The Mental Health Mission of Rep. Tim Murphy

“Those with serious mental illness (SMI) do recover and can lead fulfilling lives, but an astounding 40 percent of the 10 million Americans with SMI are not in treatment. And, even when care is delivered, it is often delayed for more than two years after the illness first appears.”

Is this a quote from one of our APA leaders? From the National Institute of Mental Health (NIMH)? From the chair of a department of psychiatry? From a major advocacy organization?

No. It is the opening paragraph of the webpage describing the Helping Families in Mental Health Crisis Act, which was first introduced in Congress in 2013 and is slated for reintroduction at press time. It’s one reason the APA Board of Trustees, in December 2014, voted unanimously to “support the bill as the vehicle to achieve comprehensive mental health reform.” The bill was written by U.S. Rep. Tim Murphy (R-Pa.), and its lead Democratic cosponsor is Rep. Eddie Bernice Johnson (D-Texas).

At APA’s 2014 annual meeting, Rep. Murphy spoke to the APA Assembly. His speech received a prolonged, standing ovation: He had made clear his goals and his determination to serve people with SMI and their families, as well as his strong support for psychiatrists and evidence-based care.

Murphy is a clinical psychologist and a lieutenant commander in the Navy Reserve Medical Service Corps at Walter Reed National Military Medical Center, where he specializes in treating military personnel with posttraumatic stress disorder and traumatic brain injury. Rep. Johnson has her own hands-on experience with mental health care: Before entering Congress, she was the chief psychiatric nurse at the V.A. hospital in Dallas.

Rep. Murphy’s experience in delivering frontline patient and family treatment and understanding the limitations of our mental health system are evident in his unflinching drive to improve services for people with mental illness in this country. It’s no surprise that Rep. Johnson and scores of Democrats and Republicans have signed onto this effort. Rep. Murphy is a critical ally in our work as psychiatrists and for the mission of APA.

Like President Kennedy’s Community Mental Health Act in 1963, over 50 years ago, the Helping Families in Mental Health Crisis Act is both comprehensive and focused on the urgent mental health needs of our time. Its core elements include the following:

• Driving evidence-based care.

• Making explicit that families, the greatest source of support for most people with any serious and persistent illness and ongoing functional impairment, can work with the clinicians serving a patient—now often constrained by misunderstandings of the privacy rule under the Health Insurance Portability and Accountability Act (HIPAA).

• Integrating primary care and behavioral health care.

• Expanding crisis training for law enforcement officers and supporting the use of mental health courts to help people with serious mental illness get treatment—not wind up in jails and prisons, where their conditions worsen and society is made no safer.

• Placing overall federal mental health policy under an assistant secretary for mental health and substance use disorders.

• Expanding the availability of mental health services in terms of both community mental health services and psychiatric hospital beds.

• Increasing research funding for psychiatric disorders and innovative programs to improve treatment for first-episode psychosis (for example, the program Recovery After an Initial Schizophrenia Episode (RAISE; see Psychiatric News, October 17, 2014).

When it comes to improving mental health in this country, multiple, coordinated actions like these are greatly needed and long overdue.

Rep. Murphy’s bill has drawn controversy over two of its features in particular. The first is its support for assisted outpatient treatment (AOT), also known as involuntary outpatient commitment. But Rep. Murphy has been clear that he, like a growing group of organizations and distinguished individuals working under the rubric of the Opening Closed Doors Alliance, recognize that AOT is a last resort when a life-saving intervention is needed to provide care for those who are at highest risk for suicide, medical complications, or chronic impairment. AOT also is dependent on a functioning, adequately resourced community mental health system. It’s but one tool we need to help our patients.

The second is Rep. Murphy’s view that the country needs a federal mental health agency led by, and with the stature of, a presidential appointee who is in the senior leadership of the U.S. Department of Health and Human Services (HHS): an assistant secretary for mental health and substance use disorders (see page 12). The assistant secretary would coordinate federal programs and ensure that community mental health services block-grant recipients apply evidence-based models of care developed by NIMH. The Murphy-Johnson bill also seeks to use HHS budgetary controls to require the provision of evidence-based services and to limit funding for programs that may advocate and litigate against psychiatric services.

These two aspects of the Helping Families in Mental Health Crisis Act, as well as the HIPAA provision, have drawn concerns and opposition. But good government requires the art of compromise—of finding common ground to do the right thing. With Rep. Murphy as this bill’s author; a Congress whose two chambers are in political alignment; strong bipartisan support; and routine, high-profile public attention on the consequences of our failing mental health care system, the Murphy-Johnson bill stands a strong chance of becoming law.

As Winston Churchill liked to say, you will never reach your destination if you stop and throw stones at every dog that barks. There is no such thing as perfect legislation. We have a unique and rare opportunity to dramatically improve a system that desperately needs it. Rep. Murphy, supported by Rep. Johnson and a broad swath of Democrats and Republicans, is on a mission. We support that mission: Our nation cannot afford to wait another 50 years for legislation designed to fix so much of what ails our mental health system, a system that deprives far too many people of what they need to build lives of fulfilling relationships, work, and contributions. ■