2014 Federal Mental Health Legislation

See below for concerns about Murphy Bill HR3717 “Helping Families in Mental Health Crisis“ Act summarized below.  

·      In its current form, HR3717 represents a giant leap backward. Years ago we relied on acute care hospitals and medications. This was breaking the bank. As a result, we pushed into community-based support that developed into “recovery” models for adults and wraparound practices within Systems of Care for children. We know that both of these practices are successful but neither have been brought to scale. We have failed consistently to allocate sufficient resources to community mental health. Rather we have had a patchwork of large grants that hire staff who are dependent upon the funds, so when those end, more half of the projects do not sustain. HR3717 effectively does away with all of what we have learned from generations of demonstration grants. Instead, it returns to reliance on a medical model sans community support. We do desperately need more psychiatrists and professionals capable of accurate diagnosis and effective medication management, but swinging the pendulum back to sole reliance on a diagnosis and medication while stripping the already inadequate resources for community support, just throws us back into the crisis that launched the recovery model for adults, and wraparound for families.

o   Wraparound started with Karl Dennis in Chicago trying to help families everyone else had given up on; simultaneously John Vandenberg was developing it in Alaska to “bring the children back” from expensive long term residential placements in the lower 48 that were breaking the bank and not producing outcomes that could generalize once the children came back to their communities. Ever since, we have been doing demonstration grants for systems of care which is the agency level integration and philosophy that provides ideal support for wraparound.

o   Second generation grants have been awarded to states to fund transformation and statewide systems of care. It is working in some smaller states, but efforts need to be expanded to support critical infrastructure components, such as robust regional training capacity and family to family supports.

 

·    Staffing is a huge issue across mental health systems. Community mental health has been under-resourced for so long that it will be a challenge to ramp up.

o   As an example, a few years ago, occupational therapists were a core member of inpatient mental health teams which allowed strong mental health fieldwork for pre-professional development. When health care shifted to a for profit model, skilled staff such as occupational therapists, left acute care hospitals and because there were never resources sufficient to hire them in the community, pre-professional training at universities have to work hard to create opportunities to practice mental health during coursework. But new therapists who want to work in mental health have to be willing to take a substantial pay cut to work in mental health versus in settings serving people with physical disabilities.

o   There are severe shortages in psychiatrists and HR 3717 begins to address this with student loan repayment programs. There need to also be resources allocated for a full team of professionals and they need to be tasked with supporting successful community participation; HR 3717 fails at this. There are severe shortages in mental health professionals in community across disciplines, including social work, psychiatric nursing, occupational therapists, and counselors. This bill artificially pits diagnosing professionals and those who are skilled in supporting performance in community. The reality is that both are needed.

o   There need to be professional peer to peer support staff accessible to all. These are people with lived experience who have acquired knowledge of systems and best practices, and who provide services, supports and advocacy to others. They should be supported and supervised by strong peer to peer organizations. This means building up networks of family peer professionals within family to family organizations for families raising children with mental health needs, youth mentors within youth peer to peer organizations, and adult peer providers within adult peer to peer organizations. It is critical to have deep resources to children, families and adults in the community. Peer resources increase initial engagement, support connections to the resources that match needs, and enable a path to recovery.

 

·      Children and youth with mental health needs are not addressed in this bill directly, although the federal training and advocacy capacity that supports vital needs is stripped and the resources are shifted to more physicians and medications.

o   The most efficient and effective driver for knowledgeable change are strong family to family support and advocacy centers staffed by families with lived experience and strong grounding in family to family support practices, systems of care, wraparound, IDEA and school metal health models, and an understanding across child serving systems. We have 42 Statewide Family Network grants but these need to be increased especially for large states. This bill eliminates them entirely.

o   Technical Assistance Centers and efforts such as the IDEA Partnership’s Community of Practice on School Behavioral Health, efficiently pull together professional organizations, professionals and other stakeholders to share and support best practices and change in school based practice to more effectively support struggling teachers and schools. These need to be funded and are not in this bill.

 

·      Adults with mental health needs also need access to psychosocial rehabilitation and a range of supports that match needs. HR 3717 reduces already insufficient resources for recovery. They also need increased access to competent staff as stated above. It is not OK to create a court program that has wide authority to mandate medications. The reality is that people living with mental illness are more often victims of violent crime than perpetrators. This provision is not the best way to support their mental health and it continues to violate their rights. They have experienced too much abuse already. This needs a lot more thought.

 

There are huge issues with our mental health system and reform and reinvestment is a good idea but it needs to be overseen by deep stakeholder representation and this bill does not include that.

 

Here are additional links and information:

North Carolina Families United Blog:

http://www.ncfamiliesunited.org/dont-fooled-name-helping-families-mental-health-crisis-act-2013-harmful-helpful/

 

Vocabulary:

Recovery model – Identifies individual and community strengths and follows the World Health Organizations emphasis on participation in community. It recognizes that we do not (even with medication) have the capacity to eliminate all symptoms but strives for having a meaningful life in spite of symptoms. It includes having relationships, being able to contribute to one’s community, and managing symptoms effectively.

Medical model – Identifies illness or disease and treats the cause if it is known, but more often with mental illness, it relies on pharmacology to treat according to diagnoses that are based on groups of presenting symptoms.

Assisted Outpatient Treatment – court ordered treatment, generally focused on medication compliance.

Wraparound – Children with intense needs are served in the community instead of being sent to long term out of home settings. Generally, it builds on child and family strengths using a team that is half nonprofessionals so that they sustain after the paid professionals are gone. The individualized plan is developed with the child and family and the team supports building successful participation, meeting regularly to track progress.http://www.nwi.pdx.edu/wraparoundbasics.shtml

Review of the 2013 83rd session at Texans Care for Children

Recap of 82nd legislature by Texan's Care for Children entitled A Session Recap on the Bottom Line - Children and the 82nd Legislature

DCFF will be partnering with the Statewide Family Organization to update our Legislative Training Materials and will link to those resources here as they are completed. See family driven & developed training resources for IDEA advocacy, family to family supports and more at FYI2.org(family to family training website supported by Texas Federation of Families and Denton County Federation of Families).

Please take a moment to read the Texas Family Community Participation Reports for information regarding what families said that they need to be successful in their community.

Texas Family Participation Reports

Texas Children's Mental Health Policy

Resources for staying on top of the 82nd legislature have dwindled as we focus on increased child and family needs with fewer resources. Advocacy Inc. is now Disability Rights Texas.  

Click for Disability Rights Texas website