I write to you today in opposition to HR 2646 “The Helping Families in Mental Health Crisis Act”. I believe this act as written is bad for Tennessee. It makes promises it doesn’t deliver on, lacks understanding of the mental health system in Tennessee and in fact would impose ineffective programs in Tennessee and put in danger some of the most promising and effective initiatives we have.
The bill promises states a 2% increase in block grant funding for states that have assisted outpatient programs (AOT). AOT is a program that mandates that an individual agree to take part in outpatient treatment. Tennessee tried a pilot AOT program the past two years. In two years it served one person at the cost of 20,000 dollars a person. Proponents insisted that the program would fulfill an important role in the Tennessee mental health system but the reality never matched the hype.
The problem in Tennessee, the challenge facing the system, has not been in forcing people to get help they may not believe they need or want. It has been in developing an adequate array of effective services that people needing help can access as needed. The problem in Tennessee has not been people not wanting help. It has been people not finding help or not being able to access the help that is there.
Under the leadership of Commissioner Doug Varney the Tennessee Dept of Mental Health and Substance Abuse Services has done a great job in using limited resources in innovative ways. The last thing it needs is to be told that a program already failed in Tennessee is going to be imposed on it to get needed funding. If bonuses are to be given I can think of several innovative programs in Tennessee that should more than qualify for any bonus given. For example, Crisis Stabilization Units for the first time serve as many people as state psychiatric hospitals at a fraction of the cost and with greater effect. Crisis Stabilization Units (CSU) are small voluntary programs set up to serve people in emotional crisis and tie them to needed community resources to maintain stability and coping in their communities. Many of them would have been hospitalized without the CSU’s. Tennessee deserves any bonus. AOT should not be a requirement to get it.
This bill would drastically and at great expense on both the state and federal level increase the amount of psychiatric hospitals beds by repealing the IMD exclusion. I urge you to contact Commissioner Varney directly and ask him if Tennessee needs more psychiatric beds. What Tennessee has found is that without adequate community services you can’t build enough psychiatric hospitals and that psychiatric hospitals eat up the funding needed for community services.
Tennessee is a leader in developing options to hospitalization which is by far the most expensive way and one of the least effective ways to help people with mental health needs. The CSU’S are only one initiative. This fall Tennessee will unveil a “Peer Engagement Program” that will target everyone in the state hospital system and try to decrease the tendency of too many people who are hospitalized to end up returning to the hospital. Aside from being the right and kind thing to do it promises to be a much better use of the financial resources in the system. The answer is not more resources to separate people but more resources to allow them to be successful members of their community.
SAMHSA is a major villain in the story this bill tells. Before accepting what you are told I urge you to contact Commissioner Varney and ask him about what SAMHSA has brought to the Tennessee mental health system. Many innovative and effective services have been implemented with SAMHSA help. It can certainly do a better job but be careful. It always costs more to fix things not broken.
There are a lot of problematic provisions in this bill. There is not space here to adequately even mention them let alone discuss them in depth. The proposal to eviscerate the protection and advocacy programs like PAIMI (Protection and Advocacy for Individuals with Mental Illness) is the last one I will mention. That program in Tennessee was primarily responsible for tremendous improvement in the Adult Group Homes system in Tennessee. They uncovered a whole realm of problems that under this bill would not have even been legal for them to even talk about. Contact Lisa Primm at Disability Rights Tennessee to hear more about this.
This letter scratches the surface of this bill. It is not good for Tennessee. Before you make a decision to support it I hope you will, as I have suggested talk first hand with people who know mental health in Tennessee and both what has been accomplished and what is needed. This is too important to be decided by political rhetoric.
We need a bill that matters and addresses the needs of Tennesseans. This is not it.
I would love to talk further with anyone who would like further information.