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Could This Be the Year for Mental Health Reform?

This might just be the year for mental health reform in Congress.

A few months ago, practically no one would have said that.

But on Wednesday of this week, the House Energy and Commerce Committee voted 53-0 to send H.R. 2646 - a significant mental health reform bill - on its way, most likely to the House floor for a July vote.  And in recent weeks, a Senate bill has gathered steam, too, and that chamber could also now take up this legislation this summer.

So what happened to make mental health reform a real possibility?

First, members of Congress sincerely wanted to do something.  The House proposal, sponsored by Rep. Tim Murphy of Pennsylvania and Rep. Eddie Bernice Johnson of Texas, has 199 co-sponsors as of today.  Our mental health system has been in disarray since - well, since as long as anyone can remember.

Second, members have finally decoupled mental health reform from gun control.  Mental illnesses and violence have never been strongly correlated, but you wouldn't know it from the headlines.  It has taken a lot of effort to change this perception, but it is - finally - changing.

Third, advocates stopped fighting among themselves.  In the past, we made it easy for lawmakers to dismiss us because we frequently dismissed the ideas of one another.  But this past year, advocates joined together and sent a message that if Congress could compromise, so could we.  

The idea of acting "before Stage 4" helped to bring all sides together.

No reasonable person thinks that mental illnesses should be treated in jails and prisons today, but a jail or a prison is the largest mental health facility in nearly every state today.  We didn't de-institutionalize our people with mental illnesses in the 1980s, we re-institutionalized them.  We didn't just close the custodial care institutions we called state hospitals. We re-opened them as county jails and state prisons.

We applied a non-clinical standard - danger to self or others - as a trigger to treatment, and we made mental illnesses the only chronic conditions we waited until stage four to treat.

And so when we began to argue that what we needed was early identification, early intervention, integration of health and behavioral health services (along with education, employment, housing, and social supports), with recovery as a goal, we advocates had language we could all rally around.

It took a major shift in thinking to move the policy needle this far.

We had to remind ourselves - and our policy leaders - that half of all mental illnesses emerge by the age of 14; three-fourths by the age of 25.  We're talking about our children here.  We had to face the fact that among all leading causes of death, suicide rates are the only ones that have continued to rise. We had to argue in the face of billions of dollars of cuts to mental health programs around the country, we needed more money, not less.  And we all had to advocate for a stronger federal presence in the mental health policy field, not a weaker one.  

And our policymakers responded by laying a foundation in their proposals on which we can build today and in the future.

There's plenty of credit to go around for the progress we have made, but there is much more to do, too.

There wasn't a single major advocacy organization that didn't step up this year to help get legislation moving, and many members of Congress have worked together on some very heavy lifting to get us this far.  To name just a few more in addition to Reps. Murphy and Johnson: Rep. Joe Pitts, Rep. Gene Green, Rep. Fred Upton, Rep. Frank Pallone, Rep. Doris Matsui, Rep. Grace Napolitano, Rep. Paul Tonko, Speaker Paul Ryan, Sen. Chris Murphy, Sen. Bill Cassidy, Sen. Lamar Alexander, Sen. Patty Murray, Sen. Al Franken, and so many more.    

We're indebted to them already, and can only continue to support their efforts to make reform a reality.  But everyone agrees that these proposals are just a start.  We'll need to do much more in the future, so our legislative agendas aren't going away.

Mental Health America issued its first legislative agenda back in 1913.

Back then, we had a different name.  But our agenda was eerily similar to what it is today.  We called for universal mental health screening for children, for an end to the use of prisons and poorhouses to warehouse people with mental health conditions, for integrated services, and for a focus on recovery.

We know we've made progress.  But if the people of a hundred years ago could see what that progress has looked like so far, I think they would be disappointed in us.  We have made some bad policy choices in the past.  But today's policy leaders are being presented with an almost unbelievable opportunity to make a good one.

Paul Gionfriddo is President and CEO of Mental Health America, the nation's oldest mental health advocacy organization. He is the author of Losing Tim: How Our Health and Education Systems Failed My Son with Schizophrenia. This is his personal blog, representing his own views. Most of the blog posts were written before he joined MHA in 2014.  Because it has a small but loyal readership each month (roughly 10,000 visitors) he has added new blogs from time to time.  Most of Paul's writing is now captured on the MHA blog at www.mentalhealthamerica.net.  Follow Paul on Twitter: @pgionfriddo, or contact him via email about this blog at gionfriddopaul@gmail.com.
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