Guest Opinion: We need to take a proactive approach with mental illness


January 13, 2014 

One year ago, in his State of the State address just weeks after the Sandy Hook shootings, Gov. Butch Otter proposed a $70 million mental health wing expansion to the Idaho State Penitentiary.

This year, the governor introduced a different approach: community-based 24-hour behavioral health crisis centers, one of which will be located here in Boise. Otter plans to pattern the crisis centers on existing models from other states in the belief that we will see “declines in use of local emergency rooms, hospital beds, and jail cells.”

What I like about this proposal is that it moves our focus from crisis-based, reactive care to a more proactive model that addresses the ongoing needs of individuals and families living with mental illness.

But what about those people who have serious mental illness but refuse to seek treatment because they lack awareness of their condition? How can a community crisis center help people who won’t ask for help but desperately need it?

The 11 million people in the United States with serious mental illness — schizophrenia, bipolar disorder, or major depression — are the most at-risk population for violence toward themselves and others. It’s this tortured group and their ongoing lack of access to medical care that drove Rep. Tim Murphy, R-Pa., a former child psychologist, to draft comprehensive new legislation to address the needs of families and individuals in crisis. Murphy, who practiced for years as a child psychologist, spent 2013 talking with stakeholders, including parents of children with serious mental illness, about what we are not getting from our mental health care system. I was one of those parents.

HR3717, the Helping Families in Mental Health Crisis Act, is a comprehensive attempt to address a variety of concerns parents shared. The proposed legislation clarifies HIPAA (Health Insurance Portability and Accountability Act) so that parents of young people with serious mental illness can communicate with their children’s doctors and caregivers.

In a nation with a critical shortage of child psychiatrists, especially in rural states like ours, it provides access to telepsychiatry that promises to narrow the current two-year average gap between initial symptoms and treatment. The bill also addresses the acute nationwide shortage of psychiatric hospital beds by tinkering with a Medicaid exclusion that caused the shortage in the first place.

But Murphy’s bill is not without detractors.

The National Federation of Families has opposed the legislation, arguing that it contributes to the stigma of mental illness by acknowledging that some, especially those with substance abuse problems or lack of insight/treatment, can be violent. The federation also opposes the assisted outpatient treatment provision, calling it an unwarranted expansion of involuntary outpatient commitment. And they are not pleased about Murphy’s call to restructure the Substance Abuse and Mental Health Services Administration, which currently funds peer-based and recovery models of treatment. Murphy would instead promote a medical model that focuses on effective treatments for brain disease with evidence-based outcomes.

The Federation of Families provides invaluable support and advocacy for individuals and families living with mental illness. I myself have benefited from their help. But I have to disagree with the national organization. By focusing the dialogue on mental health instead of mental illness, we have ignored the most seriously ill among us.

We need a mandate for medical treatment, for research funding, and for evidence-based outcomes that Murphy’s proposed legislation provides. And we cannot continue to ignore violence because the subject is inconvenient or uncomfortable. HR 3717 has the potential to create hope for millions of suffering children and their families.

Liza Long, of Boise, is a mother, writer, educator and mental health advocate. Her book, “The Price of Silence,” will be published by Hudson Street Press this fall.

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