Myths about the Helping Families in Mental Health Crisis Act (HR 3717)
【from Next Browser】
The post above was written by DJ Jaffe of mental illness policy.org. Jaffe is an interesting person. It is his answer to the critics of the Murphy Bill. Jaffe is best I can understand an advertising man by training. His primary qualification as a mental health expert is that he is an advertising man. He sells things and does so superbly.
He is a relentless advocate for Murphy and Torrey, basically functioning as the bad cop of the trio. He has absolutely no hesitation or reluctance to bash the character or motivation of anyone who disagrees with him or Dr. Torrey and does so passionately and aggressively. Before he became an established “mental health expert” his claim to fame was the piece he wrote to family members that if they called the police on a mentally ill family member to make sure all the furniture was turned over before the police got there where they were sure to get the “right impression.” I dont know if he still favors turning over the furniture or if he has moved past that.
Jaffe starts off, ” Groups representing high functioning individuals with a ‘lived-experience’ and other recipients of SAMHSA funds have made numerous claims about The Helping Families in Mental Health Crisis Act (HR 3717) that are inconsistent with the facts. The following compares the claims with the facts….”
Jaffe lumps critics into two groups: “high functioning with ‘lived experience’ and those who have a stake in continued Samsha funding. There are so many problems with this it is hard to know where to start.
One of the biggest problems with Murphy and company is their belief that no one can have an honest disagreement with them. Anyone who disagrees must have a distorted perception or ulterior motive. This has left them severely deficient in trying to build support from people who do not totally agree with them and is one of the big reasons that they did not succeed in their first go around. Instead of connecting with people they try to conquer them and seem unable to realize that the solution to alienating those they seek support from is not to alienate them farther.
Jaffe dismisses critics as “high functioning with lived experience.” He doesnt seem to understand that many of the people most critical of Murphy have the most serious of diagnosis, a history of hospitalization, multiple suicide attempts etc. They have lived what he is selling and found it not the path to health but the biggest stumbling block in the way.
The Murphy people coined a term: “worried well.” The most polite thing I can say about it is that it is one of the stupidest notions I have ever heard. It basically implies that the people who disagree with them have problems that are insignificant and they dont know where people with real problems are coming from. It is usually described as people who are very selfish and dont care about people really hurting. This is what Jaffe means by “high functioning with lived experience.” It displays a great consistency with the fundamental approach of the entire Murphy campaign: the best way to deal with people whose message differs from your own is to shoot the messenger. Only in Jaffe/Torrey terms does doing well in recovery mean you are out of touch with reality.
The people who are only trying to protect their samsha funding according to Jaffe are the organizations like Bazeldon and Mental Health America who for the most part have opposed Jaffe/Torrey for years. Again rely on smear and if you do it well enough perhaps you will never have to rely on argument. There are ton of other problems with his introduction, but in the interest of brevity I need to move on.
“HR3717 greatly promotes stigma and discrimination by its unfounded and damaging connection between mental illness and violence.”
HR 3717 does not make any claim that persons with mental illness are more violent. However, provisions of the bill have been proven to reduce violence by those with untreated serious mental illness. It is violence by this minority that stigmatizes the majority, so it can be expected HR 3717 will reduce stigma.”
The myth about the myth
Distortion battles lies that battles rationalization and I dont know which one wins out. This is playing word games. The bill may or may not link violence to mental illness but Torrey, Jaffe, and Murphy strongly do. In the last year I dont know if Rep. Murphy has missed one single violent tragedy to advertise his bill. Every time some one dies his first response is “This is proof that someone needs to pass my bill.” He has done it so often he is beginning to look very opportunistic and shallow.
The sentence about “violence by this minority that stigmatizes the majority…” seems so strange coming from him since the Treatment Advocacy Center for years has tried to do exactly that. When throwing stones it is always nice to make sure they ultimately dont come your way.
The notion that violence by a few is the ultimate cause of stigma is naive at best and willful blindness at worst. It is so much more than that and if that is all they can see people should be very careful about the agenda they are selling.
HR3717 virtually eliminates the main system of legal representation for Americans with psychiatric disabilities
The Protection and Advocacy for Individuals with Mental Illness (PAIMI) program was founded to improve the quality of care received by the most seriously ill. It now focuses on ‘freeing’ them from treatment and lobbying states to oppose policies that can help the most seriously ill (ex preservation of hospitals for those who need them. HR 3717 returns PAIMI to its original mission and reigns in their ability to use funds to lobby against treatment needed by some of the seriously ill.
The myth of the myth
I think most people define a lie as telling an untruth and knowing you are telling an untruth and still choosing to tell an untruth. By that criteria this one is a lie.
