The Murphy Bill was originally supposed to be a response to the tragedy in Newtown. It was supposed to be the “It’s not about guns it’s about mental health” statement that would protect Congress from all those people who felt like it would be harder to shoot people with guns if it was harder to get guns. It hasn’t really worked out that way. The bill has never made it out of the first committee and mass shootings occur on almost a daily basis.
Tim Murphy is the only living psychologist in the Congress and when he was anointed by the Republican leadership to craft a response to the tragedy it seemed an understandable choice. The Republicans wanted to show that they were about more than noise and sound bites and wanted to show they could actually be part of the governing process and show they could address an issue that everyone agreed needed addressing.
The bill was hijacked from the start by the Treatment Advocacy Center (TAC). The TAC is a small group that believes it is the only group that works for the interests of the “seriously mentally ill.” The agenda of the Murphy Bill and the agenda of TAC were one and the same. Rep. Murphy may have been the face, but Dr. Torrey and company seemed to everyone to be the voice of the Murphy Bill.
The promotion of the bill quickly became about casting blame. Anyone who disagreed with the bill was castigated as lacking integrity and true care. They were told all they really wanted was to promote their own agendas and programs at the expense of those who really needed help.
Problems with the mental health system they said in article after article were due to the lack of integrity and selfish efforts of so many in the system. It was a scorched earth policy that eventually left the people whose support Murphy needed feeling alienated, attacked and angry. The bill self destructed.
The original bill was a banquet of poison pills. There was something for everyone to hate.
The center piece of the bill was Assisted Outpatient Treatment (AOT). AOT was the law already in over 40 states and no one ever explained why it needed to be a national law. Nobody explained why in so many of the states where it existed it was often used infrequently. Nobody talked about the concern with costs that many states had. Nobody talked about why many of the states that had passed AOT laws never thought it would be used for more than a few people and would have laughed if you told them it was the centerpiece of major mental health reform. Nobody ever explained why if the mental health system was so bad how committing someone to that system was so good. Nobody ever talked about how a program that in its most expensive and largest incarnation only served 1/3 of 1% of the population in the mental health system could or would ever serve the large numbers of people in jail and homeless that the Murphy people insisted it would. And nobody every explained why the states that had it should be free to have it but the states that didn’t should be punished for not having it and their funding taken away. It was bad policy and bad government and I don’t think Rep. Murphy even begins to understand why.
I wondered why a conservative Republican would be so insistent on forcing Federal control of the decisions states made about their mental health programs. I still wonder.
And no one and I mean no one ever explained the simplest thing. How could they go on about the huge numbers of people failed by the mental health system and then say the answer was simple. People who didn’t know they had a problem needed to be forced to get the help they didn’t know they needed to get. Period…. In one way or another, either professionally or personally, I have been involved with the mental health system my entire life and that seemed like the most simplistic nonsense I have ever heard.
Psychiatric hospitalization was the next cornerstone. The IMD exclusion needed to be repealed so as to allow more people to be hospitalized more often. According to some not to do so was a violation of their civil rights. (It makes no sense to me either.) According to Rep. Murphy many of the ills before us like homelessness, and the incarceration of hundreds of thousands of mentally ill were basically the result of a defiency in psychiatric hospitalization and could only be cured by us having enough beds for enough people.
Like so many features of the bill it was fundamentally just not very honest. We were told that the fall of psychiatric hospitalization was the result of Samhsa, greedy providers of community services and the ever present ever dangerous psychiatric survivor community conspiring in some kind of way to keep help from getting to those who really needed it. Nobody talked about the lack of proof that long term psychiatric hospitalization did little more than prepare people to be life time patients. Nobody talked about the fact that there was little if any proof that many of the people who were hospitalized long term actually needed it. Nobody talked about the trauma and victimization inherent in the process. Nobody talked about the fact that no insurance company would pay for it anymore and anyone trying to justify the medical necessity of it would be laughed out of the building. Nobody talked about the financial toll on state systems. Nobody talked about way too little bang for way too many bucks. Nobody talked about the impact of the IMD exclusion being lifted on the budget. Rep Murphy said it would be budget neutral and came across as someone trying to sell ocean front property in Arizona. No one seemed to think it had anything to do with justice and no one talked about the lives that would be lost or shut away or wasted away for “their own good.”
