Legislative Frontline


Senate Approves Murphy’s Helping Families in Mental Health Crisis Act Should Now Become Law!


(12-7-16) Rep. Tim Murphy’s Helping Families in Mental Health Crisis Act passed 94-5 this afternoon in the U.S. Senate clearing the way for it to be signed into law by President Obama before he leaves office.

Murphy’s mental health reforms, along with Sen. John Cornyn’s (R.Tx.)  Mental Health and Safe Communities Act,  were tucked into the 21st Century Cures Act, a $6.3 billion health care bill that critics called a boondoggle for the pharmaceutical industry, which spent millions lobbying for its passage, but supporters insist will cut bureaucratic red tape that prevents life-saving medicines from reaching markets quickly. Because the Act contains two pet projects of both Obama and Vice President Joe Biden, the Cures Act is expected to be signed quickly.

Murphy, a Pennsylvania Republican who is the only practicing psychologist in Congress, was relentless in pursuing passage of his bill — a process that started nearly four years ago and often turned bitter at congressional hearings. In a release he wrote:

This historic vote is one of the rare moments in Congress where members can say with confidence their vote to pass these reforms will indeed save lives. We are ending the era of stigma surrounding mental illness and focusing on delivering treatment before tragedy. By bringing research, treatments and cures into the 21st Century, we are finally breaking down the wall between physical health and mental health. (Full text of his release can be found at bottom of this blog.)

From the start, Murphy focused on concerns raised by parents and family members about barriers they face trying to help loved ones get help, including what they consider overly restrictive civil rights protections.  Cornyn’s bill was primarily aimed at funding successful criminal justice programs, such as Crisis Intervention Team training for law enforcement, mental health courts, and jail re-entry programs. Both Murphy and Cornyn are strong advocates of increased use of Assisted Outpatient Treatment, which has been strongly opposed by many groups that represent individuals with mental illnesses and disabilities.

 One of the organizations that Murphy depended on for advice and support from the start was the Treatment Advocacy Center, founded by Dr. E. Fuller Torrey. It’s executive director, John Snook, said in an email:

“This is one of the most important moments for mental health in more than fifty years. Mental Health Reform offers real hope to families and their loved ones who have been locked out of care. It focuses squarely on treatment of severe mental illness, providing people access to a bed instead.”

Murphy’s bill met strong opposition from the start from Democrats and eventually underwent numerous revisions to make it more palatable. When the House passed Murphy’s bill last week,  I published a blog that compared some of Murphy’s initial language with what now is in the Cures Act.

In addition to posting Murphy’s release here, I am adding a review of the bill that is being circulated by a consumer group whose members  opposed Murphy’s bill. I felt it would be helpful to see how critics of the bill now see it and the revisions that they helped add to make it more acceptable to them.

Obviously I will be writing more about this bill in later blogs, but I wanted to get news of its passage out ASAP.

Rep. Murphy’s press announcement:

For Immediate Release: December 7, 2016
Contact: Carly Atchison 202.225.2301

Washington, D.C. – Today, the U.S. Senate passed Congressman Tim Murphy’s (PA-18) Helping Families in Mental Health Crisis Act, included in the 21st Century Cures healthcare reform package. The bill passed 94-5, and now heads to the President’s desk to be signed into law.  

Congressman Murphy, who led the multi-year effort to reform the nation’s failing mental health care system after the tragedy at Sandy Hook Elementary school, released the following statement:

“This historic vote is one of the rare moments in Congress where members can say with confidence their vote to pass these reforms will indeed save lives. We are ending the era of stigma surrounding mental illness and focusing on delivering treatment before tragedy. By bringing research, treatments and cures into the 21st Century, we are finally breaking down the wall between physical health and mental health. 

“As we approach the anniversary of Sandy Hook, I’m deeply moved that the House and Senate voted to include the Helping Families in Mental Health Crisis Act in the 21st Century Cures bill because it was this very tragedy that motivated my relentless effort to fix the patchwork of antiquated programs and ineffective policies to get care to those in psychiatric crisis.

“Many doubted we would make it this far, but here we are… and we’re still not done. I will continue advancing reforms so none remain in the shadows because we’ve set our eyes on one goal: to fix our nation’s broken mental health system so it works for all. 

“We traveled to every corner of this nation, listening to doctors, psychologists and psychiatrists, experts and advocates, and most importantly patients, consumers and their families. 

“Through congressional hearings and an in-depth investigation, we discovered the abhorrent, and at times fatal, disconnect between 112 federal agencies who are assigned to treat the mentally ill. We exposed a $130 billion dollar investment in a system that has done little but watch the rates of homelessness, incarceration, suicide and drug overdose deaths soar. We came together, across party lines, and went to work. Today, we have passed legislation that will save lives. 

“A special note of thanks to Chairman Fred Upton for his steadfast leadership on Energy and Commerce and dedication to seeing H.R. 2646, the Helping Families in Mental Health Crisis Act move forward, and for his tremendous medical innovation bill, the 21st Century Cures Act. 

“I’m deeply grateful to Texas Congresswoman Eddie Bernice Johnson, who teamed up with me on our original bill. Her conviction and determination, and applying her experience as a psychiatric nurse, proved instrumental in championing the cause that someone in crisis should get treatment in a hospital and not locked up in a jail cell. It is largely due to her efforts that we made it to the finish line.

“Without the commitment from House Speaker Paul Ryan we wouldn’t be here today. In his first days as Speaker of the House, he pledged his support for the Helping Families in Mental Health Crisis Act. It was his leadership and determination that kept us moving forward to ensure the House would take action on the way we treat the mentally ill in this nation.

“To all of my colleagues in Congress who spoke up, stepped up, and teamed up with our efforts to end the mental health crisis in America: Thank you.

