Trump Pick for SAMHSA Assistant Secretary Aligns with Murphy Mental Health Bill. Why Is Murphy so Upset? And Is There Hope for Children’s Mental Health Advocates?

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katzIt’s been a few weeks since President Trump announced Elinore McCance-Katz as his nominee for the Assistant Secretary for Mental Health, and I must say, the pick serves as a reminder to all children’s mental health advocates that we have our work cut out for us.

McCance-Katz is currently the chief medical officer for the Rhode Island Department of Behavioral Health. Previously, she worked under then SAMHSA Director Pamela Hyde as the first-ever Chief Medical Officer. She left the agency shortly before Hyde did, claiming then that the agency was following a mission that neglected individuals with serious mental illness.

President Trump is looking to her to make big changes at SAMHSA. If confirmed by the Senate, her aim is clear – shake up the staff, reduce the number of recovery and wellness programs, including funding for the oft-maligned programs designed to increase peer to peer support, and increase the focus on individuals with schizophrenia and bipolar disorder.

In an interview with POLITICO in 2015, McCance-Katz said she left SAMHSA because leadership “very obviously paid no attention to treatment. The most vulnerable population is being ignored by the very organization meant to support them,” she said, adding that she “felt embarrassed that the agency couldn’t talk about the neurobiological underpinnings of mental illness.” 

Most of the articles written about McCance-Katz since the President’s announcement invariably include reference to her desire (along with some national mental health advocacy groups) to see SAMHSA move away from supporting alternative medicine and recovery-based programs. Often cited as an example of SAMHSA’s loss of focus is the annual Alternatives conference, which is partially funded by SAMHSA. It appears that journalists writing about the direction McCance-Katz wants to take with SAMHSA like to include some of the tastier lines from Congressman Murphy campaign over the past three years to discredit alternative approaches to wellness by citing “wasteful” examples from the Alternatives conference such as “hip-hop Zumba for health.”

I must admit I get tired of having to correct this ignorant lumping of an exercise class at a conference as an indictment of the entire peer-support recovery movement. Instead of once again laying out the many fallacies of the smear campaign conducted by the Murphy Camp to discredit the Alternatives Conference and the peer-support movement, I invite you to read the post I wrote three years ago in response to a Wall Street editorial that took great delight in spreading “fake news” accounts of the peer support recovery movement. And to think – three years ago we didn’t even know what fake news was. Ah, we were so young and innocent then, weren’t we?

Congressman Murphy is Upset with Trump’s Appointee
And yet, Congressman Murphy, the architect of the Helping Families in Mental Health Crisis Act, is spittin’ mad about the nomination of McCance-Katz for the position of Assistant Secretary and wants the President to pull the nomination. Say what? McCance-Katz could be the poster child for the Murphy bill, so what gives?

It turns out that Congressman Murphy is torqued off that his favorite, Michael Weiner, a forensic psychiatrist, did not get the nomination. Even more upsetting to Murphy is his perception that while McCance-Katz was at SAMHSA, she did not speak out forcefully enough to make the changes she now says she wants to make.

Here is an excerpt from a press release from Murphy on the President’s nomination:

“The old regime at SAMHSA was incapable and unwilling to work with me and my colleagues in Congress to deliver the transformative changes needed at the agency and throughout the federal government to serve families in crisis. Therefore I am stunned the President put forth a nominee who served in a key post at SAMHSA under the previous Administration when the agency was actively opposing the transformative changes in H.R. 3717, the original version of my Helping Families in Mental Health Crisis Act. In fact, the previous Administration and SAMHSA actively opposed the creation of an Assistant Secretary, as well as opposing my changes to HIPAA, expanding access to inpatient crisis psychiatric hospital beds, strengthening commitment standards and a host of other reforms.

Dr. McCance-Katz served as Chief Medical Officer at the very time SAMHSA was under investigation for multiple failed practices and wasteful spending. She was the key medical leader when the agency actively lobbied against any change or accountability, including when the Energy & Commerce Committee, indeed the entire Congress, was aiming to fix our nation's broken mental health system by passing the most transformational mental health reforms in a half century. And while she was serving at SAMHSA, there were questionable hiring practices, no accountability for federal grants, an anti-medical approach to serious mental illness and substance abuse treatment and most importantly, the continued upward rise of suicide and substance abuse deaths.

“The Assistant Secretary position was created to bring accountability, effectiveness and coordination to the federal government’s 112 mental health programs and develop a national strategy for increasing the mental health workforce, help patients and families access care, treatment for serious mental illness and so much more. We must have someone reliably and resolutely committed in word and deed for these critical changes to our nation's dilapidated and deadly mental health and substance abuse care. The lives of millions of Americans depend on it. And I will be satisfied with nothing less.”

Ironic how strongly he carries his grudge against SAMHSA as a whole, and apparently anyone who worked at the agency while under the leadership (he calls it regime) of Pamela Hyde. With all due respect, Congressman, ya gotta get over it. McCance-Katz is right in the wheelhouse of your mental health reform efforts. Heck, she has already said that if confirmed, she would focus on increasing the number of assisted outpatient treatment programs, a pillar of your original bill proposal. McCance-Katz also has said that she wants to open the gates to increased inpatient psychiatric treatment and expand the behavioral health care workforce.

Of course, with TrumpCare passing the House this week (including the support of Congressman Murphy), and the draconian effect that will have on whatever budget gets passed, achieving these goals will be a challenge.

A Ray of Hope for Children’s Mental Health Advocates?
In fairness to Dr. McCance-Katz, at this point, we only have a few written articles and interviews with which to make an assessment of her overall focus on mental health. It is important to note that while she clearly is supportive of traditional psychiatric focus promoted in the Murphy bill, she also is on record crediting Obamacare and Medicaid expansion as effective approaches to improving community-based mental health and substance abuse services.

McCance-Katz's acknowledgment of the value of Medicaid expansion is an important door that we can open to have a more robust discussion about children’s mental health, virtually non-existent in any of the articles written about her so far. Take solace from this excerpt from a 2015 article in the American Journal of Public Health, in which she was a co-author:

"Through the Patient Protection and Affordable Care Act,53 several changes will help address some of these patient-level barriers. Clinical services for substance use disorders are an essential health benefit that must be covered by insurers, with specific coverage varying by state and health plan. In addition, the expansion of Medicaid in 27 states and the District of Columbia as of October 2014 means that individuals who previously did not qualify for Medicaid—many with substance use disorders—will have coverage for substance abuse treatment in the states that expand. Although these changes help to remove certain barriers, this study highlights the fundamental need for a sufficient supply of trained clinicians to provide care for these newly covered individuals."

Her recognition of the importance of essential benefits is music to my ears. We can use her understanding of the importance of essential benefits and Medicaid expansion as a way to frame a dialogue for how the potential loss of those benefits would impact families who have children with serious emotional disorders.

I am looking forward to following Dr. McCance-Katz's confirmation process closely and will keep you posted!

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scott

 Scott Bryant-Comstock
President & CEO
Children's Mental Health Network


Comments

  1. Brigitte Manteuffel's avatar
    Brigitte Manteuffel
    | Permalink
    McCance-Katz was clearly positioning herself for this job in this article she wrote in National Review. http://www.nationalreview.com/article/442382/donald-trump-mental-illness
  2. Frank Rider's avatar
    Frank Rider
    | Permalink
    Great analysis, Scott, and thanks for sharing the article Dr. McCance-Katz co-authored recognizing the importance of Medicaid expansion and ACA's essential health benefits to addressing Congressman Murphy's stated commitments "to as help patients and families access care, treatment for serious mental illness and so much more."
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