Below are a series of guesses. More than one is deeply cynical. None of them reflect necessarily what I think should happen as much as what I think might happen. The Murphys in a weird way have become almost a soap opera with good guys becoming bad guys, endless plot twists and lots of drama. I don’t mean to in anyway to downplay the significance of what ultimately happens, but the process is riveting.
I most certainly have no special knowledge. This is my attempt to make sense of what has often made no sense to me and should be taken as speculation. The whole drama has been on the whole alternately enraging and confusing. Perhaps it makes a different sense to you. I don’t know.
1. No bill will pass as a partisan bill. The Republican celebration of the Democratic failure on mental health will never see the light of day. If there is not some consensus at the leadership level nothing will happen.
2. No bill will pass that paints the dysfunction of the mental health system as a failure of Barack Obama will pass.
3. The incredible dysfunction of both the Senate and House make it highly unlikely that anything of major importance will pass. A Senate victory does not automatically mean a House victory and vice versa.
4. While there is considerable overlap between Senate and House versions there is also considerable difference and there is considerable question in my mind how far Tim Murphy will bend. He might have to bend on issues he doesn’t want to bend on to get anything he wants.
5. There will probably be an effort to shut down the government about planned parenthood in the fall. How much that will blow everything out of the water is anyone’s guess.
6. So far no presidential candidate has mentioned any of these bills. If one does, particularly if he is one of the more divisive candidates that may affect things. A bill is not going to be passed in an election year that gives one candidate a victory over another. Part of me believes nothing will happen in an election year.
7. I personally doubt any of these bills will pass as written. Nothing that costs a lot will make it and some provisions will cost.
8. Some items of the Senate bill are an indictment of the House bill. AOT as the centerpiece of any legislation is dead. The 2 year extension in funding for the AOT pilot program is more of a bone thrown to Tim Murphy to allow him to save face than a real victory.
9. Similarly the attack on Paimi is not going to fly. There is considerable sentiment in the Senate against both. A major key with the large assumption that Tim Murphy makes it through the House is how much he is willing to bend in a conference committee.
10. People I trust have told me that Tim Murphy is not making it out of the committee as written. It does have support but has strong opposition at high levels and an attempt is likely to be made to craft another effort.
11. With the resignation of Pamela Hyde the chances of her job being renamed is possible. Nothing will be passed that gives a Congressional committee oversight over the day to day operations of that agency like Tim Murphys bill suggests though. I think the renaming may be the most likely change to happen.
12. The IMD exclusion may sink the whole thing. It is likely to cost a lot of money. Also saying something can happen doesn’t mean it will. I don’t see Tennessee going back to psychiatric hospitalization. They have made a decision to commit to community treatment and are not likely to go back. There are costs that will not be paid by Medicaid that would probably make it impossible with state funding to go in that direction.
13. The advocacy community is much more splintered this time than last. Many organizations have decided to basically go it alone and everyone’s voice will be diluted. Some people are as angry at others in the advocacy community as they are at the Murphys. The loss of common voice so obvious with Murphy 1 may make it more likely something will pass.
14. Both bills require a report in 18 months comparing the effectiveness of voluntary treatment with AOT. I rarely see anyone mention this report but wonder even if AOT is down for the count this time if it will not come back in 18 months as “proven by government research” and the battle have to be refought. I do not see either Rep Murphy or Dr. Torrey going away easily.
15. The biggest problem with the bill is that it ignores the issue of social justice. Poverty, hunger, racism, trauma and victimization are all central to what it means to struggle with mental health issues in this country. I don’t see where this bill addresses the issues of police violence and the institutionalized trauma of the correctional system. I don’t think it makes anyone more likely to seek help when they need it. I don’t think it takes the notion that people with mental health issues can find a better life as central or core to what mental health reform should be about. It doesn’t understand the consequences of what a mental health diagnosis can mean in a person’s life. It falls short on many levels.
16. I may be wrong with every comment I have made. There are many obstacles to action but something may happen. The chances of major mental health reform are few and far between and many people want something to happen and if they are convinced that might get something they want or think is important they may decide they can live with what they don’t want.