The ship on psychiatric hospitalization had sailed a long time ago. We wasted some time this past year talking about new asylums but in the end hospitals make no financial sense. Beds may be added here and there. Some beds may be lost. But I see no appetite for this in any state that I am aware of.
Much of the Murphy Bill was about force and coercion. It was we were assured psychiatrically sound and anyone who did not understand that was not very realistic. Sometimes rights got in the way and for the good of people served they needed to be put on hold. Coercion doesn’t really play well with human rights and another central feature of the Murphy Bill was an effort to pull the plug on anyone who might complain.
The PAIMI programs whose mission was to protect rights needed to be disemboweled we were told and the bill proposed to do that. One major incident was held up as indicative of the whole program, a straw man was created and the attempt was to hang the entire program from that gallows. It never had much of a chance of success. I don’t think Rep Murphy truly ever understood that for some people respect for human rights might be the cornerstone of mental health reform rather than an impediment to it.
Rep Murphy was obsessed with getting rid of SAMHSA. They were the fount of all problems and getting rid of them was the core to any solution to what ailed the system. The passion seemed very personal for Rep. Murphy and people I knew in Washington said they thought it was. The congressman just didn’t like Pam Hyde and she felt the same way about him. To my knowledge it was the only time a legislator who didn’t like the way an agency was being run decided to fix it by abolishing the agency and then bringing it back with a different name and different director. Murphy even went so far as to propose that in the future grant proposals from states needed to be brought before the appropriate congressional committees (his) before they were approved. The absurdity of the idea that Congress was doing so well that it needed to have oversight over the day to day operations of an agency in the executive branch seemed lost to him.
For a long time I thought this might be the feature that ended up derailing the whole bill but with the recent resignation of Pam Hyde I wonder whether or not this is now the feature most likely to happen. I don’t think the nonsense about congressional approval of state grants is likely to happen but maybe SAMHSA may be getting a new name if any of this ever gets to the point of actually being voted on.
Mental health reform doesn’t happen much on the national level and many people wanted something to happen. Rep Murphy knew that and tried to do what he could to sweeten the pot with proposals that many people wanted from suicide prevention to the Excellence in Mental health care act and so on. The hope was to be seductive enough to convince people they could live with things they couldn’t live with to get things they didn’t want to live without. By and large it failed the first go around. But Rep Murphy did not give up and some people have come into the fold for Murphy 2.
The bill crashed and burned. The pilot AOT projects he snuck into a different bill were not funded but everyone knew that a new year would bring a new Murphy Bill and it has.
AOT became a carrot instead of a stick. States would be payed extra for adopting it instead of being punished for not doing it. In the Senate bill even that was watered down and it remains to be seen how much AOT will be part of the final version of anything. The important thing to know is that Rep. Murphy believes and if anything ever does get to the point of actual law he is no where close to giving up the fight on it.
Much of the bill remains as it was in the original bill even if the tone is somewhat softer. Dr. Torrey is no longer the omnipresent spokesperson. That mantle goes now to people like Rep Kennedy. MHA got a new president and Rep Murphy found him a lot easier to deal with than the old president who remains opposed to the bill. MHA talks now about level 4 thinking on mental illness (I don’t really know what that is I confess. I think maybe he made it up.) and since Rep Murphy has said he too favors screening and early screening in particular that MHA likes they are now in favor of the bill. Dr. Jeffrey Lieberman, former head of the American Psychiatric Association, has come out in favor of the bill since it gives him a platform to proclaim that psychiatry does indeed know best and to tell everyone that Robert Whitaker is to blame for everything.
The real problem with this bill goes past any specific feature of it. It says that the mental health system should only be about one story. People have a genetically based predisposition that can be diagnosed and treated. Everything is about deciding what people got and getting them to accept the prescribed treatment for whatever it is. We are to trust an industry that seems intent on medicating the entire world almost and to accept the faith they have the answer. The research about trauma, victimization, and hurt is ignored in this bill. It pays lip service to the notion of peer support and then tries to define it in a way that will make many of of the people who are peer support specialists no longer peer support specialists. It rests in the faith that the mentally ill are dangerous and tries to sell us on the idea that a more coercive system will make us a less violent people. It defines a large group of people as marginal and somehow lacking in the rights and privileges that others have. In the end it promises a lot and delivers little.
