Advocates urge Senate to reject forced treatment provision in Rep. Murphy's bill

The bill rushed through the House of Representatives by voice vote yesterday to patch Medicare regulations includes a highly controversial provision that has nothing to do with Medicare, and that would subject people in crisis to forced treatment. Studies have shown that such force causes trauma and drives people away from treatment, mental health advocates warned.

Today, an array of national mental health and disability advocacy groups joined together to decry this provision, which they view as a regressive attack on hundreds of thousands of Americans with serious mental health conditions.

"In its rush to fix a problem with Medicare, the House passed a bill including a highly controversial program, involuntary outpatient commitment, with no debate and no roll call vote," said Raymond Bridge, public policy director of the National Coalition for Mental Health Recovery (NCMHR), a coalition of 32 statewide organizations and others representing individuals with mental illnesses. "And it seems that the Senate may pass a version of the House bill including this troubling provision on Monday," Bridge added.

The 123-page Protecting Access to Medicare Act of 2014, H.R. 4302, includes a four-year, $60 million grant program (Sec. 224) to expand involuntary outpatient commitment (IOC) – also called Assisted Outpatient Treatment (AOT) – in states that have laws authorizing IOC. The laws allow courts to mandate someone with a serious mental illness to follow a specific treatment plan, usually requiring medication. The facts show that involuntary outpatient commitment is not effective, involves high costs with minimal returns, is not likely to reduce violence, and that there are more effective alternatives.

Assisted Outpatient Treatment is central to the controversial Helping Families in Mental Health Crisis Act (H.R. 3717), proposed by Rep. Tim Murphy in December 2013.

"This legislation would eliminate initiatives that use evidence-based, voluntary, peer-run services and family supports to help people diagnosed with serious mental illnesses to recover," said Daniel Fisher, M.D., Ph.D., a psychiatrist and an NCMHR founder. "It would bring America back to the dark ages before de-institutionalization, when people with mental health conditions languished in institutions, sometimes for life."

The provisions of H.R. 3717 would exchange low-cost, community-based services with good outcomes for high-cost yet ineffective interventions, according to the NCMHR; the National Disability Rights Network (NDRN), the non-profit membership organization for the federally mandated Protection and Advocacy (P&A) Systems and Client Assistance Programs (CAP) for individuals with disabilities; and the National Council on Independent Living (NCIL), which advances independent living and the rights of people with disabilities through consumer-driven advocacy.

NDRN, NCMHR, AAPD and NCIL note that the bill does not represent the mainstream of national thought, practice and research.

"This legislation will have a devastating impact on persons with psychiatric disabilities by stripping SAMHSA [Substance Abuse and Mental Health Services Administration] support for consumer involvement in their recovery," said Mark Perriello, president and CEO of the American Association of People with Disabilities (AAPD). "Americans with psychiatric disabilities are our friends, co-workers, neighbors, and sisters and brothers. This legislation tramples their civil rights, and must not move forward as currently written."

"Force and coercion drive people away from treatment," said Jean Campbell, Ph.D., one of the nation's leading mental health researchers. "In 1989, 47% of Californians with mental illnesses who participated in a consumer research project reported that they avoided treatment for fear of involuntary treatment; that increased to 55% for those who had been committed in the past."

Enlarging the capacity for inpatient commitment "could violate Olmstead v. L.C. (1999), the Supreme Court decision, because it would increase 'unjustified segregation of persons with disabilities [which] constitutes discrimination in violation of Title II of the Americans with Disabilities Act,' " said Kelly Buckland, executive director of NCIL.

Rep. Murphy's bill is based on a false connection between mental illness and violence, the advocates say. "Study after study shows that no such connection exists. In fact, individuals with mental illnesses are actually 11 times more likely to be victims of violence than the general public," Dr. Fisher said.

"Rep. Murphy's bill would eviscerate the rights and privacy protections enshrined in the federally mandated Protection and Advocacy (P&A) System, which is the largest provider of legal advocacy services to people with disabilities in the United States," said NDRN executive director Curt Decker.

"We all agree that incarceration and homelessness are not the outcomes people diagnosed with serious mental illnesses want or deserve," Dr. Fisher added. "We urge Congressional leaders to engage in a meaningful dialogue with our mental health communities to learn about our creative innovations that truly support the health and safety of people with mental illnesses and of all Americans."

The advocates strongly urge the Senate to reject the forced treatment provision of the "doc fix" bill.

SOURCE National Coalition for Mental Health Recovery