“Lastly, to every family member, to the tens of thousands who reached out to me, to those who stepped forward to share their story and be a voice for change, my deepest gratitude for your courageous stand to help families in mental health crisis.” 

For a full list of the provisions included in the final bill, click here.

A review of the bill by the New York Association of Psychiatric Rehabilitation Services, Inc., whose members opposed Murphy’s legislation.  

NYAPRS Note: After almost 4 years of deliberation and often contentious debate, the House has approved “21st Century Cures Act” legislation that features a lengthy section entitled “Helping Families in Mental Health Crisis Reform Act of 2016.”

There are a number of very positive advances here, especially as regards holding the line on preserving protection and advocacy and HIPAA rights protections while advancing criminal justice, parity, workforce and child, youth and school based mental health initiatives.   

However, there are some measures here that implicitly threaten to reverse course and potentially move us back from the recovery and rehabilitation agenda that SAMHSA and our movement and field have worked so hard and for so long to advance.

Elevating and integrating mental health policy and service initiatives within the federal government sounds very positive….but will that agenda remain prominent in a design where SAMHSA is absorbed within the greater Health and Human Service agency bureaucracy?

It’s critical that we make a front and center commitment to ratchet up the help we provide to individuals and families in crisis and to offer many more robust alternatives to the intolerable numbers of our community who live on the streets or in jails and prisons. But these must not be achieved at the expense of the groundbreaking advances we have made over the past 5 decades.

There’s a lot of mention here of ‘evidence based practice’ and ‘clinical focus’ that can easily be read as dismissing the newer under-researched recovery and peer practices and defaulting to a solely reductionist illness, medication and hospitalization based paradigm.

There are an extraordinary number of evaluations, reports and oversight measures over SAMHSA that appear to come from some folks out there who want to rein in the recovery, rights and consumer movements, regarding them as antithetical to the challenges experienced by the ‘most needy.’ This narrative comes from the same folks who, in their endless zeal for more court orders, more admissions and less rights and privacy protections, are either ignorant of or ignore all of the community innovations we have or are developing that will remain un or underfunded because more scarce public dollars will now go to more, costly AOT and inpatient services.

And there’s hardly any mention of the social determinants that are crucial factors to advancing health or relapse prevention, like employment, economic self-sufficiency and housing.

So, there’re a number of good things in this bill but some very real cautions too. The bill will pass the Senate and, ultimately that’s for the good, because who knows what a 2017 mental health reform bill could contain?

In any event, it will be up to each of us to ensure that the agenda championed by SAMHSA and the recovery community not be disrupted or diminished as we head into a different federal government structure and focus….and that we add to rather than subtract from that great agenda.

NYAPRS Summary of Key Mental Health Provisions

within the ‘21st Century Cures Act’ 

Federal Mental Health Agency Changes

While preserving SAMHSA, the bill moves the current duties of the SAMHSA Administrator to the new post of Assistant Secretary for Mental Health and Substance Use, seen by some as an ‘elevated’ position for behavioral health policy.

It also takes a number of steps to move the agency to a more ‘evidence based’ and ‘clinical’ focus, which is the specific charge of a new Chief Medical Officer post and the primary intent of a number of new planning and evaluation requirements, including a biennial report to Congress.

The bill also creates a National Mental Health and Substance Use Policy Laboratory (NMHSUPL) within SAMHSA to “promote evidence-based practices and service delivery models”, which will be shared with states, local communities, nonprofit entities, and other stakeholders.

The bill creates an Inter-Departmental Serious Mental Illness Coordinating Committee to better coordinate mental health services for people with serious mental health conditions amongst adults and children. The committee is made up of HHS, the Centers for Medicare and Medicaid Services (CMS), the Department of Justice (DOJ), VA, DOD, HUD, the Department of Education, DOL, and the Social Security Administration (SSA), as well as patients, health care providers, researchers, a judge, and a law enforcement officer.

The bill directs CMS to provide states with “opportunities to design innovative service delivery systems to improve care for individuals with serious mental illness or serious emotional disturbance.”

 Protection and Advocacy Organizations

The bill preserves in full the focus and duties of the nation’s Protection and Advocacy agencies, which have long played a critical role in protecting and advocating for the human and civil rights of people with serious mental health conditions, as well as investigating reports of abuse and neglect in places that either provide care or treat individuals with those conditions.

It authorizes a review by the Government Accountability Office (GAO) of P&A programs carried out by states and private, non-profit organizations and implements an independent grievance procedure for complaints.

 Medicaid Reimbursement for Institution for Mental Diseases (IMD)

While groups like NYAPRS opposed previous legislative proposals to extend Medicaid to pay for state and psychiatric hospital services instead of expanding the range of community crisis, prevention and recovery services, this policy is already in the process of being implemented….not via federal legislation but by a regulatory change approved under the Obama Administration. As a result, Medicaid managed care plans have been authorized to pay for up to 15 day inpatient stays per month in those facilities.

This legislation simply directs CMS to conduct a study and report on the implementation of this policy.

 Health Information Portability and Accountability Act (HIPAA)

The bill outlines the need for clarity around HIPAA protections, but rejects previous efforts to add exemptions to the law.

It requires HHS to issue final regulations within 1 year to clarify circumstances in which a health care provider may share protected health information

And it adds funding for the creation of training and educational programs to educate health care providers and regulatory compliance staff around the exact limitations and permissions available under current legislation.

 Assisted Outpatient Treatment

In late 2015, Congress authorized a number of pilot programs to advance and evaluate the increased use of court mandated outpatient treatment (often called ‘Assisted’ Outpatient Treatment). The ‘Cures Bill” extends and funds the pilots out several years more to 2022.

