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An inconvenient truth that needs to be addressed in a Murphy/Barber compromise: Assisted Outpatient Treatment versus individual choice

July 10, 2014

We were pleased to learn that a bipartisan group in the House of Representatives has been meeting to look for some common ground on two mental health bills introduced this Congress – HR 3717 (Rep. Murphy, PA) and HR 4574 (Rep Barber, AZ). While there are similarities in the two bills, one of the lightning rods that distinguishes the bills from each other, and is dividing the advocacy community, is the issue of self-determination and individual choice in treatment decisions for those with a serious mental illness.

A bipartisan meeting focused on compromise is a positive development and gives us hope that some useful steps toward mental health reform can come of this instead of two competing bills both dying in committee.

However, in the spirit of compromise, we hope our elected officials will not shy away from one of the most contentious elements of the Murphy bill that is not in the Barber bill – Assisted Outpatient Treatment (currently, forty-five states permit the use of assisted outpatient treatment). The concept of “forced treatment” raises a host of concerns and has put the mental health advocacy community in opposition to each other, which is the last thing we need if we are serious about improving mental health services in America.

In an interesting critique of the Murphy bill by John Grohol of PsychCentral, he states:

  • “So here are the major problems with this bill, and why it stinks for everyone — especially patients. You can kind of tell this isn’t a bill directed at patients and helping patients in the mental health system simply by its name, “The Helping Families In Mental Health Crisis Act.” You see that there —families. Not people with mental illness. This is about helping families deal with a family member who has an apparent mental illness — not about helping the actual people with a mental illness.”

And there, likely unintentionally stated, is the inconvenient truth of this debate. Yes, there are families with young adult children who are in crisis – today. And we are hearing from these families that they can’t wait for the promise of prevention programs that may provide great things, but not today. What happens today? What is their recourse today? How do they deal with the gut-wrenching worry of not being able to keep their young adult children safe from harming themselves or others today? How do parents who are ardent advocates for self-determination and individual choice resolve the internal conflict of knowing inside that their child needs help, but not being able to provide it? How do they resolve the conflict of doubt – second-guessing their internal intuitive compass that tells them there is trouble afoot?

There are no easy answers to these questions, but to deny the existence of these struggles is as wrong as it is to say that everyone has the right to choose, and that is that. Unfortunately, overlooked in much of the debate about the Murphy bill in particular, is an inconvenient truth – there are families with young adult children who need help now, today, not sometime in the future.

Strip away the personalities of members of Congress involved in this debate, national advocacy group position statements either for or against, and the research data that both sides of the issue present to provide viability to their positions. Strip away the inevitable stigma promoted in the press that individuals with serious mental illness are violent. Strip away the raging debate on the effectiveness and appropriateness of the use of medication. Strip all of that away and you still have an inconvenient truth that is festering like a burr under the saddle:

  • I am fearful for my son’s life because his brother is hearing voices telling him to kill his brother. 
  • I am fearful that if my child doesn’t take his medication he will get in trouble and end up in jail.

There are families with children in deep crisis who need help now.

The Children’s Mental Health Network is a huge proponent of the recovery movement and has written about numerous examples of successful strategies for helping individuals take a self-directed approach to getting better. But what does that mean for those families and youth who are in a different, more dangerous place? How should we respond to parents who are frightened by their child when he or she is in a psychotic state, scared for the safety of siblings, others, or themselves? Where is their voice being heard? I am increasingly hearing from parents that national advocacy groups are muting the discussion of this inconvenient truth.

We need to embrace the voices of families of young adults in serious crisis just as fervently as we do those families who have young adults with less serious challenges or just as we do with young adults who are doing amazing, self-directed things on the path to recovery.

Is one perspective more valid than the other? Should we discount the clarion call for individual determination that so many against the Murphy bill have spoken about? Of course not. Should we discount the pleas from family members to have more options in front of them when dealing with concerns about a loved one? Of course not – but in many respects, during this debate we have.

The unfortunate irony in all of this is that there is a plethora of smart, knowledgeable people on both sides of the issue. What we need is for these smart and knowledgeable people to be reasonable and come together in a calm and coherent manner to truly address this inconvenient truth. Whether that looks like a designated commission or committee, I don’t know, but the members of Congress working on compromise solutions between these two bills are in a great position to make it happen.

Representative Murphy, Representative Barber, you were elected to represent the interests of the people in your respective districts and to model collaborative efforts for the nation on how to address difficult issues. We expect you to do just that. We are thrilled to see a dialogue beginning about what parts of each of your bills can be crafted to result in meaningful legislation, but please do not shy away from this issue. It is real; it is uncomfortable, it is not politically correct, but it may be the most important area of focus you could embark on.  


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

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