Mental health advocates blast Rep. Murphy's Bill

Mental Health Advocates Blast Rep. Tim Murphy’s Bill as a Costly Step Backward, to the Days When a Mental Illness Diagnosis Was a Life Sentence

WASHINGTON – Congressman Tim Murphy introduced legislation that, if passed, would reverse some of the advances of the last 30 years in mental health services and supports. It would exchange low-cost services that have good outcomes for higher-cost yet ineffective interventions, according to the National Coalition for Mental Health Recovery (NCMHR), a coalition of 32 statewide organizations and others representing individuals with mental illnesses; the National Disability Rights Network (NDRN), the non-profit membership organization for the federally mandated Protection and Advocacy (P&A) Systems and Client Assistance Programs (CAP) for individuals with disabilities; and the Bazelon Center for Mental Health Law, a national non-profit legal advocacy organization.

“This legislation would eliminate initiatives that promote recovery from serious mental illnesses through the use of evidence-based, voluntary, peer-run services and family supports,” said Daniel Fisher, M.D., Ph.D., a founder of the NCMHR and the ED of a mental health agency in Massachusetts. “These services have a proven track record in helping people stay out of the hospital and live successfully in the community. Because hospitalization is far more expensive and has far worse outcomes than these effective, and cost-efficient, community-based services, this bill would cost more money for worse outcomes.

“Even worse,” Dr. Fisher added, “the bill greatly promotes stigma and discrimination by its unfounded and damaging connection between mental illness and violence...”

The bill introduced by Rep. Murphy (R-PA) is co-sponsored by Renee Ellmers (R-NC2). It was introduced in December 2013. Given that mainstream media is supporting the Murphy bill take time to read this article from USA Today by Wayne Lindstrom of MHA (Mental Health America):

"Opposing view: Don't link violence with mental illness" published January 10, 2014.


Context and analysis

Can anyone point me towards any context or more robust analysis of the impact of this legislation? I work in NC in public mental health and I could use a more in depth exploration of this topic.

Garrett Lagan, LCSW, LCAS

The efficacy of treatment

in reducing violence is well-documented, but before a law like this gets passed, it's hard to navigate through the persuasive information provided by advocates for each side. A lot of summaries, some taken out of context, so you end up bouncing back and forth.

All that said, there's some pretty solid stuff available from the Federal government, if you have the time to navigate their archives:

Multiple studies have demonstrated that the treatment of individuals with serious mental illnesses with antipsychotic medication, especially clozapine, is effective in reducing arrests rates and violent behavior.24,25 Researchers in Germany measured aggressive behavior (“threats, physical aggression against persons and objects, self-directed aggression” in individuals with schizophrenia before and after beginning antipsychotic medication. They reported: “The day-to-day decline of aggressive incidents after the start of neuroleptic (antipsychotic) medication was highly significant… . The results support the assumption that the increased figures for violence by schizophrenics are, at least in part, due to the lack of adequate treatment.”26 Similarly, an assessment of violent behavior among patients in the Clinical Antipsychotic Trials of Intervention Effectiveness study reported that “medication adherence across all treatment groups was significantly associated with reduced violence, except in patients with a history of childhood antisocial conduct.”27 The latter group would be assumed to have an antisocial personality disorder that would be the cause of their violent behavior; thus, antipsychotic medication would not have been expected to be as effective.

Finally, 2 studies have directly assessed the effect of assisted outpatient treatment (AOT) on violent behavior. Patients referred for AOT are a special group, usually having a history of medication noncompliance often accompanied by violent behavior. AOT is a means of ensuring that such individuals take their medication. In North Carolina, subjects with a history of serious violence had a reduction in violence from 42% to 27% when the AOT was continued for at least 6 months.28 In New York, AOT reduced the proportion of individuals who “physically harmed others” from 15% to 8% and the proportion who “threatened physical harm” from 28% to 16%.29 Thus, as Dr Insel summarized the situation: “Treatment may be the key to reducing the risk of violence, whether that violence is self-directed or directed at others.”30

Before I begin reading one of these white papers I go straight to the footnotes to make sure the paper draws on multiple, peer-reviewed studies. It isn't a guarantee of relevance, but it's a damned good start.

Contact Dr. Sue Estroff at UNC-CH

Good sources of expertise and other contacts on this are Sue Estroff, PhD, or Laurie Coker of Winston-Salem, Exec. Director of NC-CANSO and a former psychiatric nurse.

I originally got involved with this at Laurie Coker's request. We were responding to information on the Civitas site and a guest column on topic of the Murphy bill by a Civitas writer on the Charlotte Observer site a couple of days ago.