The bill does not tie state mental health block funding to expanding the use of outpatient treatment orders, as originally proposed.

 Peer Support Specialists

The bill authorizes a study and Congressional report of SAMHSA funded peer specialist programs in states that receive SAMHSA grants that looks at hours of formal work or volunteer experience, types of peer support specialist exams and codes of ethics required for such programs and recommended skill sets and requirements for continuing education.

Happily, it does not engage Congress in establishing national credentialing, licensing or program standards (at least, at this time).

 Grants: The bill creates, re-authorizes and/or increases funding for numerous critically important initiatives, including:

Treatment and Recovery for Homeless Individuals

Jail Diversion Programs

Promoting Integration of Primary and Behavioral Health Care

Projects for Assistance in Transition from Homelessness

National Suicide Prevention Lifeline Program 

Connecting Individuals and Families with Care

Strengthening Community Crisis Response Systems

Suicide Prevention

Mental Health Awareness Training Grants

Evidence-Based Practices for Older Adults

National Violent Death Reporting System

Assertive Community Treatment teams, evaluation

Sober Truth on Preventing Underage Drinking Reauthorization 

Same Day Coverage

The bill permits same day reimbursement for services delivered by both mental health and primary care practitioners

 Enhanced Compliance with Mental Health Parity Requirements

The bill requires various federal agencies to

release guidance on requirements to comply with parity law

conduct audits of health plans that have violated parity laws 5 times.

issue new guidance to health plans

convene a public meeting to produce an action plan for improved federal and state coordination relative parity law enforcement

report on federal investigations on any serious parity enforcement violations

provide a review of how the various federal and state agencies responsible for enforcing mental health parity requirements have improved enforcement in line

 Criminal Justice

Encourages the use of federally funded law enforcement, policing and fire prevention grants to create or expand mental health response and corrections programs, including police crisis intervention teams, specialized mental health response training, including crisis de-escalation, training first responders and paramedics on best practices for responding to mental health emergencies, including crisis de-escalation.

Encourages the creation of Drug and Mental Health Court pilot programs

Encourages the creation and deployment of behavioral health risk and needs assessments for mentally ill individuals in the criminal justice system.

the operation of Forensic Assertive Community Treatment (FACT) Initiatives.

use reentry demonstration project grant funds for the provision and coordination of mental health treatment and transitional services (including housing) for individuals re-entering society with mental illness, substance abuse problems, or a chronic homelessness

Requires mental health crisis and response training programs for members of each of the Federal Uniformed Services.

Creates a National Criminal Justice and Mental Health Training and Technical Assistance Center

Requires a report to Congress detailing the federal, state, and local costs of imprisonment for individuals with serious mental illness, including the number and types of crimes committed by mentally ill individuals.

Authorizes funding for prison and jail-based programs, including transitional and re-entry programs that reduce the likelihood of recidivism when a mentally-ill offender is released.

Authorizes resources for expanded law enforcement training activities, providing more officers with a basic understanding of the issues involved when responding situations with individuals with mental health crises.

requires a report detailing the practices that federal first responders, tactical units, and corrections officers are trained to use in responding to individuals with mental illness, procedures to appropriately respond to incidents, the application of evidence-based practices in criminal justice settings, and recommendations on how the Department of Justice can improve information sharing and dissemination of best practices.

 Strengthening the Health Care Workforce

Funds grants to institutions of higher education or accredited professional training programs to support the recruitment and education of mental health care providers

Uses existing mental and Substance Use Disorders Workforce grants for medical residents, nurse practitioners, physician assistants, health service psychologists, and social workers to provide mental and substance use disorder services in underserved community-based settings and programs for paraprofessionals that emphasize the role of the family and the lived experience of the consumer and family-paraprofessional partnerships.

Codifies into law the Minority Fellowship Program to increase the number of professionals who provide mental or substance use disorder services to underserved, minority populations, and to improve the quality of mental and substance use disorder prevention and treatment for ethnic minorities.

 Mental Health on Campus Improvement

Authorizes existing funds to be used to increase awareness and training to respond effectively to students with mental health and substance use disorders, to provide outreach to administer voluntary screenings and assessments to students, to enhance networks with health care providers who treat mental health and substance use disorders, and to provide direct mental health services.

Establishes an interagency working group to discuss mental and behavioral health on college campuses and to promote federal agency collaboration to support innovations in mental health services and supports for students on college and university campuses

Convenes an interagency, public-private sector work group to plan, establish, and begin coordinating and evaluating a targeted, public-education campaign to focus on mental and behavioral health on the campuses of institutions of higher education.

 Strengthening Mental and Substance Use Disorder Care for Women, Children, and Adolescents

Reauthorizes and updates programs to provide comprehensive community mental health services to children with SED.

Increasing Access to Pediatric Mental Health Care

Substance Use Disorder Treatment and Early Intervention Services for Children and


Children’s Recovery from Trauma

Reauthorizes the National Child Traumatic Stress Initiative (NCTSI)

Screening and Treatment for Maternal Depression

Infant and Early Childhood Mental Health Promotion, Intervention, and Treatment

Establishes a grant program to develop, maintain, or enhance mental health prevention, intervention, and treatment programs for infants and children at significant risk of developing or showing early signs of mental disorders, including SED, or social or emotional disability.

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Murphy’s Family Mental Health Bill Approved: Next Step Senate then White House


(11-30-16) Rep. Tim Murphy’s Helping Families in Mental Health Crisis Act is poised to become a federal law.

By a 392-26 vote late Wednesday, the House passed the 21st Century Cures Act, a massive $6.3 billion health bill, that included Murphy’s legislation. The Senate is expected to approve the legislation shortly  before sending it to President Obama to sign before leaving office.

