Another mental health bill envisions dignity and respect for patients

For more than six months, the mental health field has been following the Helping Families in Mental Health Crisis Act of 2013, (H.R.3717), a bill sponsored by Rep. Tim Murphy (R-Pa.). But as of May 6, The Strengthening Mental Health in Our Communities Act of 2014 comes to the forefront as another bill to review.

Introduced by Rep. Ron Barber (D-Arizona), it doesn’t include the provisions that were most controversial in the Murphy bill: assisted outpatient treatment, defunding of much of the Substance Abuse and Mental Health Services Administration (SAMHSA), and reduced privacy protections for patients with mental illness.

Barber–who survived being shot by Jared Loughner on January 8, 2011, in the assassination attempt on then-Congresswoman Gabrielle Giffords, who also survived–talked to Behavioral Healthcare about his reasons for introducing his bill. “Before I joined Gaby Giffords as her district director, I worked in the field of developmental disabilities for 33 years,” he said. “We were also dealing with a lot of infants and toddlers who were presenting with initial signs of mental health problems, and were very much involved in providing early intervention services for kids.”

More than a third of the patients at any point in time had mental health problems in addition to developmental disabilities.

Then, the shooting incident put another layer on the issue, said Barber. In the years afterward – which included the July 2012 shooting in a movie theater in Aurora, Colorado and the Newtown school shootings that December – he “realized that [Loughner] had been dealing with his mental health issues for years.” Loughner was “not unlike other perpetrators, both undiagnosed and untreated for his mental illness,” he said.

Barber came to Congress in 2012 a strong supporter of mental health services and wanted to “raise awareness of mental illness among teachers and first responders,” he said. “My legislation focuses on high-risk groups, including kids.”

Differences from Murphy bill

Murphy’s view, and the view of many of his supporters, is that treating mental illness, including involuntarily if necessary, would reduce gun violence.

A centerpiece of Murphy’s bill would allow mental health courts to commit patients against their will to treatment; Barber’s would not. In addition, the bill sponsored by Murphy, who has been a longtime foe of what he considers inefficiency and a lack of attention to mental illness at SAMHSA, along with his star witnesses from the Treatment Advocacy Center and D.J. Jaffe would eliminate the administrator position that heads SAMHSA and replace it with an Assistant Secretary of Mental Health and Substance Abuse Disorders. The new assistant secretary would have control of funding.

Barber told Behavioral Healthcare that he doesn’t want to get into a battle about one bill versus the other. “I don’t want this to be a contest,” he said. “I hope we can find a bipartisan path forward. I don’t know if that’s possible. Mental illness doesn’t have a partisan flavor to it, when it strikes a family or an individual.”

Right after the shooting in Tucson, talking with his family in the Intensive Care Unit of the hospital, Barber established a not-for-profit called the Fund for Civility, Respect and Understanding. The goal is to reduce stigma around mental illness with public service announcements, and to deal assertively with bullying issues in schools.

 “We shouldn’t be waiting for someone to be in crisis,” he said. “My orientation is always toward increasing home and community based services–that is what works best.”

That doesn’t mean no one needs inpatient care, but the emphasis should be on treatment in the community, said Barber. “Let’s not assume that people cannot be successful in the community, even though they may be living with a serious mental illness.”

Assisted outpatient treatment, in which a court orders treatment–usually medication– is not something Barber would favor.

 “The idea of forcing people who are living in the community to comply with certain treatment plans is very problematic,” he said. “We know that there are other approaches that are much more successful.”

For example, when patients with developmental disabilities left institutions in Arizona, “we made sure they had the kind of services they needed,” he said. “And if they needed medication, we made sure there was someone who reminded them” to take it.

When policy calls for forced treatment, it raises more questions than it solves. “You have to respect their rights, treat them with dignity, involve their family,” he said.

Involving the family is very important, said Barber. If someone is returning home to the family, he believes the treatment plan should be developed in full concert with the family

“That’s the way to deal with HIPAA barriers,” he said.