It does not give us a more honest system but builds a system that would allow less questioning.
It does not give us a system that would connect us more with those who suffer and need help but would justify their exclusion from the larger community (of course for their own good.)
It does not give a system that sees life as something more than a medical problem. It puts no brakes on the runaway medication of ordinary human life experiences.
It gives us a system that would treat a psychiatric diagnosis as the most real thing about a person instead of their goals, their passions and their ability.
In a land that prides itself on the promise of a better life for its people it would tell us that for many people life would never get better and they just needed to accept it.
It ignores things like poverty, racism, crime, trauma, homelessness, drugs and alcohol and a million other things that cause and give rise to human misery and instead treats that misery like a disease.
And finally for many people in profound distress really needing help it would teach them once again that government action has little to do with making their life better and holds little promise other than the creation of another burden to deal with.
I don’t think the Murphy Bill will happen this year. Perhaps I am wrong but for many reasons I don’t think so this year. Next year will be a much harder fight though. The Senate bill seems to have the support of much more of the leadership and may indeed make it likely something may happen.
But there is another reason I think next year will be tough. We continue like I said earlier to be plagued with almost daily gun tragedies. Nobody in Congress wants to deal with the NRA and a mental health deal, any mental health deal may be the only answer they have.
So it is very important that people speak. We don’t always do that well. Sometimes we seem more skilled at fighting with each other than fighting for the concerns we share. My hope is that we find a way to let shared concerns unite us in effective action.
If we don’t there probably won’t be a need for another Murphy Bill because we will have a Murphy law.
We need to share a vision of a better way to do things. We need to share a vision of the possibility of better life that fulfills the promises of this country instead of giving us reason and justification for our failure to do so.
I found an old post that explained some of what I believed could and should happen from a mental health reform bill that is more than noise and clamor:
There would be a range of services availible reflecting the human needs of those it serves.
Those services would be availible to those that need them.
Those services would be based on what works, not what makes money, reflects any particular philosphy or interest, and not because it is what we are used to doing.
Asking for help would not label someone, brand them, be a cause of shame, a source of discrimination. Asking for help should not be a problem.
It would realize that lack of a place to live, lack of food, lack of adequate clothing, lack of a job are frequently barriers and problems for the people they serve and address them in a direct and effective manner.
It would know that inadequate health and inadequate health care are common problems for the people they serve and be part of an effort to serve the entire person in an integrated fashion.
The goal would be to empower, educate, and support people towards gaining control over their lives so as to maximize their chances of leading happy, meaningful and successful lives.
This would not be empty words, but a passionate conviction that fuels and structures everything done in the system.
It would not mistake the people it serves for the labels it places upon them.
It would know that the most important thing about help is that it is what you do with people and not what you do to them. It would see itself as partnering with the people it serves.
It would know that people can say no and that not be a symptom of illness or distress.
It would view peoples values, hopes, thoughts, and aspirations as a source of strength and not a symptom of illness.
It would take substance abuse ultimately seriously. Drinking and drugging are the two primary ways people with mental health issues try to treat themselves.
It would make sure that one of the core experiences that someone seeking help has is contact and interactions with others who have dealt with similiar issues. It would treat seriously the idea that you can learn from the experience of others and them from you.
It would not tell people who have hard times or more problems they have failed or are failures.
It would take the issue of trauma seriously. Knowing how people have been hurt and not being part of hurting them further should be cornerstones of the system.
It would treat the issue of what happens in jails and prisons to people with mental health issues as a moral outrage and the impulse to do something about it as a moral necessity.
It would be honest about the risks and benefits of psychotropic medication. Help people to make real and informed choices.
It would treat families as important and not as irrelevant or a threat to what it is doing.
It would treat justice as a driving force and value in everything it does.
It would be honest with the people it serves about what it doesnt know if it wants them to have trust in what it does know.
It would attack the issue of suicide with passion. No one should ever feel like death is the best solution to life.
It would tell people that no problems make you less human,
It would view hope as realistic and know that when they dont they do more harm than good.