In the weeks after the shootings in Newtown, Conn., many mental health advocates hoped that the tragedy would lead Congress to address problems in the country's fragmented mental health system.
Nearly a year and a half later — and in spite of several additional shootings — Congress has yet to pass major mental health reforms.
Now, some mental health advocates wonder if competing bills introduced in the House of Representatives will improve the chances of passing new legislation or hinder it.
In December, Rep. Tim Murphy, R-Pa., introduced the Helping Families in Mental Health Crisis Act. About two-thirds of its 77 co-sponsors are Republicans.
The issue took a partisan turn Tuesday when Rep. Ron Barber, D-Ariz., introduced his own, more limited bill, supported by a handful of Democrats, called theStrengthening Mental Health in Our Communities Act of 2014. While the two bills have some elements in common, Barber's bill is far less sweeping than Murphy's, which proposes an overhaul of the way federal mental health programs are organized and funded.
Murphy and Barber both have worked in the mental health field for decades, and they agree that patients and their families need help. "We've lost billions of dollars in funding over the past few years" for mental health services, Barber says. "We've really got a crisis on our hands."
Yet mental health advocates say the bills are also in competition. Some worry that partisanship could doom any chance of passing a bill.
"In the best-case scenario, you've got two proposals addressing the same problems, and a framework for the parties to come together," says Ron Honberg, of the National Alliance on Mental Illness. "In the worst case, the partisan divide prevents them from ever reaching agreement."
Barber, who was shot alongside Rep. Gabrielle Giffords when Jared Loughner opened fire on a crowd in Tucson in 2011, says his bill makes "serious and sustained investments in existing programs" proven to work.
Barber's bill would increase mental health funding for veterans and active-duty service members; create "mental health first aid" programs in schools and communities; and create a White House Office for Mental Health Policy, similar to the White House's Office of National Drug Control Policy. The bill aims to make hospital care more accessible to seniors with mental illness, by requiring Medicare to treat mental health hospitalizations the same way as other hospitalizations. Today, Medicare sets a 190-day lifetime cap on inpatient psychiatric care.
Barber's bill has the support of the American Foundation for Suicide Prevention, theNational Association for Rural Mental Health, the Bazelon Center for Mental Health Law and the National Association of County Behavioral Health and Developmental Disability Directors.
The bill from Murphy, a child psychologist, would create a new Assistant Secretary of Mental Health and Substance Abuse Disorders, who would control mental health funding and report annually to Congress.
That would shift power away the Substance Abuse and Mental Health Services Administration, which currently administers mental health grants to states. Murphy says some of these grants are wasteful and aren't supported by good medical evidence.
The bill would require states that get federal mental health grants to change their standards for involuntary psychiatric commitment, allowing people to be hospitalized against their will when they need treatment, not simply when they pose a danger to themselves or others – the standard in about half of states. That change could allow patients to get care sooner, Murphy says.
Murphy's bill also aims to provide family caregivers with more information about their loved ones' care, by clarifying privacy rules set out in the Health Insurance Portability and Accountability Act. Today, Murphy says, privacy rules lead families to be shut out of their children's care, when kids are as young as 14.
Murphy's bill would also make changes to Medicaid funding, allowing psychiatric hospitals to be reimbursed for short-term care. Today, psychiatric hospitals with more than 16 beds aren't eligible for Medicaid funding for most adult patients, which has propelled the closing of many hospitals, Murphy says. Those closures have left many mentally ill patients without a place to go when they're in serious crisis. Many end up homeless or in jail, he says.
The National Disability Leadership Alliance has criticized Murphy's bill, charging that it would strip people with mental illness of critical privacy rights. And allowing psychiatric hospitals to bill Medicaid for services could lead patients to be institutionalized, rather than treated in the community.
Yet Honberg applauds Murphy's focus on increasing access to psychiatric beds and clarifying privacy rules.
"The assumption should be that health care providers can and should communicate with families," Honberg says. "There needs to be clarity in the law. That's the only way we are ever going to change providers' behavior."
The two bills reflect not just political divisions, but deep philosophical divides in the mental health community, says Ron Manderscheid, executive director of the National Association of County Behavioral Health and Developmental Disability Directors.
Mental health advocates disagree about the balance between respecting patient privacy and helping people who don't realize they're sick; whether scarce financial resources are better spent providing community care or hospital beds; and whether to promote general mental health or concentrate resources on those with the most severe mental illnesses, such as schizophrenia, says D.J. Jaffe, executive director ofMentalIllnessPolicy.org. And some people with mental illness reject all treatment, viewing psychiatry as the problem, rather than the solution.
Jeffrey Lieberman, past president of the American Psychiatric Association, says he hopes members of Congress can work together. Failing to act on the momentum provided by tragedies such as those at Newtown, the Washington Navy Yard and Fort Hood, he says, "would be a terrible misfortune and missed opportunity."