Lawmakers, patient advocates and the millions of Americans living with a psychiatric diagnosis agree that the nation's mental health care system is broken, and Thursday, Congress will hear testimony on the most ambitious overhaul plan in decades, a bill that has already stirred long-standing divisions in mental health circles.
The prospects for the bill, proposed by Pennsylvania Rep. Tim Murphy, R-Upper St. Clair, are uncertain, experts say, given House and Senate partisanship and the sheer complexity of the mental health system. And its backing of the expanded use of involuntary outpatient treatment has drawn some advocacy groups' opposition.
But the bill, the Helping Families in Mental Health Crisis Act, does have more than a dozen House Democratic co-sponsors, and several mental health organizations are supporting it. Last week, both houses of Congress adopted one of its central provisions, expanding funding for outpatient treatment programs through other legislation.
Today, the House Energy and Commerce health subcommittee is scheduled to hear testimony on the entire bill, which includes more than two dozen measures.
"It's the most comprehensive mental health bill we've seen in a long, long time, and that in itself is an accomplishment," said Keris Myrick, chief executive of the Project Return Peer Support Network and board president of the National Alliance on Mental Illness, which supports some parts of the bill. "I think almost everyone sees things in the bill that are long overdue, but also things they're very concerned about."
Among those opposing the bill because of its involuntary treatment provisions is the Bazelon Center for Mental Health Law, whose president, Robert Bernstein, said, "Many serious organizations seem to have an 'any port in the storm' mentality, supporting this bill even though it includes dangerous provisions."
Mr. Murphy, a clinical psychologist from Pittsburgh, put together the legislation at the behest of House Republican leaders after the Sandy Hook Elementary School massacre in Newtown, Conn., in 2012. He spent a year hearing testimony about the current system, a patchwork of community clinics and state hospitals chronically short of funding that leaves millions of people with mental illness without treatment, often homeless or in prison.
"It's a broken system, and we're not going to fix it by throwing a little money here or there," Mr. Murphy said in an interview. "We know that when people get care, they get better, but there are simply not many options: Clinics are reducing services, there are not enough psychiatrists or psychologists to go around -- we found all sorts of barriers to care."
Widely backed provisions include streamlining payment for services under the Medicaid program and providing funds for clinics that meet standards for rigorous, scientifically supported care.
The bill also provides money for suicide prevention programs and for so-called telepsychiatry, or remote video therapy, which is seen as especially crucial in rural areas.
Provisions calling for increased training for police officers and emergency medical workers in how to identify and treat people with mental disorders are also widely approved. Police and paramedics often act as ad hoc social workers, dealing with people with mental problems when they are hurt or break the law.
About 350,000 Americans with a diagnosis of a severe mental illness like schizophrenia or bipolar disorder are in state jails and prisons, while the number of psychiatric beds available has shrunk to 35,000, according to a coming analysis by the Treatment Advocacy Center, a nonprofit group that favors expanded access to treatment.