Shift in strategy for GOP on mental health reform

House Republican leaders are adopting a piecemeal approach to mental health reform in an attempt to salvage a legislative proposal that has been mired in controversy.

The House Energy and Commerce Committee indicated Thursday that it would divide the Helping Families in Mental Health Crisis Act into pieces in an attempt to pass individual provisions that are not controversial.

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The announcement deals a serious blow to the bill and its author, Rep. Tim Murphy (R-Pa.), who has argued that only dramatic and comprehensive reform would serve to help people with serious mental illness.

Work on the measure began in early 2013, when Republican leaders pushed mental health reform in response to the school shooting in Newtown, Conn.

Leaders selected Murphy, a child psychologist and chairman of an Energy and Commerce subcommittee, to craft legislation that would reform the tangled thicket of federal rules and programs related to mental health.

But his measure was in trouble from the start, and the willingness of GOP leaders to split it apart appears to acknowledge the need for a shift in strategy. The announcement was made to The Hill on background.

The defeat of the comprehensive bill is a victory for the broad swath of national mental health groups that were uneasy about or opposed to Murphy's legislation.

Taking cues from public safety advocates and families of people with serious mental illness, Murphy’s bill proposed to loosen standards for involuntary treatment, increase psychiatric beds and relax health privacy laws to give caregivers more information.

With guidance from allies at the Treatment Advocacy Center, an outside group, Murphy also sought to lay down a marker against federal mental health initiatives he calls unserious and potentially harmful.

He also proposed gutting and reorganizing the Substance Abuse and Mental Health Services Administration, the primary federal agency in charge of grants for mental health services.

These provisions are unlikely to move under House leaders' new strategy, as critics say they will disrupt mental health program and enshrine a perspective that discounts the input of major outside groups. 

Energy and Commerce leaders are expected to advance non-controversial provisions that involve training for mental health services, coordination of care and increased funding for research before the end of the year. 

Murphy's office declined to comment on Thursday's announcement, but indicated that they are still pushing for action on the comprehensive bill.

"There needs to be recognition that what Dr. Murphy is advancing is in the realm of serious mental illness, which remains off the table by the opponents of his bill," said Susan Mosychuk, Murphy’s chief of staff, in a statement.

"We'll continue to educate other members that those with SMI, a brain disease, and cannot recognize it or agree to treatment on their own are deserving of, and need, specialized services."

Outside groups strongly doubted that the measure would advance in its original form. That view was bolstered by Energy and Commerce Committee Chairman Fred Upton (R-Mich.), who said repeatedly in private that he would not move a controversial bill.

In response, Murphy initiated an aggressive push to get Democrats on board with the measure and courted the national media's attention. Papers such as The Washington Post began to endorse Murphy’s bill, and he gained additional co-sponsors.

But leading Democrats balked at the bill, preventing it from gaining the strong bipartisan support it would need for Upton's green light.

Consumer groups such as Mental Health America came out against the measure from the start, arguing it is regressive and ignores the possibility of early intervention for people before they reach mental health crisis.

"If you wait until stage 4, you're always going to be dealing with stage 4," said Debbie Plotnick, senior director of state policy at Mental Health America.

"We know we can intervene early and prevent the crises that leave people in extreme states. This bill shifts all the resources to the back end, which is not only unwise but costly."

Other major mental health groups have been caught in the middle, desiring reform but unwilling to support Murphy's vision.

Murphy later called on former Rep. Patrick Kennedy (D-R.I.), a noted mental health advocate in his own right, to work with organizations on a package of possible revisions to the measure.

The so-called Kennedy Workgroup floated a series of changes in early May but has received no indication that Murphy will adopt them, members said.

Rep. Diana DeGette (D-Colo.), Murphy's counterpart on the Oversight subcommittee, sought to nudge the process forward on Thursday.

"We should be able to achieve consensus on many improvements to the mental health system if we work in a truly collaborative and bipartisan fashion," she said in a statement.

"We need to improve critical programs and services for individuals with mental illness, provide new investments in prevention and early intervention of mental illness, and advance research into mental health and serious mental illness."