Mt. Vernon Register-News

Opinion

December 24, 2013

Law could finally fix mental-health care

In the wake of gun violence such as occurred at Sandy Hook Elementary School and Virginia Tech, commissions are organized and institutional reviews are conducted. Rarely, however, are meaningful reforms proposed.

The legislation recently introduced in the House of Representatives by Tim Murphy, R-Pa., is a refreshing change. The Helping Families in Mental Health Crisis Act of 2013 addresses a long list of inadequacies in services for people who suffer from schizophrenia, bipolar illness, major depression and other severe conditions — problems that Murphy uncovered in his yearlong investigation of the U.S. mental- health system.

These flaws begin with the dubious “recovery model” of treatment, extolled by the Substance Abuse and Mental Health Services Administration, the federal agency charged with administering $440 million in state block grants to fund community mental-health facilities. The recovery model is based, in SAMHSA’s wording, on “change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential.”

This may work for certain high-functioning patients. But for those languishing in back bedrooms and flophouses because they are too paranoid, oblivious or lost in psychosis to “self- direct” their lives, it amounts to malpractice.

By focusing on “recovery,” SAMHSA promotes only a handful of treatment programs aimed at the sickest patients.

Meanwhile, the agency fails to recommend “assisted outpatient therapy,” a form of civil-court-ordered community treatment for patients who are known to be self-destructive or dangerous when off their medication.

Much research has shown this therapy to be extraordinarily effective for people with severe mental illness.

The Murphy bill would set things straight by taking away SAMHSA’s authority to administer the mental-health block grants and turning it over to a new assistant secretary for mental- health and substance-use disorders. It would also fund assisted outpatient therapy programs and require that each state have a law on the books to administer them as a prerequisite for receiving block grants.

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