Paimi was not founded to improve the quality of care received by the most seriously ill. (personal disclosure. I am a member of the Paimi council in Tennessee) The phrase “now focuses on freeing them from treatment and lobbying states to oppose policies that can help the most seriously ill….” is simply not true. It is not even close to being true. Paimi protects peoples rights. In Tennessee like many other states the track record is of the successful exposure of abuses for many many people. It does not lobby the state for any changes in policy. It deals with individual issues period. My personal opinion is that if I was going to prescribe a policy like AOT with so much potential for the abuse of individual rights the last thing I would want to have is an organization in place that protects the rights of the most vulnerable. The overall message of Torrey/Jaffe/Murphy is that anyone who dissents from the program they have laid out is irresponsible, selfish, unprofessional and simply doesnt care about the plight of the severely mentally ill and their effort seems to be to try in many different ways to get them out of the way.
From everything I have been told this provision of the bill is one of several poison pills. I dont think that if some version of the bill does pass it will pass with this provision in it.
Note: Throughout his discussion of critics of the bill he talks about their stake in seeing it defeated. He passes over or glosses over the idea that the Treatment Advocacy Center is far from a disinterested party in this process.
The bill would amend HIPAA and erode privacy rights for people who have a mental health diagnosis and strip away privacy rights for Americans with psychiatric disabilities.
HIPAA and FERPA require doctors to keep parents in the dark absent a specific waiver by the mentally ill individual. Mentally ill individuals who “know” the FBI planted a transmitter in their head are unlikely to sign the waiver. Parents who are caregivers need the information about the diagnosis, treatment plan, medications and pending appointments of mentally ill loved ones so they can ensure they have prescriptions filled and transportation to appointments. HR 3717 writes very limited exclusions into HIPAA that allow parents who provide care out of love to get the same information paid caretakers already receive.
The myth about the myth
Always beware of arguments that start with the execution of straw men. Murphy is talking about far more than people “who know the fbi has implanted a transmitter in their head…..” Then he says all they want is “have the medications filled and transportation to appointments….” This aint what they are talking about.
People have rights. Inconvenient for those who would like to have power but they still have rights. And there already is an exclusion in Hippa. ” A health care provider or health plan may also share relevant information if you are not around or cannot give permission when a health care provider or plan representative believes, based on professional judgment, that sharing the information is in your best interest.”
Again there is a larger agenda at work here. Mr Jaffe and company believe in and push the value of coercive mental health care as the cure for much of what ails the mental health system. They wish to shut up organizations like Paimi that might stand in the way. With Hippa the goal is far more than making sure people get to appointments on time. It is to give family members the ability to force “loved ones” to accept treatment that they believe is not in their best interest.
Incentivize needless hospitalization and civil rights violations
The Institutes for Mental Disease (IMD) provision of Medicaid prevents states from receiving reimbursement for persons with mental illness who need care in a state psychiatric hospital. So states kick the seriously mentally ill out of hospitals. Many wind up incarcerated. Patrick Kennedy called the IMD Exclusion federally funded discrimination against the mentally ill since Medicaid reimburses for hospital care when the illness is any organ other than the brain. HR3717 makes small revisions in Medicaid so those who need hospital care are more likely to receive it. It does not require anyone to be hospitalized or gives states an incentive to hospitalize.
The myth about the myth
Again word games. Jaffe and crew have been very vocal about the fact that they believe the cure for people in jails is people in hospitals. This is not a minor part of their argument. It is central to it. How many times have you seen some mention of the story from the Treatment Advocacy Center that there are many more mentally ill in jails that there are in psychiatric hospitals. It is normally quoted in such a way as to imply that incarceration is a defiency of hospitalization.
The problem with hospitalization is not the IMD exclusion. Basically fewer and fewer people believe. The ship has sailed. Past crisis stabilization (and some would even question that) fewer and fewer people believe in the efficacy of psychiatric hospitalization to deliver anywhere close to what it advertises. From what I have been told this is another poison pill provision in the bill and if it does pass in some version this is unlikely to be there. Again though it is the same argument: Coercive treatment is good- Shut up the people who might question it (paimi), encourage families to pursue it (hippa and aot) and make it where it is paid for (imd and aot).
Redirect federal funds from effective, voluntary community services to high-cost, involuntary treatment, including outpatient commitment
HR3717 does not redirect funds away from voluntary community services. It does give states an incentive to help people who were offered voluntary services and refused to accept them. For example, Assisted Outpatient Treatment (AOT) is for people who fail on voluntary treatment. It is often the last off ramp before hospitalization or incarceration. By replacing hospitalization and incarceration with community treatment, it cuts costs in half.
