A tale of two letters: Members of Congress weigh in on the Helping Families in Mental Health Crisis Act of 2015

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Members of Congress sent two important letters regarding the Helping All Families in Mental Health Crisis Act of 2015 (H.R. 2646) to House Energy and Commerce Chairman Fred Upton and Ranking Member Frank Pallone this week - one on Thursday and one on Friday. I am including the letters at the end of this post and encourage you to read them. The letters will give you a sense of the position these members of Congress are currently taking on H.R. 2646.

The first letter encourages the markup of H.R. 2646, presenting the bill, apparently in its current form, as ready to go. The second letter, from a different group of congressional representatives, identifies many concerns about specific items in H.R. 2646, that, if enacted, would do more harm than good.

As always, read the letters and use the information to help guide your decision-making, but before you leave this post, I want to point out an interesting difference in the approach taken in the two letters, specifically the first paragraph of each. The first paragraph sets the tone for the rest of the message in each letter. And, as we all know, the conversation around H.R. 2646 is dominated by messaging. Let's take a look at both paragraphs.

Letter #1 - H.R. 2646 is good to go
The paragraph from the first letter hits the reader right in the gut, making a correlation between guns, violence and mental illness. The tone of this paragraph follows the formula being used in the weekly roll-out of editorials, newspaper endorsements, and various mental health blogs supporting H.R. 2646, that invariably invoke the all too frequent horrific mass shootings, gun violence, and mental illness.

The simple message of "Pass this bill and we can prevent mass shootings" has an incredibly strong general public appeal. The message is straightforward and suggests a direct answer to a complicated question. The more subtle message infused in the first paragraph comes in the form of a quiet whisper that grows louder on the heels of each new tragedy - Pass this bill and this type of horror will never happen again.

Now, of course, we know that the lock, stock, and barrel passage of H.R. 2646 would in no way prevent mass shootings. But in politics, that doesn't seem to matter. The messaging matters. And the messaging being used to promote full-scale passage of this bill is consistently on-point. Do you hear the whisper? Guns. Violence. Mental illness. Pass H.R. 2646 and you will be safe.

Letter #2 - H.R. 2646 needs more work
The tone of the first paragraph from letter #2 is significantly different from letter #1. The tone of this paragraph does not include the elements of fear in the first letter. There is a much more holistic feel to the paragraph, which is much more consistent with the reality that I hear expressed by mental health providers in communities across the nation. For me, the most important part of the paragraph is the last sentence:

With letter #2, there is an upfront recognition of the need for a comprehensive array of services and supports, while also honoring the concept of recovery.

However, letter #2 faces the daunting challenge of not proposing a simple solution. Complicated solutions, no matter how on-target they may be with the realities of providing mental health services at the local level, tend not to be as embraced by the general public as something that is simple and straightforward.

Both letters raise important questions for children's mental health advocates
Are we, as children's mental health advocates, going to allow ourselves to be bullied and steamrolled into blindly accepting a bill that presents itself in such a way that preys on our deepest darkest fears and terrors of a lack of safety?

Or, are we going to question our politicians, compare their assertions with the realities we, collectively, know all to well at the local level?

The authors of the second letter that raise concerns about H.R. 2646 are right about a most fundamental truth - mental health reform is about a broad spectrum of approaches that honor each other and recognize the importance of their inter-connectedness.

Mental health reform is about seeking answers through collaboration, not domination. There are many parts of H.R. 2646 that could be helpful to improving mental health services in America. But there are equally many parts of the bill that need a serious rewrite. Let's not be hijacked by a brusque attempt to use fear-mongering to push a bill through without addressing its major flaws.

I vote for letter #2.

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


  1. jennifer hoff's avatar
    jennifer hoff
    | Permalink
    As the parent of a seriously mentally ill adult child whos "choice" to stop his medications and live homeless in the gutter by was supported by our county behavioral health director AND his "peer" led support system I Strongly Support the helping families in mental health crisis act.

    Any parent who has a child who reguraly meets the current standard of "dangerousness" our civil commitment laws require for a 5150 will tell you that VIOLENCE IS 100% Predictable and YES many of the recent mass shooting (and other acts of violence) were carried out by very very sick young men who NEEDED HELP!!

    Current laws Prohibit parents from getting their sick adult child into a Hosiptal unless Danger is Immanent....We didn't make these terrible laws ...But somehow it's up to us to FIX Them because not one Disability "rights" group will help us keep our children Safe and off the streets because doing so would reform themselves out of a job...see they actually make money off of the current system of helping only the worried well and leaving those who LACK INSIGHT to live in the street until they die in the gutter!