Some of the info you cited, Steve,is bogus. There is a group of folks in NAMI and at the Treatment and Advocacy Center run by E. Fuller Torrey, that sponsors (pays for) studies and those studies are slanted to support their pre-conceived theories. If you go to the MHA (Mental Health America) or Bazelon Center web sites, you will find a very different story and references to studies that refute the Torrey/TAC propaganda.

Also, keep in mind that many people with mental illness stop taking meds for good reason. One of the largest class action settlements in US history was about a psych drug called Zyprexa. Eight years ago its manufacturer, Eli Lilly, settled for over 1.3 billion dollars when plaintiffs accused the giant pharmaceutical company of promoting the drug despite its own research that found links between its drug's use and greater risk of diabetes and other health conditions.

Folks who take psych drugs for decades have a life expectancy of at least 15 years less than "normal person." To be blunt and to the point, the pharmaceutical industry and their friends in the psychiatric community have money to be made by keeping people on drugs, whether those drugs are safe over the long-term or not.

Keep in mind that there are situations in NC and NY like with Duke's Marvin Swartz, MD, a pychiatrist, who did the evaluations for the results of Kendra's Law in NY state. They get paid fat fees to do the evaluations. Given they have "skin the the game" to keep saying the law works and get more and better consulting contracts, they may not be totally objective.

Dr. Sue Estroff ( of UNC's School of Medicine can direct you to good, validated research that goes counter to the results you mentioned above. Dr. Estroff has been at UNC for over 25 years and is nationally and internationally known for her research on mental health issues.

I will provide links later on the clinical issues of the Murphy bill, as I am short on time right now. But to make the main point--this is not just a clinical or medical issue. It is also, and always has been, a civil rights issue as well. The theme of the mental health client movement nationally is "nothing about us without us." The quote is taken from African civil rights leaders, but it applies.

Too often we have medical doctors or other professionals telling mental health clients to do whatever the doc thinks is best for them. It is well past time for a change from the paternalizing of medicine, and the adoption of the recovery centered treatment that many other states have adopted.

The Murphy Bill also contains many different and drastic changes in Mental Health law. One of its proposals would greatly reduce or eliminate funding for the Protections and Advocacy Agencies (one for each state and territory) that investigate abuse and neglect in mental health facilities and the community. The P & A for North Carolina is Disability Rights NC based in Raleigh, NC; Vicki Smith is its director, and I was once employed there as a policy analyst.

The article I posted above which quotes Dr. Dan Fisher cites other supporters of their press release as including the National Disability Rights Network based in D. C. DRNC (NC's protection and advocacy agency for persons with disabilities) is a member of NDRN.

I speak here as a long-time consumer rights activist, but I also speak as a writer who has done policy research for years, both professionally and as an unpaid advocate. If you are inclined to hear the greatly under-reported clients' side of the story, contact me through BlueNC.

(I use to give out my phone number freely, but recent months events have made me more cautious about that.)

Martha Brock

Not really an advocate for anti-psychotics,

and I'm definitely not an advocate for most of the unnecessary drug treatments pushed by big pharma.

All that being said, certain ailments can only be (safely) treated via pharmacological means. There should definitely be more facets to the treatment, such as therapy and occupational training and such, to help patients become (and even more important feel) productive. But to advocate for a total non-reliance on drug treatments is as dangerous (in my opinion) as prescribing them for every problem that surfaces. I'm not saying you're doing that Martha, I'm just saying.

The Murphy Bill: civil rights for Persons with Disabilities

Talked to Vicki Smith at Disability Rights NC this afternoon. She says under the current wording in the Murphy bill in Congress, 83% of the NC P&A's funding for Protection and Advocacy for Persons with Mental Illness (better known by the acronym: PAIMI) would be cut from the federal SAMHSA budget.

Also, new restrictions on what kinds of advocacy DRNC could do in the community versus institutions would be added. It is imperative that the media be made aware how this would impact persons with psychiatric disabilities.

DRNC has taken NC DHHS and local mental health agencies to court on behalf of many, many persons with psychiatric disabilities in the 6 years it has been around. They have provided legal representation for individuals, and when necessary, taken the legal action to the next level by going with class action lawsuits. In my opinion, things would be even worse than they are for persons with disabilities in NC without the protection and advocacy this non-profit provides.

Just to give one example of advocacy that gets little attention--DRNC has helped children with disabilities facing school suspensions and unable to get real help with studies while on suspension; the suspensions often resulted from behavioral problems that led to disciplinary actions.

For more information contact Vicki at Their office is closed this Monday.

Martha Brock