Review of America’s Mental Health Care Advancements During 2008

Yearend is a good time to take stock of advancements and set new goals.  Health advocates likely agree that 2008 was very positive for mental health law.  For one thing, President-elect Obama won the presidency, and his successful campaign prioritized health care.  Secondly, judges in 10 of the nation's 11 largest cities declared 50% more defendants incompetent to stand trial, which reduced the number of mental patients being punished as criminals.  The Bush Administration announced a reduction in the nation's homeless rate through a program that provides subsistence assistance and other services.  A new mental hospital is being built in Salem, Oregon.  Oregon is blessed to have a governor who is concerned about mental health care like Gov. Ted Kulongoski.  He noted that the state needs to do more than build a new hospital building, but should improve its mental health care system, including improved early care that might help keep people out of hospitals.

Best of all, four important mental health bills passed in our nation's capital in 2008 with overwhelming bilateral support by members of the Senate and House.  Mental health advocates have reason to look forward to 2009 with optimism, because as of December 27, Congress.org listed 20 bills pending before Congress to address mental health care.  During 2008, the following legislation became law:

1)  Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act of 2008  - SR2304 - A bill to amend title I of the Omnibus Crime Control and Safe Streets Act of 1968 to provide grants for the improved mental health treatment and services provided to offenders with mental illnesses, and for other purposes. – This important bill passed in the House on September 29, after having passed the Senate by unanimous consent, and was signed into law by President George Bush on October 14, 2008.  http://www.opencongress.org/bill/110-s2304/show  

2)  After a decade of negotiations, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act finally became law on October 1.  This landmark legislation requires health insurance plans that offer mental health coverage to equalize financial and treatment coverage for mental and physical illnesses.  This bill was co-sponsored by Vice President-elect Joe Biden.  See more about it here:  http://my.nowpublic.com/health/mental-health-parity-now-law-land 

3)  In September, a major civil rights bill was passed by Senate on a voice vote without descent.  It expands protections under the Americans with Disabilities Act by helping to prevent workplace discrimination against people with disabilities, including mental illness.  Safeguards protecting citizens against employment discrimination had been weakened over the past decade by the Supreme Court, but this bill strengthened the ADA and prevents workers from having to choose between accessing the treatment they need and continuing their employment.  More information about the bill is at this link:  http://my.nowpublic.com/health/u-s-senate-and-house-pass-legislation-expanding-americans-disabilities-act  

4)  In June, our representatives passed the Medicare Mental Health Parity Bill by veto-proof bipartisan support.  Among other things, it provides for mental illness to be placed on a par with other medical conditions in terms of Medicare insurance coverage.  More about the bill is here:  http://my.nowpublic.com/health/medicare-mental-health-parity-bill-approved-senate-69-30-mary-neal

Of the twenty mental health bills listed on December 27 by Congress.org as pending before Congress, seven would increase access to mental health services for military personnel and veterans.  Other bills concentrate on mental health care for minors.  Some pending bills address alcohol and substance abuse, which often accompany mental illness for several reasons:  (a) Some people have a tendency to self-medicate rather than seek professional help due to a lack of resources; (b) others seek to avoid the stigma attached to mental illness, and (c) many suffer from a condition that is quite common among acute patients called anosognosia, the inability to recognize their illness and willingly accept treatment.  Therefore legislation that addresses drug dependency is appropriate.

The mental health bills before Congress as presented by Congress.org on December 27, 2008 were at this link: http://www.congress.org/congressorg/issues/bills/?start=1&keys=mental+health&chamber=H 

Only one of the pending bills listed at Congress.org on December 27 regards mental illness and crime.  Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act of 2008, Bill # H.R. 3992, was originally sponsored by Bobby Scott (D-VA).  It promotes “effective strategies to identify and treat mentally-ill offenders.”  H.R. 3992 was supported in the House by members of both major political parties, like the three important bills listed above that were signed into law in 2008.  The bill was presented by Congress.org as having 14 co-sponsors, including eight Democrats and six Republicans.  Its purpose is “to provide grants for the improved mental health treatment and services provided to offenders with mental illnesses, and for other purposes.”  This bill is similar to Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act of 2008 -  SR2304, which passed into law on October 14.

See important provisions of the House version of H.R. 3992 below.

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Bill # H.R.3992 

(Sec. 4) Authorizes the Attorney General to make grants to states, local governments, Indian tribes and tribal organizations for training programs and other services to assist law enforcement officers and campus security personnel in responding appropriately to incidents involving mentally-ill individuals. Authorizes appropriations for FY2008-FY2014.