    Here's a news flash...the folks who need the help of this law are so sick they Believe the Voices they hear and Do What They are Told..the services under this bill would help families like ours get our sick and DANGEROUS loved one get the medical attention required so they can get healthy enough to live Safely in our communities....is t that really what we all want...

    For the Adam Lanzas and the Eric Klebolds and James Holmes of the world to get Treatment BEFORE Tragedy?!

    The authors of the "Holistic" letter seem only to care about keeping their clients out of a hospital At All Costs...even if it means compromising the safety of my child and the safety of my community.

    Enough of the spin that it's a choice to live homeless thinking you are from the sky!

    Enough of the bs that this bill is going to rob everyone of their rights and create some shareholding experience like we had before deinstitutionalization.

    Give families the Tools to keep everyone SAFE!

    Pass the Murphy bill NOW!
  2. Amanda Woodward's avatar
    Amanda Woodward
    | Permalink
    I prefer to vote for Bill HR2646 not which letter is better. I agree that the letter seems to pander to fear, not to the real problems out there. Robert'a response above is superb. I would much prefer to see treatment teams decide who should be in jail rather than some magistrate as it now stands. Worried about civil rights? Try observing the slow decay of a human mind in solitary confinement over a period of months while a person with smi and anosognosia circulates through the "system" for the 5th time. How about his right to treatment? If a mute person were having a medical problem would we deny treatment because he couldn't ask for it?
  3. Robert Powitzky's avatar
    Robert Powitzky
    | Permalink
    I agree with objections to fear mongering. But I have problems with letter #2.
    They start out by saying they agree the mental health system is broken and the brain should be treated like any other organ, yet they offer no changes that would fix the problems.
    They say HR 2646 treats mental illness differently than other diseases. Let's get some ED experts to talk about how they treat someone unable to know they are sick and cannot give consent. Like those unconscious with head trauma or heart failure. Or those conscious but incompetent to give consent like those with insulin shock, hepatic encephalopathy or medication abreaction.
    HIPAA does allow communication with significant others if doing so assists the patient in receiving proper care. HR2646 only clarifies the criteria for appropriate communication.
    I'm amazed by their objection to involve the courts with AOT. This is the ultimate safeguard of a person's civil rights. In addition what world do they live. The very rare person needing AOT has already been in and out of jails and the criminal justice system because there was no AOT available for them.
    As far as funding, by not putting some guidelines in the system they are actually perpetuating the very status quo which they themselves said was not working.
    The same argument can be b made about SAMHSA. If the status quo is so great why are we in the mess we're in?
  4. George Patrin's avatar
    George Patrin
    | Permalink
    Scott, I agree with you. The best approach in introducing legislation to right the broken mental health care in this country is so important. Unfortunately, discussion of correcting mental health care is talked about only after tragedies occur. Letter one misrepresents the truth - "When mass shooters strike there seems to always be a severe mental health issue associated with the criminal... ." Actually, it's not so much about the shooter having a label of mental illness as it is their having pent up anger over a lifetime of neglect and poor healthcare in general. This audience has heard my lament over and over - we need to transform resourcing and processes for Primary Care Teams to be integrated with behavioral health for same day access when depression and anxiety are first mentioned, providing continuous care before the person explodes in crisis. In fact, there is "a direct link between serious (anger and frustration) and violence." Letter #2 - H.R. 2646 is more appropriate to get at the core issues of our nation’s broken mental health crisis-oriented sick-care (non)system. It's not that complicated - provide ongoing mental health care in the primary care setting. (Of course, if the person can't get health care coverage at all, it will not change the outcomes if it is set up optimally, will it?)
  5. Laura Boyd's avatar
    Laura Boyd
    | Permalink
    My question builds on John's. I notice all Democrats on letter #2. Howver, letter #2 has both Ds and Rs and some typically 'progressive Ds'. I'm wondering strategically if at least getting a hearing on HR 2426 as is might not be the only strategic step to moving forward to improve the bill. Too often a letter (position) that is not bipartisan is ignored.
  6. daniel Fisher's avatar
    daniel Fisher
    | Permalink
    Scott, I and our National Coalition for MH Recovery agree with your analysis. Letter two is superior. We are concerned about the same issues. In addition the dismantling of SAMHSA would derail much of our MH and Addiction Recovery transformation.
  7. John Franz's avatar
    John Franz
    | Permalink
    A thoughtful analysis of the two positions, Scott. I agree that door number two makes more sense. But as you point out, making sense doesn't score points in politics. Do you think that the bill as written and as it might possibly be amended in the normal course of congressional sausage-making and all that happens after the provisions are implemented by the bureaucracy, is better than nothing, or a step back? It's really hard to tell.
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