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Congressman Tim Murphy The Helping Families in Mental Health Crisis Act (H.R. 2646)

Congressman Tim Murphy The Helping Families in Mental Health Crisis Act (H.R. 2646). Oversight Investigation. Post Newtown investigation by the House Energy and Commerce Subcomittee on Oversight and Investigations

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Congressman Tim Murphy The Helping Families in Mental Health Crisis Act (H.R. 2646)

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  1. Congressman Tim MurphyThe Helping Families in Mental Health Crisis Act (H.R. 2646)

  2. Oversight Investigation • Post Newtown investigation by the House Energy and Commerce Subcomittee on Oversight and Investigations • A systemic review of all federal programs, policies, and spending on Mental Health • More than 20 hearings, forums, and roundtables in 12 states and more than 20 cities • Hundreds of meeting, interviews, and document reviews • 2 Government Accountability Office Reports • 1 Office of Management and Budget Report

  3. Investigative FindingsAnnual Rates of Mental illness • 60 million Americans with a mental illness • 43 million adults with a mental illness • 17 million children with a mental illness • 10 million adults with a serious mental illness • 4 million do not receive care • 100,000 new cases of psychosis per year

  4. Investigative FindingsRates of Co-Occurring Disease • Primary medical risks among those with SMI: • 2 X more likely to have obesity, diabetes, stroke, and heart disease • 3 X more likely to have a metabolic syndrome • 4 X more likely to have high blood pressure • Side effects from Antipsychotics: • Increased risk for diabetes and cardiovascular disease

  5. Investigative FindingsMinority Mental Health • African Americans are half as likely to receive psychiatric treatment • 3 percent of psychiatrists and 2 percent psychologists are African American • 5 percent of psychiatrists and 3 percent psychologists are Latino • Among Hispanics with a mental disorder, fewer than 1 in 11 see a mental health specialist • Overall out-patient mental health spending is 40 percent lower for African Americans and 25 percent lower Latinos

  6. Investigative FindingsMental Health and Criminal Justice • Rates of mental Illness Among inmates: • 64% Local jail • 56% State prison • 45% Federal prison • Mentally ill inmates cost taxpayers 3x more than those without a mental illness • Incarcerating someone with a mental illness is 20 times more expensive than community treatment (AR Study) • Over 80% mentally ill inmates do not receive care • Over 70% of people in jails with serious mental illness also have a co-occurring substance-use disorder.

  7. Investigative FindingsVictimization Among the Mentally ill • Individuals with a mental illness are: • 4 to 6 times more likely to be the victim of sexual violence • 2.5 to 4 times more likely to be victim of a physical attack or mugging • More likely to be victims of scam • Children with disabilities are 4 times more likely to be victims of attack • One-third of homeless Americans have a serious mental illness

  8. Investigative FindingsViolence and Mental Illness • Individuals with a mental health condition are NOT more violent than the general public • However, a history of violent behavior, noncompliance with meds, and substance abuse are important predictors of future violent behavior among those with SMI. • Those with untreated psychosis are 15 times more likely to be violent when not in treatment • 80 percent of the violence committed by those with untreated psychosis are attributable directly to their illness • Individual with SMI on antipsychotics or mood stabilizers are 45% less likely to commit violent crimes

  9. Investigative FindingsImpact of Mental Illness in 2015 • 43,000 suicides • 47,000 drug overdose deaths • 1,000 murders by mentally ill • 250 SMI died in a violent encounter with police • There are 350,000 deaths related to mental illness each year

  10. Investigative FindingsProvider Shortage • 9,000 Child and Adolescent Psychiatrists for 17 million children with a mental health condition • 36 states have a shortage of psychiatric nurses • The total number of physicians in the country increased by 45% from 1995 to 2013 • The number of psychiatrists over that same period increased just 12%, from 1995 to 2013 • 55% of counties don’t have a practicing psychiatrist, psychologist, or social worker

  11. Investigative FindingsCrisis SMI Beds: ICU for SMI • 1955: 550,000 psychiatric beds (US population 150 million) • Today: 40,000 psychiatric beds (US population 317 million) • Only one state has enough beds to meet the minimum standard (Mississippi)

  12. Investigative FindingsOpioid Crisis Poor quality and barriers to treatment • Shortage of services and providers (hospital beds, qualified provider shortages, insurance companies not covering treatments) • Most patients don’t receive evidence-based treatment • 90 % of people with a Substance Abuse Disorder do not seek medical attention • Of those who do seek medical attention 37.5% were unable to get it • 90% of those in treatment did not get evidence-based treatment

  13. Investigative Findings of GAO StudyGAO Findings • 130 billion dollars annually by 112 agencies across 8 separate departments • “coordination for programs supporting individuals with serious mental illness is lacking.” • Agencies do not collect data on how mental health dollars are spent: • Few evaluations of the programs specifically targeting individuals with serious mental illness. • Federal grants and programs to treat the seriously mentally ill do not utilize the best available medical treatments and protocols: • Only 20 % of grants required “use evidence-based practices to treat individuals with mental illness.”

  14. The Helping Families In Mental Health Crisis Act (H.R. 2646) Assistant Secretary for Mental Health and Substance Use Disorders • Must be a psychiatrist or psychologist • Evaluate, coordinate, elevate, reform programs • Head the National Mental Health Policy Laboratory • Focus on applied research based on scientifically sound principles • Focus on programs that can be replicated across states, Medicaid, VA, etc • Promote innovation in secondary and tertiary prevention and treatment

  15. The Helping Families In Mental Health Crisis Act (H.R. 2646) Mental Health Parity • Ensures insurance companies are living up to parity • Develops federal interagency agreements for sharing parity information • Require federal agencies hold meetings with stakeholders, including patient advocates, to produce an action plan for improving parity • HHS would be required to publish any serious violations of parity compliance • Requires a report to Congress on the effectiveness of parity and any shortfalls in meeting parity enforcement, education and coordination requirements. • Clarifies that plan issuers offering coverage for eating disorder benefits must do so in alignment with current mental health parity standards.

  16. The Helping Families In Mental Health Crisis Act (H.R. 2646) Grants and Finding • Innovation & Demonstration Grants.......$14 million • School Based Early Treatment…………… $20 million • Tele-Mental Health Grants…………………. $9 million • Crisis Intervention Training…………........$9 million • Psychology Workforce………………………. $12 million • Minority Fellowship………………………...... $13 million • Assisted Outpatient Treatment……........ $19 million • Assertive Community Treatment……….. $5 million

  17. The Helping Families In Mental Health Crisis Act (H.R. 2646) Remove Federal Barriers to Care • Fix the shortage of inpatient psychiatric hospital beds for crisis stabilization (up to 15 days per month) • Eliminate the same-day doctor rule • Parity implementation and enforcement • Expanding access to eating disorders treatment

  18. The Helping Families In Mental Health Crisis Act (H.R. 2646)HIPAA Changes • Most MI can care for themselves • Substantial cognitive impairments with SMI • Neurological harm, chronic illness, and side effect increase associated with SMI • Absence of treatment increases morbidity and mortality • Prognosis for SMI improves when caregivers involved • For incapacitated: guardianship and advanced directive • Therapy notes must remain confidential • Health and safety requires HIPAA clarifications for provider disclosure under specific circumstances

  19. Congressman Tim Murphy Murphy.House.Gov/HelpingFamiliesInMentalHealthCrisisAct114 @RepTimMurphy Facebook.com/RepTimMurphy

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