(Sec. 5) Authorizes the Attorney General to make grants to states, local governments, Indian tribes and tribal organizations to provide services to female offenders with a mental illness, including mental health treatment, intensive case management services, and family support services. Authorizes appropriations for FY2008-FY2014.

(Sec. 6) Authorizes the Attorney General to make grants to states, local governments, Indian tribes and tribal organizations to provide services for mentally-ill offenders, including:(1) assistance to correctional facilities for identifying mentally-ill offenders and for providing treatment plans for them; (2) local task forces to assist such offenders in reentry into the community; (3) housing options for such offenders; (4) development of community crisis services; and (5) links with local community mental health providers for assisting mentally-ill offenders with services prior to release from a correctional facility. Authorizes appropriations for FY2008-FY2014.

(Sec. 7) Authorizes the Attorney General to make grants to assist states, local governments, territories, and Indian tribes in planning and coordinating treatment programs for offenders with mental illnesses. Authorizes appropriations for FY2008-FY2013.

(Sec. 8) Reauthorizes the mental health courts grant program for FY2008-FY2014. Expands the permissible uses of grant funds to include pre-trial services and programs to provide alternatives to incarceration for offenders with mental illnesses.

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As presented in the House, H.R. 3992 addressed most of the problems that affect chronically mentally ill persons and subject them to repeated arrests at exorbitant costs to taxpayers.  Congressman Scott and the co-sponsors of this bill are to be congratulated.  The bill passed in the House, and an engrossed version of the bill is now before the Senate. 

Provisions in the House version of H.R. 3992 would likely help many mental patients avoid prison and thereby unburden taxpayers to a large degree.  It is far less expensive to treat mental illness than to punish citizens for being sick. 

Although Congressman Scott's H.R. 3992 provided for improvements in community care, it apparently did not seek to appropriate funds to build or expand hospitals that are sorely needed to provide inpatient care as an alternative to warehousing our sick citizens in prison, or to provide for enforced hospitalization and mandatory community care, unless same was to have been included under the treatment plans in Sec. 6 of the bill.  

Without easing restrictions on enforced inpatient and outpatient treatment, prison will continue to be the main resource for removing acute mental patients from society who commit crimes while not in control of their faculties due to bipolar disorder, schizophrenia, or other mental illnesses.  People who lack good reasoning skills should not be expected to make major health decisions.  Without mandatory treatment provisions, many psychiatric patients face the likelihood of repeated arrests for crimes committed during mental health crises, and society is less safe.  Please see this:

Murder for Christmas:  Arizona Schizophrenic Man Bludgeoned Youngsters
http://my.nowpublic.com/health/murder-christmas-az-schizophrenic-man-bludgeoned-youngsters 

There is resistence to enforced treatment from civil liberties groups and others, but enforcing care for people who lack the clarity of mind to avoid incarceration because of mental illness is akin to enforcing blood transfusions and other medical intervention when needed for minors whose parents object on religious grounds.  The alternative to enforced treatment for offenders who are mentally ill will continue to be a high incarceration rate among our most vulnerable citizens and a national prison budget that exceeds $50 billion per year according to the PEW report issued in February of 2008.  However, many expenses preceed prison, like the cost of  police services and trial.

Although the House version of H.R. 3992 did not appear to specifically address mandatory treatment and increasing inpatient hospitals, it spoke to numerous changes needed to decriminalize mental illness.  The House bill included expanded mental health services in our communities, housing assistance for psychiatric patients when needed, establishing treatment plans for mentally dysfunctional inmates exiting prisons, reauthorizing mental health courts for jail diversion, and instituting other important reforms.  This writer is unsure how many of the House bill's proposed provisions for psychiatric patients caught in the criminal justice system are being presented for vote in the Senate version, or how many might already be addressed in S.R. 2304, which passed in October.

All of the provisions of H.R. 3992 as approved by the House are needed to reduce America's tax burden for prisons and provide more humane options for citizens who have trouble understanding and/or abiding by laws due to their mental dysfunctions.  Hopefully, if some provisions were omitted as the bill traveled through committees, etc., some righteous-minded lawmaker will propose them in another bill soon.  It is unnecessarily expensive to imprison rather than treat sick citizens, and moreover, it is wrong. 

The link below carries information about other mental health laws and status information:

SENATE
http://www.senate.gov/general/search/search_cfm.cfm?q=mental+health&site=default_collection&num=10&filter=0&x=7&y=6

Mental illness is reportedly a health problem faced by one in every five Americans.  Hopefully, mental health bills pending before Congress in 2009 will be successful like the important mental health legislation that our lawmakers in the House and Senate passed in 2008 to benefit many Americans.  

THANK YOU, REPRESENTATIVES, FOR RESPONSIBLE GOVERNMENT!  HAPPY NEW YEAR!

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