I mean, this isn't gonna be some Vox shit, but there are a lot of parts to this year's biggest legislation regarding mental health. Let's start with some background.
Adam Lanza, Movie Theater in Colorado, Fort Hood
These are the only reasons that any legislation on mental health is making any progress. A new question has been added to the post-shooting checklist: was it a terrorist, what race were they, and now, what were their mental health issues. There are a number of reasons for this, but it's fair to say that the NRA has played a large role in this. You may remember in 2012, they called for an "active national database of the mentally ill". Wayne LaPierre, head of the NRA, kept up the charge last year: it's a handy way for the NRA to call for restrictive legislation that doesn't involve guns. A culture has been created where the elevator pitch to Congress is less "mental health is a civil right" and more "we need to stop these people without emotions from shooting at us". A culture of fear, one could say.
He's the Congressman who's behind the bill, although he's gotten 72 co-sponsors as well (a rough split between Democrats and Republicans). He's the only psychologist in Congress, which weirdly makes him the butt of ribbing by fellow Republicans. "Be careful, Tim can read your mind" one said, which, really?
He's from Ohio and represents a socio-economically diverse part of Pennslyvia. Rick Santorum used to hold this seat, but Murphy has been there for almost ten years. In 2002, when he was a State Senator, he wrote a book called The Angry Child: Regaining Control When Your Child is Out of Control. Here's an interview with him about it, where he first starts off talking about the dangers of angry kids (this was only three years after Columbine), but balances that by talking about anger as a mask for other emotions, and a need to understand core concepts about them.
Health professionals are far and away his largest donors, although those are likely more on the medical side of things as opposed to the psychological. When he was running for State Senate the Pennsylvania Psychological Association gave him $5,730, which pales in comparison to the fourteen grand they've given another Pennsylvania Republican.
SAMHSA and AOT
SAMHSA is the Substance Abuse and Mental Health Services Administration. It's part of the Department of Health and Human Services, and is the U.S. government's main outlet for mental health research. Fun fact: it was once known as the Mental Hygiene Division, which calls to mind MIB-style mind-sweeping dentists. It's currently run by Pamela Hyde. Murphy has been critical of SAMHSA's priorities, saying that many of SAMHSA's grants "are directed to advancing services rooted in unproven social theory and feel-good fads, rather than science". Murphy wants to significantly weaken SAMHSA by creating a new office within the HHS, the Assistant Secretary for Mental Health and Substance Use Disorders, which is a lot of words. The big divide between Murphy and SAMHSA regards Assisted Outpatient Treatment, which we'll explain right now.
Assisted Outpatient Treatment is the fancy term for forced commitment. Murphy's bill wants to spend $60 million on AOT pilot programs and grants, giving it the potential to become much more commonly used. It's legal in 45 states and the District of Columbia, and often goes by a name: Kendra's Law in New York, Laura's Law in California. Both Laura and Kendra were killed by a person with severe mental disabilities who was resisting treatment.
It's a highly controversial issue, as you can imagine. Mental Health America put out a statement saying that it "rejects the expanded use of involuntary treatment—ignoring the rights of persons with mental health conditions to make decisions concerning their treatment or minimizing the dignity, autonomy and self-determination of persons affected by mental health conditions".
Dr. E Fuller Torrey, who has written several books on schizophrenia, runs the Treatment Advocacy Center and is a fierce supporter of AOT, has a backgrounder on the subject, which brings up civil liberties in the second question:
A: No. Severe mental illness, not its treatment, restricts civil liberties. By assuring timely and effective intervention for the disabling medical condition of severe mental illness, assisted outpatient treatment restores the capacity to exercise civil liberties and reduces the likelihood of the loss of liberty or life as a result of arrest, incarceration, hospitalization, victimization, suicide and other common outcomes of non-treatment.
One thing that's clear is that if AOT is to work, and that is to say, if it can help improve a person's life, is if it is done in context. There have been, many, many studies on the subject, but the most important one in terms of the Mental Health Crisis Act is The Cost of Assisted Outpatient Treatment: Can It Save The States Money? It sounds heartless, and looks at Kendra's Law in New York in terms of raw numbers. What it figured out is that one reason AOT in New York is so successful is that AOT has the most money in the system. The study concluded that " those who do not qualify for assisted outpatient treatment, voluntary participation in intensive community-based services may also reduce overall service costs over time, depending on characteristics of the target population and local service system."
If that doesn't sound enthusiastic, you're right.
This is a bill that's over 120 pages long, it's been called the greatest potential overhaul in the government's treatment towards mental health since the Kennedy Administration. There's a lot here. It wants a census of the number of mentally ill in prison and a Google-style National Mental Health Policy Laboratory to help find new procedures. Everywhere you look in the bill, there's a focus on the "serious" mentally ill, as opposed to people like me, I guess, which regular old Asperger's. There's very little about children or family as well. It's a bill that has the potential to help, I think, but is clouded by the culture of fear and stigma of violence currently associated with mental health in America.