Legislation Contains Important Policy Proposals Relating to the Workforce and Innovation,
 but PRA Strongly Opposes the Promoted Expansion of Involuntary Treatment.

(McLean, VA, June 29, 2015) – As the leading organization focused on growing and training the recovery workforce, the Psychiatric Rehabilitation Association (PRA) appreciates that Representative Tim Murphy (R-PA-18) has taken seriously the grave concerns expressed by many in the mental health community regarding legislation he introduced in the prior Congress and has taken many steps to ameliorate these concerns in the much-revised “Helping Families in Mental Health Crisis Act of 2015” (H.R. 2646).  However, PRA continues to have serious concerns with the legislation insofar as it encourages the expansion of court-ordered, involuntary treatment, which is euphemistically referred to as “Assisted Outpatient Treatment” (AOT). 

In 2010, PRA awarded Representative Murphy the PRA Congressional Award in recognition of his work in Congress on issues of importance to the psychiatric rehabilitation community.  We applaud Mr. Murphy for bringing mental health issues to the table for discussion in Congress, for actively engaging with the mental health community, and most importantly, for responding to the community on many issues.  It is with hope that we can continue to work with Mr. Murphy and the sponsors of this legislation to further improve it for families and individuals in need of mental health and substance abuse treatment and related services in communities across America. 

PRA members work every day with adults, adolescents, and children facing severe and persistent mental illness. We work collaboratively within our communities to build bridges that enable our consumers to live more productive lives - connecting individuals and families with physical health services, housing, education, and job training, while addressing the behavioral and mental health issues that are recurrent in their lives. PRA believes that involuntary treatment is a last resort, used only when it is clear that an individual is a danger to themselves or others. Recovery is possible when the individual in treatment acts in partnership with the rehabilitation workforce and strengthens integration into their community; coercion is not an incentive to recover and all too frequently may be implemented where other treatment and community support options could achieve a better result. 

We appreciate that Representative Murphy seeks to stand with families facing mental health crisis and that this legislation does not contain the mandatory expansion of AOT proposed in 2013.  However, H.R. 2646 aims to encourage, support, and incentivize the expansion of AOT, which we believe will do more to harm than help individuals and families seeking a pathway to recovery.  Specifically the legislation,

- Includes $20 million in grants for AOT programs in states and communities through 2020, with 80 percent of such funds earmarked for new AOT programs, creating an incentive and providing resources and infrastructure for the establishment of AOT programs where they do not exist today. 

- Creates an unprecedented link between AOT and funding for the Community Mental Health and Substance Abuse Block Grant (CMHSABG) by establishing a two percent increase in funding for states with AOT programs. 

- Establishes a requirement in the CMHSABG to engage persons with serious mental illness who are unlikely to seek out their own treatment – a laudable goal – naming only AOT as an example of programs that would meet such a requirement.  Although this section grants discretion to the implementing agency to identify other options, by including AOT in the statute and failing to include other types of programs, the legislation demonstrates a clear bias towards involuntary treatment in a block grant program for community mental health. 

We ask Mr. Murphy to reconsider these sections of the legislation – to eliminate the AOT grant program, to eliminate the linkage between the CMHSABG and AOT, and to eliminate the reference to AOT in the requirement to engage with individuals with severe mental illness in the CMHSABG. 

We urge policymakers to work with PRA to more fully understand how our profession provides, on a daily basis, the kind of treatment that brings individuals through rehabilitation into a recovery and how this is a far more effective way than coercively confining and “treating” individuals against their will.

In addition, many in the mental health community are concerned about the proposed reorganization of the Substance Abuse and Mental Health Services Administration (SAMHSA) contained in H.R. 2646.  SAMHSA has been a key ally in the promotion of mental health and substance abuse services to states and in local communities for many years and the establishment of SAMHSA represented an acknowledgement of the unique importance of these critical healthcare issues.  PRA encourages the sponsors of this legislation to ensure that any reorganization of this Agency serves only to elevate and promote the criticality of mental health and substance abuse prevention and treatment within the federal government and to safeguard the critical programs contained therein. 

While we have serious concerns regarding the promotion of AOT in HR 2646, we also recognize that there are many positive elements contained within the legislation.  We applaud Mr. Murphy for including the following new and expanded policies:

- Development of a nationwide strategy to increase the mental health workforce focused on recruitment of professionals, increased access to child and adolescent services, and underserved populations.

- Examination of best practices for peer-support specialist programs, training, and certification.

- Expands the pilot program authorized in the Protecting Access to Medicare Act of 2014 to create Certified Community Behavioral Health Clinics. 

- Expands access to resources to behavioral health professionals to adopt electronic health records and related technology services. 

- New grant opportunities to demonstrate innovation through the National Mental Health Policy Laboratory and Innovation Grants.

- Focused Grants on early childhood intervention and treatment. 

PRA believes that Representative Murphy’s legislation is well intentioned, contains many important policy initiatives, and is much improved over the 2013 version, but is in need of amendment before it should move forward to better help the families and individuals in mental health crisis claimed by its legislative title. PRA stands ready to work with Rep. Murphy and his congressional colleagues to make important changes to this legislation to help more people and families find their road to recovery.

About the Psychiatric Rehabilitation Association (PRA):  As the nonprofit organization focused on growing and training the recovery workforce, the Psychiatric Rehabilitation Association, is the preeminent association for the development, support, and dissemination of information about the practice of psychiatric rehabilitation and recovery. PRA believes that the practice of psychiatric rehabilitation leads to recovery, and thus is committed to the growth of psychiatric rehabilitation in both quantity and quality, and to the universal availability of state-of-the-art psychiatric rehabilitation services for all individuals with mental illness who seek such services. For more information, visit www.psychrehabassociation.org.