By Gina Nikkel (Originally published here)
HR 3717, authored by Congressman Tim Murphy, has been introduced in response to mounting concerns about the treatment of persons with mental health challenges. It is universally recognized that improvements are needed in the mental health system. Unfortunately, HR 3717 will have serious unintended consequences. It will reverse many key advances made in mental health care in the last 30 years and place federal and state governments at high risk for litigation under the Americans with Disabilities Act and the Supreme Court’s Olmstead decision. No other population needing care is subject to the civil rights violations that will be implemented by the provisions of this bill. Furthermore, the criteria proposed for coercing people into treatment, especially mandated medication usage, will bring a new level of government intrusion and control. Finally, HR 3717 completely ignores emerging scientific research regarding long-term harmful outcomes of medication use and the negative impacts of forced treatment.
Increased discrimination and stigma will be the result of several of the bill’s provisions. These are based on an erroneous belief that people with mental health challenges are more prone to violence than other populations. This mistaken proposition ignores a great body of evidence showing that they are more often victims of violence, not perpetrators.
- There are a number of other major problems with this proposed legislation: It eliminates many initiatives that are already shown to promote recovery from mental health problems through the use of evidence-based, voluntary, peer-run programs and family services and supports. Dr. Daniel Fisher, PhD, MD states: “These services have a proven track record in helping people stay out of the hospital and live successfully in the community. Because hospitalization is far more expensive and has far worse outcomes than these effective and cost-efficient, community-based services, this bill would cost more money for worse outcomes.”
- The bill’s attack on the Substance and Mental Health Services Administration seems ill-advised given that SAMHSA is the lone federal agency voice of hope with its focus on recovery principles. This policy direction is supported by an increasing and impressive body of carefully designed research showing that long-term outcomes are far better than has been assumed by the mainline mental health world. Recent studies supported by the Foundation for Excellence in Mental Health Care and other funders are showing definitively that hope is a reasonable expectation for most people with major mental health challenges, in particular people diagnosed with schizophrenia. These studies (Harrow, Wunderink, Harding, et al) can be provided at the request of any legislator or committee.
- There is no evidence that creating yet another federal bureaucracy with yet another Assistant Secretary and Department will reduce costs to either state or federal governments. The best way to reduce costs and disability is to promote recovery and wellness, those priorities for which SAMHSA is already providing leadership and inspiring hope.
- As noted above, key provisions of this proposed legislation violate Olmstead V. L.C. (1999) which requires treatment services to be delivered in a least restrictive environment. Many states are already dealing with costly challenges to their current systems of care and this will add to the burden of both state and federal governments. The US Supreme Court has clearly laid the legal foundation to move away from institutional and coercive care.
- It is clear from research and much field experience showing that when people know or believe they are going to be placed on a list and be forced into treatment, they will become even more resistant and try to avoid services as much as possible. These coercive provisions will backfire and result in the exact opposite of the intentions of the bill.
- Finally, this bill would eviscerate the rights and privacy protections enshrined in the federally mandated Protection and Advocacy (P&A) System, which is the largest provider of legal advocacy services to people with disabilities in the United States. At a time when people with mental health challenges are most likely to be misunderstood so that their American civil rights are violated, HB 3717 puts not only federal and state governments in even more litigious positions but threatens the hope and well-being of people and families struggling to regain their lives.
A much more robust federal policy foundation, than is provided for in HB 3717, should be based on recovery, wellness and effectiveness. Increased resources for now well-researched early psychosis intervention programs, evidenced based prevention services, community and peer supports would dramatically increase the availability of cost-effective community-based services—all of which offer hope rather than misplaced fear. HB 3717 moves the United States in exactly the wrong direction.
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