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The Federal Climate on

Mental Health:
Challenges and Opportunities
Presentation by Ron Honberg, J.D.
Senior Advisor, Policy and Advocacy
National Alliance on Mental Illness (NAMI)
September 21, 2016

Presentation Topics
The Push for federal mental health reform
The facts about mental illness and
violence
Mental illness and the justice system
A promising approach to treating Early and
First Episode Psychosis
Policy Challenges moving forward
Questions and discussion

The Push for Federal Mental Health


Reform
In 2016, both parties identified mental health reform as a
priority
Sparked to some extent by violent tragedies in recent
years
New champions have emerged in Congress:
Rep. Tim Murphy (R-PA)
Rep. Eddie Bernice Johnson (D-TX)
Sen. Chris Murphy (D-PA)
Sen. Bill Cassidy (R-LA)
Is mental health reform a viable strategy for reducing
violence?

Are people with mental


illness more violent than
the rest of society?

Serious Mental Illness and


Violence
Generally, a serious mental illness diagnosis does
not increase risk of violence.
Risk does increase with:
o
o
o
o
o
o

Co-occurring substance use or dependence


Young and male
Past history of violence
History of physical abuse or victimization
Family criminal justice history
Perceived threats from others (sometimes characteristic of
psychosis)

Gun related suicides are a much higher risk than gun


related homicides.

The Bottom Line

Most people with mental illness are


not violent, and most acts of violence
(with guns or otherwise) are not
committed by people with mental
illness.
Approximately 4% of violence in U.S.
is attributable to mental illness.

So, why do we need


reforms?

Fewer than 50% of youth, adults with MH conditions


receive treatment.
Costs of untreated mental illness are prohibitive:

$193.2 in lost earnings per year;


Mood disorders third most common cause of
hospitalizations;
2 million incarcerated in jails per year;
Adults with SMI die on average 25 years earlier than
others, largely due to treatable medical conditions.
Crisis in emergency room boarding.

Status of Mental Health


Reform
House bill (HR 2646) passed full House 422-2 in
July.
Senate bill (S 2680) passed HELP Committee
unanimously, pending vote by full Senate.
Two bills have many similarities, some differences.
Like CARA, they primarily authorize programs, dont
guarantee funding.
2016 election is a complicating factor.
If final bill is not enacted in 2016, Congress will
have to start over in 2017.

Non-controversial
provisions
Suicide prevention
Strengthen enforcement of parity
Improved integration of physical and mental
healthcare
Strengthen MH workforce
Improve crisis responses
Maintain or strengthen set aside for FEP
Improve translation of research into practice
Same day billing
Tele-mental health services

Controversial Issues
Court-ordered outpatient treatment or
Assisted Outpatient Treatment (AOT)
Communications with caregivers (HIPAA)
Institutions for Mental Diseases (IMD)
exclusion in Medicaid
Role of SAMHSA
Federal protection and advocacy program

Lost in Translation
Elimination of 190 day lifetime limit on
inpatient care in Medicare
Expansion of Excellence in MH Act Demos
Behavioral Health IT improvements
Curbs on ability of Medicare Part D plans to
limit access to psychiatric meds
Broader IMD reforms
Reforms to federal substance abuse
confidentiality law (42 CFR Part 2)

What Happens Next?


Its all about politics and the elections.
Majority in the Senate is in the balance.
Passage by the Senate prior to the election
recess gives more time to reconcile the
two bills.
But, passage during the lame duck
session is probably more likely.

Mental Illness and the Justice


System
Low estimate: 20% of people in jails and prisons in
the US have a serious mental illness (about half a
million people on any given day)
Most charged with non-violent offenses
72% of people who have mental illness in the
justice system have a co-occurring substance
abuse issue
66% of boys, and almost 74% of girls in the
juvenile justice system meet the diagnostic criteria
for at least one major mental illness

Mental Illnesses: Overrepresented in


Our Jails
General
Population

5%

Serious
Mental Illness

Jail Population

17%

Serious
Mental Illness

72%

Co-Occurring
Substance Use
Disorder

Leadership from the Criminal


Justice
System
The Sequential Intercept Model:

Model developed by Mark Munetz and Patty Griffin

Criminal Justice Bills


Comprehensive Justice and Mental Health Collaboration Act (S.
993, H.R. 1854)
Mental Health and Safe Communities Act (S. 2002) provides
resources for:
CIT
MH and Vets Courts
Forensic ACT programs
Enhanced correctional treatment
NCICS provisions have been controversial
For more information about these bills and others and what you
can do, go to:

Early and First Episode Psychosis


Programs
Coordinated array of specialty care:
Outreach to schools and communities
Family support and education
Peer support
Supported education and employment
Case management
Cognitive behavioral therapy (CBT)
Low does of anti-psychotic medication
Patient-centered care and shared decision making are central to
early and FEP programs

Promising Research
RAISE multi-site NIMH funded study found
improved quality of life for those in FEP
programs
Multiple research studies in other
countries (AU, UK, Canada and others)
also show positive outcomes for those
receiving services in early and FEP
programs

Challenges in Financing
Current 10% set aside in Mental
Health Block Grant for FEP.
But, insurance coverage is needed
for the full array of specialty care.
Private insurers and Medicaid do not
typically cover supported
employment and education.
Bundled rates and other approaches
to cover full array of services are
needed.

Policy Challenges Moving


Forward
Find proper balance between basic research
and clinical research
Integrating mental health into mainstream
healthcare
Improving quality outcomes measurement
Address workforce shortages
Human rights concerns (criminal justice, ER
boarding, etc.)
Engaging people in treatment and services

Questions and Discussion!


I wish I had an answer to that
because Im tired of answering that
question.
Yogi Berra

Thank You!
Ron Honberg, J.D.
Senior Advisor, Policy and Advocacy
NAMI
RonH@nami.org
703-516-7972
www.nami.org

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