“This is a huge victory,” Andrew Sperling, NAMI’s director of advocacy, wrote in an email. “The entire enterprise could have easily collapsed given the election results.” 

D. J. Jaffe, who publishes the website Mental Illness Policy Org., and was active behind the scenes pushing the bill, called Murphy a “hero” and praised the Pittsburgh Republican and Sen. John Cornyn (R-Texas) for their tenacity. Both endorsed greater use of Assisted Outpatient Treatment, which is strongly supported by Jaffe.

“AOT was a great win in this legislation,” he said. “Now, the question is if the new assistant secretary (for mental health) will drain the swamp at SAMHSA (Substance Abuse and Mental Health Services Administration) and make that agency focus on the seriously mentally ill.” 

Murphy began laying the groundwork for his bill in March 2013, three months after Adam Lanza’s 2012 attack on the Sandy Hook Elementary School that left 28 dead, including him. I was questioned at his first House session about problems my family faced trying to get help for my son.

Murphy’s original bill faced strong opposition from Democrats and a slew of mental health organizations, including Mental Health America, who claimed it would eliminate and roll back hard-won civil rights protections. Some mental health groups scoffed at Murphy’s chances of getting any legislation passed. The  National Alliance on Mental Illness was the only major group that supported Murphy’s bill. (see correction at end of blog.) It wasn’t until after Murphy had collected more than a hundred co-sponsors that his critics became alarmed.

Supporters welcomed Murphy’s legislation, saying it was one of the first that recognized the problems that parents and families faced, rather than focusing primarily on the rights of individuals who were ill. Because much of what Murphy first proposed was nearly identical to reforms that Dr. E. Fuller Torrey had been pushing for years,  I once dubbed the bill “Torrey’s revenge” against SAMHSA and mental health lobbying groups that had widespread support in Congress.

Democrats kept Murphy from getting his legislation passed during the 2013-14 session by introducing their own bill specifically to block his. But during the current session, Rep. Fred Upton (R-MI), was able to get a much rewritten version passed out of his House committee by a unanimous vote of 53-0 vote. Senators Chris Murphy (D-Conn.) and Bill Cassidy (R.-La.) initiated the fight for Murphy’s bill in the Senate. Their efforts were bolstered when Sen. Lamar Alexander (R-Tenn.), the leader of the Senate Health Committee (HELP), took charge of their legislation. Next came, Sen. John Cornyn (R.Texas), the Senate Majority Whip, who pushed the Senate version further. During the Thanksgiving holiday, all sides agreed to merge Murphy’s bill and parts of Cornyn’s into the 21st Century Cures Act, a major bill that had widespread support in both parties and the White House. If the Senate version of Murphy’s bill would have not been attached to the Cures Act, it probably would have died. Merging it with the Cures Act required another House vote.

The highly revised language in the Murphy bill was eventually supported by Mental Health America and several of its earlier critics who were able to weaken some of the areas that they found most offensive.

The 21st Century Cures Act, which you can read here,  is 996 pages and confusing even if you have followed this ongoing debate closely, especially because much of it concerns changes large and small at the National Institutes of Health and the Food and Drug Administration. It’s those changes, which were heavily lobbied for by the pharmaceutical industry, not Murphy’s mental health bill, that was the major focus of debate yesterday in the House chamber.

Murphy’s bill was heavily revised during his three year battle to make it more palatable to critics. But he succeeded in keeping several of his most controversial changes in place.

SAMHSA — Murphy initially wanted to refocus the Substance Abuse and Mental Health Services Administration because he said the agency focused more on mental health than mental illness, was wasteful, and funded programs that encouraged patients to stop taking medications and were anti-psychiatry. He proposed shifting SAMHSA funds to the National Institute of Mental Health.

Under the 21st Century Act, the government will elevate the importance of mental health by creating an Assistant Secretary for Mental Health and Substance Use inside the Department of Health and Human Services, giving mental health a much higher bureaucratic presence. While the bill doesn’t require that the new secretary, a patronage job, be a psychiatrist as Murphy initially wanted , the law creates a new position called Chief Medical Officer at SAMHSA who must be one. (SAMHSA was led recently by a lawyer and employed no psychiatrists.) The bill also instructs SAMHSA to focus more of its programs and funds on the “serious mentally ill” and spend its dollars on “evidence based practices.”

Although the final bill didn’t go as far as many of his supporters wanted in spanking SAMHSA, consider this a win for Murphy.

HIPAA — Murphy heard testimony from parents, including my friend, Pat Milam, who were outraged because they were refused medical information because of the Health Insurance and Portability Accountability Act  (HIPAA) when their sons and daughters were admitted into a hospital. Murphy wanted to change the law to permit a loved one limited access to medical information even if the patient didn’t want it released. That suggestion alarmed disability groups and consumer organizations.  The new law requires the Health and Human Services to undertake a review of its current HIPAA regulations, knowing that the “congressional intent” is for HHS to “clarify” the regulations with an eye toward finding a way to release some information to parents if it is deemed to be in the patient’s best interest.

This could be another major win for Murphy if HHS actually decides to loosen the regulations, but the act’s language has been watered-down to the point that it isn’t currently clear  — at least to me — if anything beyond a study and review of HIPAA regulations is required.

AOT –– In addition to HIPAA, the next most controversial Murphy push was for greater use of Assisted Outpatient Treatment. Although 46 states already have approved AOT, funding is rarely provided and many mental health providers resist using it because they do not like the idea of forcing someone to accept treatment by appearing before a judge and being subjected to a court order. AOT is an evidence based practice, according to the government, and has been proven to help save lives and tax dollars, but over the years, it has become a symbol to many consumer groups of much-hated forced government compliance.  Murphy initially wanted to penalize states that didn’t adopt and encourage use of AOT but there was such a backlash that he cleverly revised tactics and instead offered to reward states with a higher percentage of block grant funding if they stepped up use of AOT.  Murphy gained an important AOT ally in the Senate in Cornyn, a former prosecutor, state attorney general and judge, who supports AOT, and the bill reflects Cornyn’s influence. Under the new law, AOT will receive more funding and for a longer period — up to 2022.

