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Manhattan Institute

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Congress Is Making Bipartisan Progress on Mental Healthcare Reform

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Congress Is Making Bipartisan Progress on Mental Healthcare Reform

The Hill August 9, 2017
Urban PolicyOther
Health PolicyMental Illness

As Republicans and Democrats have battled strenuously over healthcare reform in recent years, important bipartisan developments have been underway in mental illness policy. Last December, President Obama signed into the law the “21st Century Cures Act.” This legislation contained a raft of reforms that congressional Republicans designed to push federal mental healthcare services and programs to place a greater priority on addressing serious mental illness.

At least in the case of mental healthcare reform, the dream of bipartisan policymaking is not yet dead.

Central to that effort was the creation of a new assistant secretary for Mental Health and Substance Use in the Department of Health and Human Services. On Thursday, the Senate unanimously approved President Trump’s nominee for that position, Dr. Elinore McCance-Katz.

Ensuring that the mentally ill get the treatment they need, instead of winding up in prisons or homeless on the street, as is commonly the case, will require strong leaders with a clear understanding of how flawed our policies have been over recent decades. Dr. McCance-Katz is likely to provide that leadership.

That the Trump administration made such an excellent nomination, and the Senate gave Dr. McCance-Katz such strong backing suggest that, at least in the case of mental healthcare reform, the dream of bipartisan policymaking is not yet dead.

The idea behind the new assistant secretary position was that there needed to be more oversight of the federal mental healthcare bureaucracy. Of particular concern was the Substance Abuse and Mental Health Services Administration (SAMHSA), where Dr. McCance-Katz once worked.

SAMHSA is tasked with leading federal efforts on mental health but has unfortunately long interpreted that mandate to mean the promotion of policies that do little to help those with the most severe mental illnesses. It is easy to help someone who is sad and wants help for his sadness. It is very hard to help a dangerously delusional person who refuses help because he believes he is perfectly sane. And yet the former cohort has benefited the most from SAMHSA’s programs and initiatives and this has been the case under Republican administrations just as Democratic ones.

The congressional hearings that led to the passage of the mental health reforms in the “21st Century Cures Act” brought to light SAMHSA’s many failings. Speaking at a 2013 oversight hearing, Rep. Tim Murphy, the chief architect of those reforms, pointed out that, while SAMHSA’s most recent strategic plan discussed “wellness” “emotional” health at length, nowhere to be found were the terms “schizophrenia” or “bipolar disorder.” He concluded, “I’m afraid serious mental illness such as schizophrenia and bipolar disorder may not be a concern at all to SAMHSA.”

One important barrier to reform has been resistance to the notion that the challenge of addressing serious mental illness as principally a medical one. That view is rejected not only by many activists, but the very federal bureaucrats whom we hire and pay to reduce the harm that inflicts on so many families and communities. Writing last year in National Affairs, E. Fuller Torrey and Sally Satel noted that not one of SAMHSA’s 570 staffers at that time was a psychiatrist.

Dr. McCance-Katz has spoken eloquently about SAMHSA’s deep need for reform on precisely this issue. Last year, after resigning her position at SAMHSA’s Chief Medical Officer, she wrote in Psychiatric Times that “There is a perceptible hostility toward psychiatric medicine: a resistance to addressing the treatment needs of those with serious mental illness and a questioning by some at SAMHSA as to whether mental disorders even exist—for example, is psychosis just a ‘different way of thinking for some experiencing stress?’.”

In addition to reforming SAMHSA, there are several other ways in which better federal leadership on mental health can work to reverse the longstanding bias against serious mental illness. The Trump administration can promote evidence-based practices such as assisted outpatient treatment which, despite numerous studies demonstrating its effectiveness in New York, is rarely used in other states. They can work with Congress to pass legislation addressing the many counter-productive federal laws such as the one which, in the name of privacy protections, prevents family members of mentally ill individuals from accessing their loved one’s medical records.

In her testimony before the Senate earlier this week, Dr. McCance-Katz said that, if confirmed, she would prioritize “focusing on those with serious mental illness.” To many ordinary Americans, this may sound like the sort of pabulum nominees are expected to serve up when they’re trying to say nothing. But within mental health policy circles, those words mean a great deal. They mean that, at long last, the federal government is poised to begin redirecting mental health resources and attention to those who need them the most.

This piece originally appeared at The Hill

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Stephen Eide is a senior fellow at the Manhattan Institute and author of a recent report, Assisted Outpatient Treatment in New York State: The Case for Making Kendra's Law Permanent.

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