A proposed law would make it easier for the mentally ill to be treated, but would it come at the expense of their rights?
WHILE THE SPATE of recent mass shootings has done little to shift the debate on gun control, it has sparked another discussion - about treating Americans suffering from severe mental illness. And a Pittsburgh-area congressman has been at the forefront.
In December, shortly before the oneyear anniversary of the Sandy Hook school shooting, Republican Tim Murphy introduced a massive overhaul of the country's mental-health system, known as the "Helping Families in Mental Health Crisis Act."
Murphy, a psychologist, has accused some federal mental-health agencies, like the Substance Abuse and Mental Health Services Administration, of being ineffective, and says patient-privacy rules need to be changed in order to protect the public from those who pose a theat. He hasn't been shy about linking mental-health treatment to events like the May shooting at the University of California, Santa Barbara: The shooter in that incident, Elliot Rodger, was reportedly being treated for mental illness.
In a statement, Murphy said he was "angered because once again, our mentalhealth system has failed and more families have been destroyed. How many more people must lose their lives before we take action on addressing cases of serious mental illness?" (The congressman did not comment for this story before press time.)
Some aspects of Murphy's bill - like extra funding for suicide prevention, and training police to better spot mental-health problems - are widely popular. Others are more controversial, such as a measure allowing judges to force some patients into "mandatory outpatient" treatment, in which patients are ordered to take medication or risk jail. Also controversial are provisions allowing doctors to share more confidential information about patients' mental health with caregivers.
The bill is supported by groups like the American Psychiatric Association and the National Alliance on Mental Illness.
"Up until now, almost all mental-health legislation has been aimed at helping the highest-functioning individuals," says DJ Jaffe of Mental Illness Policy, a New Yorkbased group that has vocally supported Murphy's bill. Jaffe says Murphy's bill is the first to "address the elephant in the room" - the roughly 4 percent of individuals with severe mental illness who Jaffe says do not benefit from the current approach.
"These are people who usually have a past history of violence and incarceration and who have gone off of treatments," says Jaffe. Murphy's bill, he says, "provide[s] an off-ramp at the edge of the cliff rather than an ambulance at the bottom of it."
But portions of Murphy's bill remain contentious, with some saying it may stigmatize mental-health treatment, infringe on patient rights and reverse progress made in humanely treating mental-health issues.
"This bill is very broad-reaching in an effort to help a minority of the population affected with mental-health issues," says Laurie Barnett Levine, executive director of the Westmoreland County office of the advocacy group Mental Health America. Murphy's bill, she says, could strip rights and services from those with mental illness: "For example, they talk about 'assisted outpatient treatment,' but it's not assisted - it's coerced. And if you coerce people into treatment, it's not as effective because they're not engaged."
Barnett Levine also worries that Murphy's approach will lead the public to believe people with mental-health concerns "are more dangerous, when they are actually more likely to be victims and not perpetrators." According to a roundup of studies on the topic by the Treatment Advocacy Center, which supports Murphy's bill, multiple studies have shown this to be the case.
A better approach, Barnett Levine says, would be "to get people at the beginning to work on prevention. But this bill would strip a lot of funding from those programs." Murphy's approach would emphasize "evidence-based" treatment - including medication - at the expense of approaches like peer-to-peer therapies, which include outreach and treatment plans developed by trained and licensed peer specialists in the state. Barnett Levine says the program, which could see drastically reduced funding under the Murphy bill, allows individuals to get assistance from someone who has "been there, done that."
Under Murphy's bill, she worries, "We would lose a lot of very promising, cuttingedge programs. Even though you may not be cured of your mental illness, these programs make you realize that you can live very full and rich lives."
"We used to have hundreds of thousands of mentally ill patients in institutions: Now we have that many in jail or living on the streets," counters Jaffe. "As bad as hospitals were, they were not as bad as jail. A mentally ill person incarcerated - that's abuse. Trying to get them help is not."
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