Mark this a definite win for Murphy and his supporters.

PAIMI –the Protection and Advocacy for Individuals with Mental Illness Act (PAIMI programs) are funded by the government to safeguard the rights of persons with mental illnesses and disabilities. Over the years, many of these groups morphed into Disability Law Centers and broadened their reach beyond monitoring how patients were treated in institutions, including jails and prisons. Some PAIMI groups actively worked against passage of AOT laws, which outraged Murphy and his supporters. He initially wanted to strip much of the PAIMI programs’ funding, but met Democratic opposition, so he relented and instead wrote language aimed at limiting the powers of PAIMI advocates by restricting their authority. They would only be permitted to investigate cases of abuse and neglect and would be specifically banned from lobbying public officials and from “counseling an individual with a serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of such individual’s caregiver.” That sentence was aimed at William Bruce situations where a PAIMI advocate told Joe Bruce’s son, William, what to say in order to be discharged even though his medical team considered him unstable. William was released and murdered his mother.

The new act doesn’t include any specific Joe Bruce inspired wording. Instead, it instructs the new Assistant Secretary to undertake a study of PAIMI programs to determine if federal funds are being spent on investigations of “alleged abuse and neglect of persons with mental illness; investigations into the availability of adequate medical and behavioral health treatment; and investigations of the denial of rights for persons with mental illnesses.” That study also will examine if PAIMI organizations are in compliance with “the Federal prohibition on lobbying.” Put simply, the new law does not force PAIMI organizations to change how they operate but the threat of a federal study that will look at how PAIMI groups are spending federal funds is considered both instructional and a warning.

Although this language is considerably diluted from the original, it’s another win for Murphy.

IMD Exclusion – Current federal law imposes a 16-bed limit for inpatient beds. This limit was designed to prevent states from re-opening large hospital warehouses. The Feds refused to allow Medicare and Medicaid payments to larger than 16 bed facilities. Murphy originally called for repealing the so-called IMD exclusion as long as a facility kept patients less than 30 days. But that idea ran into opposition, especially when both sides began calculating how much lifting the ban could cost Medicaid.

The new language calls for a study of the IMD exclusion, providing both sides a way to avoid the issue.

I’ve only touched a few high points of the proposed law. In addition to Murphy’s bill, Cornyn blended his Mental Health and Safe Communities Act into the mix. I testified in favor of it because it funds Crisis Intervention Team training, mental health courts, and a slew of other jail diversion programs that should help our country begin curbing the inappropriate incarceration of individuals with mental illnesses in our jails and prisons. Cornyn, who is familiar with the Bexar County model in San Antonio, which is considered the gold standard at jail diversion, made certain these important programs were included in the act after they were removed from Murphy’s bill when it was first introduced in the Senate. Murphy had endorsed the same criminal justice reforms in the House bill.

The Cures Act also includes funding for Mental Health First Aid and allocates millions for educational and suicide prevention programs that were pushed largely by Democrats and were added during give-and-take with Murphy and Cornyn.

It’s actually a bit unfair to compare what Murphy initially proposed and what eventually was passed. Like selling a car, you begin with a price that you don’t expect to get and negotiate. But there are two things that no one can argue against.

The first is that the Helping Families In Mental Health Crisis portion of the bill is the first major reform of our mental health system in decades.

The second is that Rep. Tim Murphy, the only practicing psychologist in Congress, was tireless, relentless, determined and dedicated to getting reforms passed. While Sen. Cornyn deserves praise for getting the criminal justice package pushed through, the reform of SAMHSA and the other changes that I’ve identified never would have gotten off the ground without Murphy. Few House members would have had the fortitude to continue pushing for controversial mental health reforms during what became an often vicious process.

Love him or not, Rep. Tim Murphy has accomplished much of what he proposed three years ago and in today’s Congress that is a monumental achievement.

* Additions:

I asked Michael Fitzpatrick, the former executive director of NAMI, his opinion of Murphy’s mental health bill as written in the Cures Act because he spoke with me at the first congressional session that Murphy held and he was the first to announce NAMI’s support for the congressman’s efforts.

This legislation will do some good.   It creates a new comprehensive focus on serious mental illness.   It has really brought together the various factions within the mental illness  community.  This is a significant outcome in of itself. 

You have captured the essence of the bill.  Like all complex pieces of legislation the proof of impact will be its implementation over time. 

 The bill creates an Assistant Secretary for Mental Health and Substance Abuse and a Chief Medical Officer who must be a psychiatrist.  It forces SAMHSA to focus on evidence based and scientifically sound programs. It focuses  the federal Block Grants to states on serious mental illness.  It does provide some help with HIPAA.  It directs the HHS Secretary  to clarify circumstances where families may access protected health information about their family member with serious mental illness.  It does remain to be seen how this will play out.  It also requires that HHS develop  HIPAA training for providers and others.  While these steps are not what I had hoped for.  They are significant advances that again will need to be watched closely during the implementation phase. 

The bill also extends and increases funding of the existing AOT grant program.   It creates a study that reports back to Congress on the activities of the P&As. It also sets up an independent grievance procedure.  This  is an important step forward.  The bill also extends the Garret Lee Smith Act suicide prevention programs. 

It moves to loosen the IMD exclusion which will create additional short term options in private facilities.   This is an important step!. It creates a grant program for ACT (Assertive Community Programs).  These  programs should be available in all communities.  Unfortunately this is rarely the case.

