In the spotlight

The "Helping Families in Mental Health Crisis Act” (H.R. 3717)

The Helping Families in Mental Health Crisis Act (H.R. 3717) is a large overhaul of the nation’s mental health system.  The intent is to focus “programs and resources on psychiatric care for patients and families most in need of services.[1] Mental health groups are split on whether to support it or oppose it.[2]

Among other things the bill, proposed by Representative Tim Murphy, would “increase access to acute care psychiatric beds for the most critical patients,”[3] provide funding for Assisted Outpatient Treatment (AOT) as an alternative to long-term in-patient care, provide for Medicare and Medicaid reforms, apparently including more medication coverage, and increase funding for certain research by the National Institute of Mental Health (NIMH).[4]

PWDF supports aspects of this bill, including funding for research, expanding Medicaid coverage of treatment, linking primary care physicians with psychiatrists or psychologists through tele-psychiatry in order to better serve underserved and rural populations, training to first responders on how to recognize and properly intervene with individuals with mental illness, increasing education about reducing the stigma of severe mental illness in schools, and allowing for more physician volunteers by revising the Federal Tort Claims Act.

Although well-intentioned, several provisions of the bill are of concern because they could erode the civil rights of persons with mental illnesses.  The bill as currently written will reduce privacy protections under the Health Information Portability and Accountability Act (HIPAA), will restrict advocacy provided to people with severe mental illness, and may not provide adequate protections against involuntary commitment.

HIPAA:  The bill would require health care providers who are covered by HIPAA to disclose protected health information to the caregiver of a person with a serious mental illness who does not consent to disclosure when the service provider “reasonably believes it is necessary” to protect the health, safety, or welfare of the individual or the safety of other individuals.[5] The bill does not provide for a judicial or other check to ensure that the non-consenting person’s privacy is not unnecessarily violated.  PWDF recommends shifting the burden of making HIPAA less restrictive from the patient to the "caregiver" who is trying to force the consumer into treatment, either as an in- or outpatient.

AOT:  The AOT is intended to promote alternatives to long-term inpatient care and incarceration.  The bill will provide grants for programs that allow courts to more easily order outpatient mental health treatment for eligible patients while they live in a community.[6]

While the bill lists criteria for an “eligible patient,” there is still concern about how the various state laws that enable AOT will be applied and not abused when seeking involuntary commitment.  Additionally, the bill lists the criteria for “eligible patient” in two sections, but with slightly different wording: one would require a narrow reading but the other could enable a very broad reading of who could be ordered to undergo treatment.[7] PWDF recommends the bill be modified to include safeguards, including but not limited to the burden shifting discussed above, to prevent AOT programs from being over-used and abused.

Advocacy:  The bill prohibits advocates who receive federal funds under the Protection and Advocacy for Individuals with Mental Illness Act (PAIMA) from “counseling an individual with a serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of such individual’s caregiver.”[8] This can be particularly problematic when the clients are seeking or need advice about changing caregivers or when the client’s relationship with the caregiver may be the reason for mandatory treatment. 

PWDF urges more discussion and consideration of how to ensure that the bill provides its intended benefits without eroding the civil rights of persons with severe mental illnesses and eliminating restrictions on the legal advice that may be provided.

PWDF Profile

Who We Are

People With Disabilities Foundation is an operating 501(c)(3) nonprofit organization based in San Francisco, California, which focuses on the rights of the mentally and developmentally disabled.

Services

Advocacy: PWDF advocates for Social Security claimant's disability benefits in eight Bay Area counties. We also provide services in disability rights, on issues regarding returning to work, and in ADA consultations, including areas of employment, health care, and education, among others. There is representation before all levels of federal court and Administrative Law Judges. No one is declined due to their inability to pay, and we offer a sliding scale for attorney's fees.

Education/Public Awareness: To help eliminate the stigma against people with mental disabilities in society, PWDF's educational program organizes workshops and public seminars, provides guest speakers with backgrounds in mental health, and produces educational materials such as videos.

Continuing Education Provider: State Bar of California MCLE, California Board of Behavioral Sciences Continuing Education, and Commission of Rehabilitation Counselor Certification.