HR 3717), why a competing bill doesn't help, and myths raised by mental health advocates about it. 

To improve care for people with serious mental illness money is not missing, leadership is. We have to stop listening to mental health advocates and start listening to mental illness advocates. We need to replace mission creep with mission control. As Police Chief Biasotti, testified to Congress,

We have two mental health systems today, serving two mutually exclusive populations: Community programs serve those who seek and accept treatment. Those who refuse, or are too sick to seek treatment voluntarily, become a law enforcement responsibility. …(M)ental health officials seem unwilling to recognize or take responsibility for this second more symptomatic group.”

We have to stop ignoring the seriously ill.

Thank you.

Research Shows Assisted Outpatient Treatment (AOT) Works

AOT allows courts to order six months of mandated and monitored treatment in the community for a very small group of people with very serious mental illness who have previously become arrested, incarcerated, violent, homeless or hospitalized multiple times as a result of their failure to comply with treatment, often because they are so ill they don't know they are ill ("anosognosia").

More than two decades of research and practice show it works. AOT reduced hospitalizations[i], arrests[ii], incarcerations, crime[iii], victimization[iv] and violence[v] and improved treatment adherence[vi] The Department of Justice deemed AOT to be an effective evidence-based program for reducing crime and violence[vii]; AOT also produces significant taxpayer/system cost savings. New York’s program achieved savings of 50% in the first year and an additional 13% in the second year. A study in North Carolina reported similar cost savings of 40%[viii]. These savings free up mental health funds to treat more people or provide better treatment.

Research showing AOT (Kendra's Law) in New York works

Research showing AOT (Laura's Law) in California works is here

Footnotes