The bill also creates a number of studies, databases and data collection initiatives across all aspects of the mental health delivery system which should in time inform future decisions by policymakers (and advocates).  It acknowledges the need to fund evidenced based and scientifically sound programs.  This legislation also focuses on extending early intervention, brain research (CURES),  training and support for law enforcement (CIT grants, Mental Health Courts, and a national training center) and  workforce issues within the mental health delivery system.

This reform legislation was years in the making. 

Its time is now.  It will take many years to implement  There is much momentum.  The success of this comprehensive  reform effort will depend on a mix of financing, ongoing work by champions on Capitol Hill and work by advocates on the Hill, in the media and back home in their communities.  The hard work is to make these changes make a difference in all states in all communities in the lives of persons with serious mental illness and their loved ones.


After posting my blog, I received word from Dr. Paul Summergrad, a former president of the American Psychiatric Association, who took issue with my statement that NAMI was the only major mental health group to back Murphy’s bill.  “The American Psychiatric Board of Trustees voted to support Murphy’s legislation when I was president at the end of 2014 and continued that support when he reintroduced his legislation as HR 2646 in 2015 while I was still president,” he noted.

I regret the error. Other groups also backed the bill. I specifically remember NAMI because Mike and I spoke at Murphy’s first House subcommittee session about his bill.

Mike and I speak at Murphy's first hearing to House members

Mike and I speak at Murphy’s first hearing to House members

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Murphy’s Mental Health Bill Stymied Again, This Time Because Of Dust Up About Guns

Another obstacle bottlenecks Rep. Tim Murphy’s mental health reforms. Photographer: Andrew Harrer/Bloomberg via Getty Images

(7-28-16) Rep. Tim Murphy’s Helping Families in Mental Health Crisis Act was passed by a 422-2 vote in the House earlier this year, but it’s now treading water and the prospect of it being signed into law this session is fleeting.

The trouble has nothing to do with the contents of Murphy’s much altered bill. As first reported by Peter Sullivan in The Hill, this time around the fight is in the Senate and it is about guns.

The companion bill to Rep. Murphy’s in the Senate is SR 1945, the Mental Health Reform Act of 2015, bipartisan legislation introduced by Sens. Chris Murphy (D-Conn.) and Bill Cassidy (R-La.) that mirrors the House bill with a few exceptions. That bill was on a fast-track, speeding forward when it hit a brick wall because of Sen. John Cornyn (R-Texas.)

He told members of the Committee on Health, Education, Labor, and Pensions that he wanted to blend his bill, SR 2002 – the Mental Health and Safe Communities Act of 2015 –– with Sen. Murphy’s and Cassidy’s SR 1945 legislation.

I testified at a U.S. Senate Judiciary hearing Cornyn held about his bill because I support his call for reauthorization of the Mentally Ill Offender Treatment and Crime Reduction Act (known in Washington DC parlance as MIOTCRA). That act calls for funding of crisis intervention team training in local law enforcement and the creation of mental health courts. It also supports prison and jail-based transitional services and reentry programs for persons with mental illnesses when they are released from incarceration.

Those provisions have wide bi-partisan support, but there are two parts of Cornyn’s bill that don’t and that is where the problem has arisen. His bill supports greater implementation of  Forensic Assertive Community Treatment or AOT, which always draws an immediate attack from anti-AOT groups. The bigger issue, however, is a provision in Cornyn’s bill that would change the rules about gun ownership by individuals with mental illnesses.

At lunch in the U.S. Capitol, Cornyn told me that the language in his bill is intended to help veterans who are denied gun ownership arbitrarily. There are a lot of Texans who are veterans and many of them like to hunt and own guns, he explained.

This gets a bit complicated, but here is the gist of his argument.

Under current regulations, the Veterans Administration can step in when a veteran has been diagnosed with a mental illness and appoint a “representative payee” to handle that veteran’s benefits. When that happens, that veteran’s name is automatically added to the National Instant Criminal Background Check System (NICS) as a “prohibited person due to mental health issues,” which means that individual can’t purchase a gun. The VA often is inconsistent and arbitrary when it comes to appointing “representative payees,” Cornyn claims.

Cornyn and the National Rifle Association, which is backing Cornyn’s bill, claim that the VA’s actions are unfair because the federal government is stripping away an individual’s Second Amendment rights without a judicial hearing. (In addition to the NRA, I need to mention that Cornyn’s bill also is being supported by a variety of law enforcement and mental health organizations, including the National Alliance on Mental Illness, the American Correctional Association, the National Association of Police Organizations, the National Association of State Mental Health Program Directors, and the American Jail Association.)

“Basically, right now some agencies like the VA make their own determination of mental illness and bypass the court process,” Cornyn spokesperson Drew Brandewie told the Washington Free Beacon. “This bill codifies into law that individuals must get their day in court they’re entitled to, and no agency or state can make their own determination without that…The current statute is ambiguous, so our bill clarifies by saying individuals must have these things (notice, a judicial hearing, and a determination from a judge) before any government or federal agency can try to include them in NCIS. This bill actually strengthens Second Amendment rights in this way.”

Hold on, Joshua Horwitz, executive director of the Coalition to Stop Gun Violence, counters in an editorial published in The Hill, which covers legislation in more detail than most publications. In an opinion piece titled, “Cornyn’s mental health bill: Wolf in sheep’s clothing,” Horwitz claimed there’s more to this than just veterans’ rights:
    Most people with mental illness will never be dangerous and research shows that people with serious mental illness are more likely to be victims, rather than perpetrators, of violence. However, there are certain factors based on behavior, not diagnosis, which increase a person’s risk of future violence. One of those factors is involuntary hospitalization based on risk of harm to self or others, which is why federal law prohibits those who have been involuntary committed to a psychiatric institution from purchasing of possessing firearms until a court restores their rights.

