I have read many criticisms of the Murphy Bill but there is one provision I don’t think I have ever heard anyone talk about. It sounds a little innocuous until you read it and think about the implications of it. It is a statute calling for a “report on the state of the states in mental health and substance abuse treatment. On the face of it that seems very appropriate and something long past due.
But when you read the provision several questions come to mind. (A portion of that section of the bill is reposted below. For the full flavor of the provision read the whole text in the bill.)
(c) Report on the state of the States in mental health and substance use treatment.—
(1) IN GENERAL.—Not later than 1 year after the date of enactment of this Act, and not less than every 2 years thereafter, the Assistant Secretary shall submit to the Congress and make available to the public a report on the state of the States in mental health and substance use treatment, including the following:
(A) A detailed report on how Federal mental health and substance use treatment funds are used in each State including:
(i) The numbers of individuals with serious mental illness or substance use disorders who are served with Federal funds.
(ii) The types of programs made available to individuals with serious mental illness or substance use disorders.
(B) A summary of best practice models in the States highlighting programs that are cost effective, provide evidence-based care, increase access to care, integrate physical, psychiatric, psychological, and behavioral medicine, and improve outcomes for individuals with mental illness or substance use disorders.
(C) A statistical report of outcome measures in each State, including—
(i) rates of suicide, suicide attempts, substance abuse, overdose, overdose deaths, emergency psychiatric hospitalizations, and emergency room boarding; and
(ii) for those with mental illness, arrests, incarcerations, victimization, homelessness, joblessness, employment, and enrollment in educational or vocational programs.
(D) Outcome measures on State-assisted outpatient treatment programs, including—
(i) rates of keeping treatment appointments and compliance with prescribed medications;
(ii) participants’ perceived effectiveness of the program;
(iii) rates of the programs helping those with serious mental illness gain control over their lives;
(iv) alcohol and drug abuse rates;
(v) incarceration and arrest rates;
(vi) violence against persons or property;
(vii) homelessness; and
(viii) total treatment costs for compliance with the program.
(E) STATE AND COUNTIES WITH ASSISTED OUTPATIENT TREATMENT PROGRAMS.—For States and counties with assisted outpatient treatment programs, the information reported under this subsection shall include a comparison of the outcomes of individuals with serious mental illness who participated in the programs versus the outcomes of individuals who did not participate but were eligible to do so by nature of their history.
(F) STATES AND COUNTIES WITHOUT AOT PROGRAMS.—For States and counties without assisted outpatient treatment programs, the information reported under this subsection shall include data on individuals with mental illness who—
(i) have a history of violence, incarceration, and arrests;
(ii) have a history of emergency psychiatric hospitalizations;
(iii) are substantially unlikely to participate in treatment on their own;
(iv) may be unable for reasons other than indigence, to provide for any of their basic needs such as food, clothing, shelter, health or safety;
(v) have a history of mental illness or condition that is likely to substantially deteriorate if the individual is not provided with timely treatment; and
(vi) due to their mental illness, have a lack of capacity to fully understand or lack judgment, or diminished capacity to make informed decisions, regarding their need for treatment, care, or supervision
What stands out about this provision?
1. This provision basically says that it is the policy of the United States Government to find justification for Assisted Outpatient Treatment and by implication for the expansion of AOT past its current level.
2. If you strip away the wordiness away the report asks for a description of AOT working and an accounting of how many people not served by AOT who could be. The report is due within a year after the act takes effect and every 2 years after that.
3. It is important to realize the significance of this. It means that while AOT provisions in the House bill may, by all accounts, not make it through the Senate bill this report basically is an end run around any vote that gives the federal government a basically permanent role in the promotion and expansion of AOT. Even if the final legislative decision is resoundingly against AOT (and I think it might be) the commitment to AOT is made through the back door. Does anyone not think Rep. Murphy and friends will not be back in a year preaching once again the expansion of AOT?
4. It is important to realize this provision rewrites the rules. It is not simply a decision to use “evidence based practices.” It is the decision by the federal government to spend the money and effort on proving a specific practice is “evidence based” and promoting that practice even though many people have extreme reservations about its effectiveness and moral standing. It is governmental overreach at its worst. It is bad government, bad choice, and a terrible precedent to set.
5. This may not be the most dangerous feature of this provision, as hard as that is to believe.
6. Look at the information the bill would require states to present.
7. No state that I am aware of has anywhere close to the level of information required by this provision. To get a sense of the task and the expense of the task consider this as you read below. The mental health system in Tennessee serves over 400,000 people. New York state I think is close to 700,000.
8. Rates of suicides, suicide attempts, overdose, overdose deaths , emergency psychiatric hospitalizations, emergency room boarding,
arrests, incarceration, victimization, homelessness, joblessness, employment, school, rates of keeping appointments are some of the data required. These are only some of the data required. Go back and read the list. It is not the requirement for data per se that is the problem. It is what that data requirement means.
9. For Tennessee (and I think virtually every other state I believe) it would mean they would need to develop a data base of virtually every person in the state with a mental health diagnosis with real time tracking of significant events in his life. In effect, the “mentally ill” would need to be registered so that the state could prove to the federal government that funds are being spent effectively.
10. It is hard to know what to begin screaming about first. A country that will not register guns thinks it is appropriate, needed, and indeed good business to register those with psychiatric labels. And all of this in the name of evidence based practice. Who is really mad?
This should fill you with both a sense of dread and a powerful sense of rage. I promise you your representatives have never closely looked or questioned what this provision means or what its ultimate dangers are. Please speak loudly and share this post with others.
The danger is real. Please act.