Saturday, January 31, 2015

The APA and The Helping Families in Mental Health Crisis Act

If you are not familiar with Representative Tim Murphy's legislation to overhaul America's broken mental health system, this post isn't for you.  The legislation died when congress convened, but Rep. Murphy is planning to reintroduce the legislation to this congress, and he has 115 co-sponsors for the bill.  In the last session, APA took no stance on the bill; they wrote a letter supporting the idea of legislative change and said they looked forward to working with Murphy on this.  Rep. Murphy has said that the new legislation to be proposed will have some changes, changes that APA finds more in alignment with member concerns, such as an effort to increase the mental health workforce (I believe through tele-psychiatry) and to increase the emphasis on parity.  The bills requirement that every state have an outpatient civil commitment program may include funding to other types of treatment such as mental health courts, and I'm not aware of any changes to the idea that HIPAA privacy rights to patients will be modified such that mental health professionals will be permitted to communicate with caretakers of people with severe mental illnesses if it's felt to be necessary for the patient's safety or welfare.  While the text of the bill has not been released yet, the APA has come out in support of the soon-to-be proposed legislation.

I was disappointed to see that APA supported this, and I'm planning to write an article on it.  If you're a psychiatrist and an APA member, I'd love to hear your thoughts and possibly quote you.  Feel free to comment here, or to contact me at shrinkrapblog at g mail dot com.  And as always, everyone's thoughts are welcome.  


Anonymous said...

The Helping Families in Mental Health Crisis Act will only discourage patients from sharing their family's contact information. I have not shared my parents' contact information with my psychiatrist and I haven't shared the name of my psychiatrist with my parents, so this law can pass but they still wouldn't be able to communicate. When I was in college and saw a psychiatrist through the student health center, I didn't share my parents' contact information with him either, because I had concerns that my privacy would not be respected. I love my parents, but I don't want my parents talking to my psychiatrist under any circumstances.


Anonymous said...

One of the many things that concerns me about this legislation, is that I really believe it will drive people away from seeking mental health care when they are in college. When I was in college if it had been possible for the psychiatrist to contact my parents without my permission, it would have stopped me from getting mental health care. If patients don't feel like their privacy is respected, then they're not going to talk to a psychiatrist. I know I wouldn't have.


Joel Hassman, MD said...

Not an APA member, and Murphy's credentials as a seasoned and well versed clinician as suspect at best. can't find the link I wrote about a year or so ago as trashed the blog post last year, but, there are challenges to how much a real psychology practice he provided since the early 90s at least.

One link, although over a year old, to offer one point of view about this "legislation"

then this one over 18 mos ago:

(yeah, I know, from MIA)

And the wikipedia link about Murphy specifically:

read and digest. Oh, and just remember this one thing, honest practicing of mental health and being a politician are not congruent agendas, in my opinion. You are not impartial and objective especially once in federal politics. Think about it.

Susan Inman said...

I realize how lucky families like mine in British Columbia are because we have the BC Mental Health Act. The Act allows for involuntary treatment for people who are considered a danger to themselves or others or who have become so ill that they can't take care of themselves. Additional legislation allows clinicians to share information with families that they need to provide continuity of care.

I know many families like mine; our ill family members received the treatment they were too ill to understand they needed. Later they thanked us as they see the devastation that untreated psychosis can bring. My family is especially fortunate in that we have worked collaboratively with our daughter's psychiatrist who is a Canadian expert on schizophrenia. It's the kind of collaboration that routinely occurs with other catastrophic brain disorders.

I discuss the Murphy bill from the perspective of family caregivers in this article:

Joel Hassman, md said...

When you figure out a way to enforce insight and judgment globally, please, me a call!

It's amazing how all these advocates for AOT think that it's simply about making people be in treatment will thus dramatically improve society! Yes these patients need help and they need services, but you can't enforce it, on an outpatient basis at least.

As I have written over and over when you make treatment punitive, you then ruin the alliance until proven otherwise. Its amazing to me how many non clinicians are screaming the loudest about this, and then are showing the most incredibly clueless signs and features that they have no idea how we are the ones at risk, while they just want to pass the buck overall.

If you think I'm wrong, spend some time with ACT or mobile treatment programs and watch how these people who come to patients homes are basically putting themselves at risk because some political process thinks they know better than we who we should be treating and how we should be treating them. you might find it at least interesting if not incredulous how sometimes the family members are the primary problems and not these patients being labeled as "the sick ones"

and then we're supposed to put our trust that these family reporters are to be believed?!?!

it really is that simple as a start to see how the process really works!!!

jacob l said...

my thought is look at the bill piece by piece and ask if the good outweighs the bad.
the biggest bad points I've seen are increased AOT and family contact.

the other stuff listed in the 4 page summary sound, only sound, good

any thoughts one the other item's

P.S. as of 2/7/2015 4 page summary
is at

Dinah said...

Jacob, unless I'm wrong, the 4 page summary you linked to is for HR3717, the bill from 2013. The text of the new bill is not out yet (maybe this week?)

jacob l said...

dinah thank you, my bad.
The good vs bad point remains and is a individual judgment. I can only hope that most clients and therapists find the bill, if it passes, to be better than nothing.

my biggest fear is that moderate cases with have to go sever before they get the resources they need will increase. There are a few proposals that may help, but the very sick vs that sick risks more very sick if not handled very carefully, something that no law can do.
thanks for letting me post