A glimmer of hope for reforming mental health care in America
By Editorial Board June 25
AMID THE gridlock over guns this month in Congress, there was one bright spot of progress on another pressing problem: In the House, an ambitious mental-health reform bill made its way through committee.
Rep. Tim Murphy (R-Pa.) has led the charge for improvements in mental-health-care policy since the Sandy Hook Elementary School shooting in December 2012. His efforts may finally be paying off: The Helping Families in Mental Health Crisis Act passed out of committee last week with unanimous support. In the Senate, a more modest mental-health bill also awaits a vote on the floor. If the House and Senate proposals pass — as they should — they could move into conference before the August recess.
Both bills would shore up mental-health grant programs and reward evidence-based care. They would restructure the federal agency in charge of mental health to better coordinate care across the country. But the House bill, though watered down from its initial incarnation, includes key provisions that are missing from the Senate’s.
First, the House legislation would revise a rule that prevents people on Medicaid from getting same-day inpatient care in large facilities, a change that could encourage the building of bigger treatment centers and help solve the national shortage of nearly 100,000 psychiatric beds. It would also better clarify the circumstances under which a physician can access a patient’s records and speak to his family. Finally, it would incentivize states to adopt something called “assisted outpatient treatment” — court-ordered care outside of mental-health centers for those unwilling or unable to seek it on their own.
Opponents of the law take issue with the last provision in particular. They say sick people have the right to choose for themselves whether to get treatment and that early prevention programs would keep mental illness from spiraling out of control in the first place. Prevention is important, but those programs can and should walk hand-in-hand with aid for those who reach a point where they will not or cannot admit that they need help — before they can harm themselves or others, and before they end up committed or incarcerated.
Though the House bill is more comprehensive than anything else on the table, there’s more that could be done. Rep. Joe Kennedy (D-Mass.) says that while the bill would nudge insurers toward providing mental-health care on the same terms as other services, it wouldn’t do much to enforce the rule. The bill also does little to raise Medicaid reimbursement rates for providers. And then there’s cost: The bill creates new grants, but it does not guarantee new funding.
None of that, though, should take away from a rare moment for bipartisan action on an important issue. Fixing our broken mental-health-care system will take more time, more money and more than one bill. But in today’s political climate, that one bill is itself a remarkable achievement.