Mental health reform: We can't wait for politicians to do it for us

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Back in August, when we first conceptualized the idea of the dialogue series, it was in large part based on the encouragement from a Politico article in June that stated that a bipartisan group of House lawmakers were looking for compromise mental health legislation between the two bills in the House (HR 3717 & HR 4574). In the Politico article, Rep. Tim Murphy (R-Pa.) expressed hope that common ground could be found on his Helping Families in Mental Health Crisis Act, which he introduced late last year. And Rep. Ron Barber (D-Ariz.) expressed similar optimism for his bill, which was introduced six months after Murphy’s. According to news reports, the negotiations would begin during the July recess. 

Of significant concern to the Children's Mental Health Network was the fact there was very little discussion of the impact of these two bills on the children's mental health community (including emerging adults up to the age of 26). This vacuum in the conversation about children's mental health reform encouraged us to begin a dialogue with advocates, families and providers, figuring that if members of Congress were going to do it, we should as well. 

Alas, here we are in late October, and still no apparent discussions between the offices of Representatives Murphy and Barber. The lack of conversation between these two congressional offices is a disappointment for sure but also serves as a reminder that we can't solely wait and hope for politicians to lead the way on this issue. Now more than ever, with Congress reconvening soon, we need to come together and seriously look for compromise opportunities in HR 3717 and HR 4574.

Let's keep in mind three central points:

If we in the advocacy community have difficulty talking to each other then how can we expect congressional members and their staff to do what we will not? 

Fortunately, if you look, you can see positive signs pointing towards dialogue everywhere. We were thrilled to see a great article on dialogue written by Patrick Hendry, Mental Health America, which captures our dialogue process quite well. In addition, Ron Manderscheid, National Association of County Behavioral Health and Developmental Disability Directors writes eloquently about the importance of building bridges between those who support HR 3717 and those who support HR 4574. 

Our dialogue series has produced fruitful discussion and a beginning of broadening the conversation around what could and should be included in the framing of the best of the HR 3717 and HR 4574. Our initial dialogues have been around Assisted Outpatient Treatment (AOT) and already, illuminating factors have come to light. For example:

What do we know about how AOT works?
Assisted Outpatient Treatment is on the books in 45 states, yet we have not been able to find one study that describes how AOT is being used in the 45 states that currently have that provision. Specific examples, yes, but not a thorough national review. Amidst all of the highly charged emotions around AOT, not one comprehensive study showing how states are using it. A national review of AOT is much needed.

In our dialogue series, we have heard from providers in Virginia and the District of Columbia. Each has significantly different requirements in their respective AOT laws. And that is just the two examples that we have focused on. Imagine if we knew how the other 43 states were using the AOT law. That knowledge and understanding of implementation challenges would enhance the discussion around the type of services and supports that federal government should be emphasizing with their funding efforts.

Why is this important? 
It is one thing to say a particular process like AOT must be in place to improve mental health services in America. However, understanding what happens beyond the initial act of ordering treatment, is what makes or breaks the relevance of any legislation passed.

Services and supports that are provided once the AOT process is in place sure do look a lot like what we see promoted by the Recovery Movement.
In our last dialogue, we focused on the process of AOT and asked the question - "What happens after implementation of the AOT process?" In response to our question, providers spoke of the need to find appropriate housing, peer-related services and supports in addition to inpatient and outpatient treatment. 

Providers in the dialogue spoke about the importance of community, health, and peer support as integral components of a comprehensive approach to treatment for those involved with AOT. My mind raced to one of the intense discussion points of HR 3717 - the questioning of the value of some SAMHSA funded programs. Particularly beat up in editorials and stump speeches over the past year has been SAMHSA funded efforts such as the Alternatives conference, which promotes a peer-directed approach to recovery for those with serious mental illness. Yet, listening to these providers talk about the importance of community, health, and peer support for those involved with AOT I was reminded once again that the two "opposite sides" actually have more in common than they might think.

For yet another great example of synergy, a recent NIMH study of First Episode Psychosis programs found that elevated risks of heart disease and metabolic issues such as high blood sugar in people with first episode psychosis are due to an interaction of mental illness, unhealthy lifestyle behaviors, and antipsychotic medications that may accelerate these risks. Recovery folks are all over the importance of a healthy lifestyle. Treatment advocates and recovery advocates need each other. The "science" is proving that again and again. Just sayin'.

Network faithful will remember the Morning Zen post - The Power of Words: What the Wall Street Journal didn't tell you - written after a particularly scathing editorial in the Wall Street Journal, excoriating SAMHSA for funding what the authors of the editorial perceived as a waste of money. If you revisit the Power of Words Zen piece you will see why it is so important to peel the onion of any soundbyte you hear about meeting the needs of the seriously mentally ill. Not only is it more complicated than any one-liner, if you talk to providers and families involved with the process you will begin to see more similarities than differences when discussing what is needed to improve mental health services in America.

But what about the core issue of forced treatment?
I have no idea if there will ever be consensus around the issue of forced treatment in the AOT debate. Given that AOT is on the books in 45 states, can we at least "park" the forced treatment question to talk about what can be agreed upon as important to include in mental health legislation that combines the best of both bills? We've gotta start somewhere folks.

I hope you will join us at our next dialogue in Washington, DC on November 21st from 9 - noon in the Cannon House Office Building. We are blessed to have a courageous parent who has recently gone through the AOT process who will be with us to talk about her experience, what worked and what did not. In addition, we will be reaching out to national advocacy groups who are based in the Washington DC area to see how they can be more involved in collaborating together, even though they may be diametrically opposed in their positions on AOT, HR 3717 or HR 4574. 

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



  1. Kevin's avatar
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    Scott - Id love to support finding funding for a review if national data on AOT. The more I hear and experience families traumatized by the disconnect between inpatient and outpatient services, the more passionate I become in supporting the bridging of these systems. Mental health homes are even a great start, but again - each if these 'initiatives' opperate in silos due to seperate finding streams. A systemic approach to children and families mental health is at a critical mass. It's beginning to tip and as of now it appears as if the current 'system' is going to fail a lot of needs.
  2. Joan's avatar
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    Scott, thank you so much for a thorough update. Wish I could be there on the 21st.
  3. Laurie's avatar
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    Great work! Any chance for input from those of us that do not live in DC/Virginia? Social media, surveys, webinars etc.?
  4. Leah's avatar
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    Thank you deeply for your efforts, Scott!
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