Congress should focus reforms on the most severely mentally ill
May 16, 2014 12:00 AM
Reps. Tim Murphy and Ron Barber both have reasons for wanting Congress to address mental-health issues.
Mr. Murphy, a Republican from Upper St. Clair, is the only practicing psychologist in Congress. Mr. Barber, an Arizona Democrat, was injured in a mass shooting by Jared Lee Loughner, a paranoid schizophrenic. (Mr. Barber was working for Rep. Gabby Giffords, whose injuries were more severe.)
The two have introduced rival bills on the topic — and are now in an increasingly bitter dispute.
Mr. Murphy’s supporters speculate that Mr. Barber is sabotaging Mr. Murphy’s bill to deny House Republicans a bipartisan success. Mr. Murphy tells me his Democratic co-sponsors are under pressure to walk away. Mr. Barber tells me that he has no partisan intent and accusations to the contrary are attempts “to politicize this bill.”
Beneath the charges of partisanship, though, lies a real philosophical divide on how to handle mental illness.
Mr. Murphy thinks that existing government policies and bureaucracies don’t place enough emphasis on the severely mentally ill, instead catering to those with milder problems and the “worried well.” He also thinks they’re too solicitous of the “right to refuse treatment” when it is asserted by people who are too mentally ill to have a meaningfully free will. An inability to see that one has a severe mental illness can, he says, be a symptom of it.
So Mr. Murphy would prod states to set up mental-health courts that could order treatment for people with a history of arrests, violence or repeated hospitalizations. He would clarify federal law so that doctors could more easily share information about people in an acute mental-health crisis with their parents and caregivers. He would change Medicaid payment policies so that they no longer discourage long-term hospitalization for people with severe mental illnesses. He’d also make federal mental-health bureaucracies show evidence that they’re spending money in ways that work.
And he would cut spending for a federal program called Protection and Advocacy for Individuals with Mental Illness, which funds state agencies that often sue and lobby to stop the sorts of mental-health policies Mr. Murphy backs. Opponents of the Protection and Advocacy program often bring up the case of William Bruce, who got out of a psychiatric facility over the objections of doctors thanks to such legal advocacy — and later killed his mother.
Mr. Barber’s bill includes none of these provisions. He thinks what’s most important is not to reform the existing programs — although he allows that they could do a better job — but to give them more money. His emphasis is on increasing awareness and early treatment of mental illnesses. He would fund bullying counseling at schools, for example, because bullying often leads to mental illness. That’s very far from Mr. Murphy’s focus on the worst cases.
Mr. Barber also rejects Mr. Murphy’s approach to the Protection and Advocacy program, saying the Republican’s bill “would basically abolish a very important part of our mental health system.” Mr. Murphy’s office counters that the bill would end one stream of federal funding that goes to the program, while leaving others intact. It’s true, though, that the program would receive less funding than Mr. Barber’s bill would give it.
Drew Hammill, a spokesman for House Democratic leader Nancy Pelosi, told the Hill newspaper that she wanted a bill “that actually has the support of the mental-health community.” The comment highlights one of the differences between the two approaches. For Mr. Murphy, parts of that community are a problem that requires reform.
Which approach you favor depends on what you think matters more: reform or more funding; a focus on the most severe cases or something broader; more options for people who want treatment or more compulsion for people who don’t.
Former Rep. Patrick Kennedy has said that he hopes the Barber legislation is a spur to negotiations that improve whatever Congress finally passes. Whether it will depends on what gets compromised. If negotiations are about more funding for anti-bullying efforts, Mr. Murphy could give way while preserving the thrust of the bill. Giving up on the hospital-bed or involuntary-commitment issue, on the other hand, would gut the bill. He won’t do it, and he shouldn’t.
Let’s assume that Mr. Barber is following sincerely held views, not making any partisan play. His bill reflects a way of thinking about mental-illness policy that has been influential for many years. It deserves to be judged on the merits, and rejected.
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