Tim Murphy is raising the right issues but proposing the wrong solutions
September 10, 2014 12:00 AM
By Leah Harris
Mental health advocates and experts agree that our mental health systems are the shame of the nation. As many psychiatric institutions — some of which were notorious for abuse and neglect — were shut down in the 1980s, jails and prisons became the new asylums and people struggling with mental health and substance-use issues were warehoused in even more inhumane and costly settings.
Our community mental health systems are fragmented, ineffective, difficult to access and fail to engage people who need the most help. Instead of providing needed social services for those who are homeless and experiencing serious mental health challenges or addictions, we criminalize their suffering.
Rep. Tim Murphy, R-Upper St. Clair, is to be lauded for shining a powerful spotlight on these issues. However, despite his good intentions and clear commitment, Rep. Murphy has it wrong when it comes to one of his most prominent prescriptions for fixing our broken mental health care systems.
The Murphy proposal — included in the Helping Families in Mental Health Crisis Act — pressures states to divert more than $130 million to expand the use of “involuntary outpatient commitment” court orders that serve only to force people into the same service approaches that have already failed to help them. It was drafted in response to the Newtown school shooting tragedy, in which a mentally ill Adam Lanza killed 22 people and himself, although people with mental illness are more likely to be victims than perpetrators of violence.
People with psychiatric disabilities who would be directly affected by Rep. Murphy’s bill are vehemently opposed to it. In every other area of medicine, it is recognized that patient-centered approaches that foster personal choice and dignity are far more successful in engaging people with the most serious conditions as active participants in their own health care.
Rep. Murphy argues that involuntary outpatient commitment — also known as assisted outpatient treatment — is a “less restrictive alternative” to the horrors of prison and mental institutions. But why make people choose the lesser of two evils? Why not focus instead on providing an upfront investment in voluntary housing and support services that are proven to work?
One such model is Housing First, an evidence-based supportive housing program that does not make people jump through hoops in order to get off the streets and find a safe place to live. Many individuals who have found decent places to live through Housing First go on to work toward recovery from their mental health issues and to become clean and sober.
One success story is Shaelynn, who was living on the streets, had a felony conviction and was using drugs and alcohol when she was accepted into the program. With the program’s support, she has achieved sobriety, has reconnected with her daughters and grandchildren, and is now doing very well.
Another evidence-based model is peer-to-peer support, which deploys trained individuals in recovery from serious mental health and or substance-use conditions to engage the hardest to reach people on the streets, help them access needed services and supports, and avert crises and tragic outcomes. For example, New York’s Peer Bridger program was able to reduce avoidable and expensive re-hospitalizations by 71 percent in 2009.
But instead of promoting these innovative and promising forms of engagement, Rep. Murphy’s bill seeks to cut federal funding that would make them more available.
Contrast this with Britain, which is working instead to reduce coercive interventions and promote patient-centered approaches. British psychiatrist Tom Burns, once a former supporter of community treatment orders — the British equivalent of assisted outpatient treatment — has changed his mind about the practice. He says that the research shows these laws don’t accomplish much.
Rather than pouring even more taxpayer dollars into promoting controversial coercive approaches, we should be expanding proven and promising practices.
We in America do not lack resources. What we lack is the political will to get this done.
Leah Harris is director of the National Coalition for Mental Health Recovery (email@example.com).
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