The myth of the myth
Mr. Jaffe successively slays another dragon. But only he sees it. I dont know of a single person who has made the claim he talks about. No one I know believe that HR3717 redirects federal funds. In the next thing though that he describes as “the fact” he changes what he is talking about. “…does not redirect funds away from voluntary community services.” Federal funds are no longer mentioned. The problem is that Aot does take away from community services because the funds to pay for it must be found somewhere. The reason I believe it is such a minimal, inconsequential program in most states is that the states have experienced first hand how much it costs. Since state budgets are so limited the funds for big ticket items must come from some where. In Tennessee 1 person was served in AOT for a price tag of roughly $25,000. The behavioral health safety net serves over 33,000 at about $750 a person. It is way too little bang for way too big bucks.
The New York program serves about 2000 people a year for $32,000,000 a year plus investments in each year in new programs and infrastructure. Tennessee’s $32,000,000 is coming straight out of community services and people who are suffering from lack of services will then find out how to suffer with no services.
In a way they cut their nose off to spite their face. It matters what you commit people to. There is no reason to believe that skeletal services administered in a coercive way works any better than the same services provided on a voluntary basis. With a full fledged AOT program the expense of that program would make it very difficult for a state to afford to improve the level of services it offers.
Jaffe has two or thre more points. But I am not going to do the same exhaustive point by point analysis on them. This is already far longer that I meant for it to be and so the remainder of the post will be brief.
He agrees that the Murphy Bill is trying to destroy Samsha, but basically just says they deserve it. His biggest complaint I think is that SAMSHA does things he doesnt agree with like treating recovery as an important part of the mental health system. (Jaffe prefers the “mental illness treatment system. I think he doesnt want for anyone to get any high hopes. He wants you to know it is a life time curse.) And it again it follows along with the same process: silence potential threats-paimi, make it easier to commit people- hippa, make it financially viable- imd and aot and control the conversation by gettng rid of anyone who disagrees with you- samsha.
He likes to use the term evidence based treatment. I just dont know of any the bill supports. Psychiatric Hospitalization is not an evidence based practice. Medication is not an evidence based practice. Aot is a law, and not an evidence based practice since the actual services people are exposed to would differ from state to state. If you look at any list of evidence based practices you can find you will find a very large list of practices that fall under that rubric of peer based or peer support practices. Again it is word games. But Mr. Jaffe can sell. Man can he sell.
He has another myth about AOT. Most of what I wanted to say is said in the previous point about that. The one thing that really does stand out for me is the question of why when virtually every state has an AOT law why we even need to have a national law. In the queen of AOT heaven in New York 2000 people out of 675,000 people in the system are served per year. That translates into 1/3 of 1%. The biggest problem with AOT is simply that for the most part it is inconsequential. The idea that it is a far ranging reform for the mental health system just doesnt look at the facts. One of the justifications for AOT is the idea of anosognosia. Supposedly 50% of the people with severe mental illness dont know they have a problem and that is why they need to be committed. If you do the math in New York state that means about 370,000 people should have anosognosia. AOT serves 2000. 368,000 are missing.
He says that the bill by funding AOT would support the Olmstead decision about individuals being served in the most intergrated setting. The bill in whole identifies people with mental illness as people who should not be allowed to make decisions for themselves and that pose a real and increasing risk to the community. Somehow that doesnt seem like inclusiveness. And the assumption that Jaffe makes that the bill through the use of AOT would reduce people being in jails is one giant assumption. More than anything I just think it would be inconsequential. Again think New York. 1/3 of 1%
In his final point Jaffe talks about research showing peer support programs dont work. He does say what research or how that conclusion is reached or does he mention the reams, literally reams of research, that show exactly the opposite. I guess if he says it must be true. At least he seems to think so.
I think this post is too long and apologize for that. Jaffe says so much it seemed important to try to deal with as much of it as possible. You may find things misstated in your opinion or that I have taken liberties with Mr. Jaffe’s ideas that are not warranted. That is ok. It is not my intention. And if I have I certainly apologize.
The mental health system is in trouble we all know that. Personally I believe the Murphy Bill (at least the parts he did not borrow from other people’s bills) is not reformation but deformation. It seems that Mr. Jaffes ideas are normally accepted as gospel and that is a shame. He can say the most outrageous things and as long as he does it with passion and outrage it seems that little he says is seriously questioned. We can do better.
The bigger truth and more important truth that Jaffe does show is the deep divisions among those people who care about mental health. Jaffe is right when he says the treatment of those with mental illness in jails and prisons is a national disgrace. But until a vision can be developed that unites people in their common concerns I wonder how much chance of real change there is.