For some inexplicable reason (or maybe as a favor to the NRA), S.2002 would change federal law by creating a disqualification that lasts only as long as a commitment order is in effect, which is typically a matter of days. This could be disastrous because research shows that the period immediately following a discharge from an inpatient facility is the time of most concern for many patients who are going back to the outside world where all the same stressors (including drugs and alcohol) are still there.

Additionally, Cornyn’s bill would immediately remove those who are so mentally impaired that they have a court appointed guardians to manage their financial affairs from the National Instant Background Check System (NICS). Currently, federal law prohibits those who have been adjudicated as “mental defectives” (I admit, this derogatory term needs to be changed) from purchasing or owning firearms. S.2002 would narrow this category of persons significantly so that financial incapacity would no longer qualify as a firearm prohibition. While some might argue the financial incapacity disqualification is too broad, in this setting, where a state court judge with full due process has ruled, we should not offer across the board restoration without ensuring that individuals who pose a risk to self and/or others remain prohibited. The answer to out-of-control gun violence in our society is not to give thousands of individuals who are at potential risk for future violence immediate access to guns.

Which brings us to the bottleneck in the Senate.

Writing in The Hill, reporter Peter Sullivan reported that Sen. Murphy immediately balked when he learned Cornyn was hoping “to attach gun-related language…that would require a full judicial hearing to ban someone from buying guns due to mental illness” into his and Cassidy’s bill.

Sen. Chris Murphy (D-Conn.), one of the sponsors of the health committee’s bill, said such provisions would prevent him from supporting the bill…Murphy said, ‘Obviously I can’t support a bill on the floor that has those provisions in it.”

The result is that Rep. Tim Murphy finds himself stuck in the House in a canoe without paddle. Until the Senate passes the Murphy and Cassidy bill, the House bill is stymied.

Writes Sullivan in an article published a few days ago:

Democrats warn that any gun language could derail the mental health bill, and they’ve won some support from GOP colleagues.

Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate health committee, told reporters this month: “Hopefully we can keep gun amendments off of it. If it turns into a gun bill it won’t go anywhere.”

He said that (Chris) Murphy has been “eloquent” on the need to keep the issues separate and keep gun control amendments off the bill. 

A lack of time is also an obstacle. The Senate will be in full election mode when it returns for one month in September, and will be preoccupied with passing a continuing resolution to fund the government. If any floor time does open up in that month-long window before Congress breaks for the election, it could go to a different health bill, the 21st Century Cures Act, which seeks to speed up the approval of new drugs. Alexander has made clear that this legislation, which faces its own struggles, is his top priority.

If the mental health bill cannot pass the Senate before the election, there would be little time to get it through this Congress.

This has to frustrate Rep. Tim Murphy who has been relentlessly pushing mental health reform ever since the Newtown shootings in 2012, as well as supporters of his bill.

The post Murphy’s Mental Health Bill Stymied Again, This Time Because Of Dust Up About Guns appeared first on Pete Earley.

Group Home Funding Runs Dry

February 23, 2015 by Editor in Disabilities, Featured, Long Term Care, Medicaid, Mental Health

By Rose Hoban

Without adequate funds, group homes for people with mental health and developmental disabilities are at risk of closure.
Hundreds of people with developmental and mental health disabilities around North Carolina are faced with losing their homes – again – as state funding to support them is running out.
The people at risk are those who live in group homes with six or fewer residents who have part of their living expenses paid for by state dollars. They’re people who lost Medicaid-funded personal care services in 2012 when the General Assembly tightened guidelines on who could receive those dollars.

Photo credit: Rose Hoban.

Group home residents and their advocates at a rally for funding in front of the Legislature in 2013. They may need to return this spring as funds that support the homes runs out. Photo credit: Rose Hoban.

And they’re people who faced a similar crisis in 2013 when lawmakers failed to create a long-term solution to care for residents who can’t get Medicaid dollars but still need help. Instead, the legislature created “bridge” funding to tide the group homes over temporarily.
Now that bridge funding is drying up, with little hope for more dollars to flow.
“I’ve been in panic mode for the last two months,” said Tonia Donnell, who runs two group homes – one for men with developmental disabilities, the other for mental health issues – in Morganton. “I just got an email from the [regional mental health agency] that there’s some money from the bridge funding. It’s not enough for the rest of the fiscal year.”

