Opponents of mental health bill balk at AOT mandate

While the revamped Helping Families in Mental Health Crisis Act (HR 2646), which was introduced last week, has seen its share of support from industry groups, not everyone is amenable to the proposed legislation.

For one, the National Coalition for Mental Health Recovery (NCMHR), which represents a number of consumer advocacy organizations, believes HR 2646 “is designed to dismantle” SAMHSA and also would compromise individuals’ civil rights “through forced treatment and increased institutionalization.”

HR 2646 calls for a new assistant secretary with behavioral health credentials who would immediately replace the current SAMHSA administration. The coalition is concerned that SAMHSA programs that are currently helping individuals would be shut down.

Additionally, Rep. Paul D. Tonko (D-NY) has also taken issue with the measure, saying HR 2646’s cuts to SAMHSA programs include over $100 million in cuts to substance abuse treatment and prevention programs and a 43 percent cut to the Minority Fellowship Program, which helps to increase the representation of minorities in the behavioral health workforce.

“I am always willing to examine ways we can find smart savings by eliminating specific outdated or ineffective programs, but I do not support the indiscriminate approach that this legislation takes,” Tonko said in a statement.

Ire over AOT

HR 2646 also calls for an increase in state laws implementing court-ordered assisted outpatient treatment (AOT), which NCMHR characterizes as coercive, involuntary outpatient commitment. "In reality," said NCMHR board member Joseph Rogers, in a statement, "AOT is the opposite of a community-based alternative."

NCMHR concerns over AOT include the effectively mandated use of medication and the potential progression to institutionalization for the individual if AOT conditions are not met.

The proposed legislation also makes AOT laws a requirement for states to access block grant funds.

Another HR 2646 provision that would end the Medicaid IMD exclusion has also raised concerns. Tonko pointed out that removing the IMD exclusion would result in increased federal spending, yet, HR 2646 implies that the new policy would not go into effect unless federal officials certify that there is no net spending associated with it. Tonko doesn’t believe that certification would be possible.

“Changes to these policies won’t actually occur until we admit that they cost money and work to make the necessary investment. I plan to introduce legislation tackling both of these issues soon,” he said.

The Subcommittee on Health has scheduled a hearing for Tuesday, June 16, 2015, to review HR 2646.