On federal mental health policy, who's the next Tim Murphy?

On federal mental health policy, who's the next Tim Murphy?
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The resignation of Rep. Tim Murphy (R-Pa.) has families of the seriously mentally ill like mine worried. While many legislators are willing to give the mental health industry money to improve mental wellness for the highest functioning, we know few like Rep. Murphy, who is willing to stand up to the mental health industry and insist their programs serve the most seriously mentally ill, and is solidly evidence-based.

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The industry claims their programs are evidence based. But as mental illness researcher James Coyne noted, “‘evidence-based' is too often an ill-gotten branding based on weak evidence generated by promoters of treatments who want us to ignore their conflicts of interest.”

To be worthy of federal mental health funding a program should be independently proven to improve meaningful metrics such as rates of homelessness, arrest, incarceration, suicide, violence, victimization and hospitalization in people with serious mental illness. Congress regularly gives the mental health industry funds for programs that meet none of those criteria.

It’s easy for non-profits to claim programs they invent are “evidence-based” because anything that makes anyone happier can be said to “improve mental health.” Sports, yoga, after school activities, social gatherings, talk, all improve mental health.  If it feels good, it must be therapy, and chances are the Center for Mental Health Services (CMHS) is promoting it.

What Congress fails to understand is that throwing more money at mental health is not the same as treating the seriously ill. The 4 percent of adults who have serious mental illnesses including schizophrenia and bipolar disorder need more grounded and intensive interventions to prevent their deterioration. This is the population Rep. Murphy tried to help and the industry largely avoids.

Congress too often looks at what the mental health industry proposes, rather than what the seriously ill need when deciding what to fund. When Representative Murphy inserted a provision in an early draft of the Helping Families in Mental Health Crisis Act that would require federally funded programs to be evidence-based, representatives weakened the provision in response to complaints from the industry. The Children’s Mental Health Network sent them an e-mail alert urging members to stop the bill. The proprietor of PsychCentral complained about being required to rely on evidence.

The same thing happened when Murphy tried to expand the use of Assisted Outpatient Treatment (AOT). AOT allows courts to order six months of mandated and monitored treatment in the community for people with serious mental illness who previously became dangerous as a result of their failure to comply with treatment. Extensive independent high-quality research shows it lowers rates of homelessness, arrest, and incarceration of the seriously ill in the 80 percent each range. No other program has had such stellar results.

But AOT can require the mental health providers to admit the most seriously ill into their programs. The industry fought back and once again, Congress decided to ignore science and evidence. They diluted the AOT provisions and refused to increase funding in the recent continuing resolution bill.

The industry regular succeeds in getting Congress to allocate funds to useless programs. The powerful National Council for Behavioral Health sells an all-day pop-psychology training session they call “Mental Health First Aid (MHFA).” There is evidence — direct from the inventors — that the trainers and trained feel informed immediately after finishing the program, but there is no evidence people with mental illness are helped by it, and there is evidence they are not. Yet Congress succumbed to pressure from the mental health industry and authorized $15 million for it.

On the positive side, Congress did accept provisions proposed by Murphy that established an assistant secretary of Mental Health and Substance Use Disorders, and an Interdepartmental Serious Mental Illness Coordinating Committee.

Both Assistant Secretary Elinore McCance-Katz and the committee are tasked with and committed to recommending to Congress specific evidence based programs that help the seriously mentally ill.  But if Congress is willing let political pressure from the mental health industry trump whatever science says, and put the needs of the highest functioning ahead of the most seriously ill, what will become of their recommendations?

Like Senators Pete Domenici (R-N.M.) and Paul Wellstone (D-Minn.) before him, Rep. Murphy stood up for the seriously ill. It didn’t win him any friends in the mental health industry or Congress. With Murphy soon to be gone, we families of the seriously mentally ill need another Murphy.

DJ Jaffe is author of "Insane Consequences: How the Mental Health Industry Fails the Mentally Ill" and Executive Director of Mental Illness Policy Org. Follow him on Twitter @MentalIllpolicy