Donnell said she was scrambling to resubmit invoices totaling about $5,500 for several months of services that had been previously denied because of lack of funds.
“They said it’s first-come, first-served,” she said. “I’m getting mine in as soon as I can.”
Same problem, new year
“It’s like Groundhog Day,” said Julia Adams, the governmental affairs liaison for The Arc of North Carolina, which provides services and support for people with developmental and intellectual disabilities. “We’re right back to where we were at the beginning of the 2013 budget cycle.
That year, the General Assembly allocated $2 million to tide the group homes over for the year, but administrative red tape led to a delay of close to four months before the money was released to providers. That meant lawmakers didn’t have a solid handle on how much money the group homes would need for an entire year.
In the 2014 budget, lawmakers again allocated $2 million and released the funds at the start of the fiscal year on July 1. Now that money is exhausted, about four months before the end of the fiscal year.
“To ask these individuals to go through yet another crisis is heartbreaking for those of us who work on this issue,” Adams said. “We’re looking toward leadership at [the state Department of Health and Human Services] to create a short-term fix while we wait for a long-term solution.”
Dave Richard, DHHS’ assistant secretary for mental health, developmental disabilities and substance abuse services, said he’s aware of the issue. He’s been aware of it since his days as Adams’ boss at The Arc, prior to entering state government.
For years, in order to receive Medicaid “personal care services” and remain in their own homes, people with mental health disabilities were required to need assistance with two or more so-called activities of daily living – such as bathing, dressing, toileting or eating. But if that same person lived in an institution, like a group home, they were only required to need assistance with one activity in order for Medicaid to pay for the help. For many living in group homes, that essential activity was help managing their many medications.
The federal Centers for Medicare and Medicaid Services warned North Carolina repeatedly that this “institutional bias” was illegal under the 1992 Americans with Disabilities Act. CMS pressed the state to resolve the problem, but meanwhile kept paying the bills.
But in 2011, CMS finally ran out of patience. The agency told North Carolina to resolve the problem.
When the legislature worked on this in 2012, the discussion centered around a possible “woodwork effect,” by which state officials estimated that thousands living in their own homes could become eligible for the entitlement if the level of assistance required remained at one activity of daily living. That could have cost the state tens of millions annually.
Instead, in order to discourage a flood of new recipients and save state dollars, lawmakers fixed the issue by requiring everyone, no matter where they lived, to have greater needs in order to get reimbursed for the help. The legislature also disqualified payment for medication management.
Since 2013, group home residents, operators and their advocates have been waiting for a long-term funding solution from the General Assembly.
Richard has convened a workgroup of providers, advocates and state officials to address the issues. He’s required to get a report to the General Assembly by April 1.
“The legislature recognizes that there are significant issues in how we’re funded,” he said. “This is a product of years of a patchwork system of fixes to the system.”
Richard noted that not all of the state’s mental health managed care organizations are out of money for group homes. In part, it’s a problem of population distribution, he said. Some MCOs have more group homes in their regions than others, and thus spent their allocations more quickly.
“We’re surprised about how fast some of the [managed care organizations] had gone through the money,” he said.
But Richard didn’t hold out much hope for additional funding for the rest of the fiscal year.
“Whatever recommendations come out of this workgroup, nothing is an immediate fix,” he said.
When pressed about legislative moves, or even an executive order, that might free up money to solve the problem, Richard was pessimistic.
“I don’t have a magic wand,” he said.
Perhaps, he said, some MCOs have money they can allocate to the problem, but they’re limited in how much they can move from one program to another. And with the current budget year winding down, there aren’t a lot of unallocated state dollars remaining.
“There maybe are small things to do that can relieve pressure,” Richard said.
Roller coaster
Service providers say their frustration is that they’ve been in this position before and feel like the state’s uncertain funding stream leaves them lurching from crisis to crisis, with policymakers slow to find a permanent resolution. They say they’re stretching their dollars where they can, but several said they’re at a breaking point.

Photo credit: Rose Hoban

Jenny Gadd displays the medication cabinet at one of Alberta’s group homes in Chapel Hill. Between them, three residents in that facility have dozens of medications that they take for mental illness and other conditions. Photo credit: Rose Hoban

“Food is a real issue,” said Jenny Gadd, the group home manager for Alberta Professional Services, which runs several group homes for people with mental health issues. “We buy more stuff that’s canned and frozen, not many things that are fresh. You make sure you hit all the sales.”
Gadd bemoaned the lack of stimulating activities for her residents; for example, trips to museums, drives, time at the YMCA. “Those things have gotten whittled away at until you never go on a drive to Jordan Lake because you can’t afford the gas,” she said.
Gadd also noted that salaries haven’t increased in years, even for staff who have a lot of experience.
“We keep paying those folks $10 an hour for the care of human beings. And then we wonder why sometimes bad things happen in group homes,” she said. “Maybe because you don’t give people the tools they need to provide good services.”
“The clients I have at one home are mentally ill,” Donnell explained. “They do fine if they have medications, if they have staff redirection, assistance in getting their meds, making sure they eat good and healthy.”
The residents at her other home, she said, are lower functioning. “They can still dress and feed themselves, but they need someone who’ll get them to doctor appointments and get their medications ready and provide them the security they need.”
When asked if her clients could live independently, Donnell said that it would be “like putting an 8-year-old in an apartment by themselves.”
Money to pay for residents’ care comes from their own monthly Social Security disability payments, plus some from county dollars. State dollars make up the rest, to a maximum of $1,238 per resident per month.
Donnell explained that when her six beds are filled, she receives a total of $89,856 to feed and house her clients in each facility. Of that money, she is required to employ an administrator, for which she pays around $40,000 per year, and provide round-the-clock staffing, for which she pays about $8 an hour. All told, it comes to just over $90,000 per year to staff each of the facilities, not to mention food, insurance, utilities and other costs of keeping the places going.
One year, Donnell said, she paid herself the equivalent of $1.25 an hour.
“It is always something,” wrote a frustrated Donnell in an email to Dave Richard that she shared. “I am left to explain to the bill collectors why the bills are late again. Then as always I am forced to pay late fee and penalties which has been in the thousand (sic) of dollars over the past several years.”
“It has been a real roller coaster ride,” Donnell said.

New public policy specialist to advance NAMI North Carolina’s advocacy efforts

Nicholle-KarimThe National Alliance on Mental Illness North Carolina (NAMI NC) has hired Nicholle Karim, MSW, LCSW, into the role of public policy specialist. This new role was created to increase NAMI NC’s voice by working with our 34 affiliates to increase grassroots advocacy regarding public policies necessary to improve the quality of life for all those affected by mental illness. Karim will work to fulfill our mission through training and education of our grassroots advocates, through advocacy around funding and policy issues, state legislation, as well as through rules and regulations.

Nicholle Karim has reviewed the many pages of the North Carolina budget bill, and here are the highlights related to mental health:

Things that are positive:

• There are no changes to eligibility for Medicaid
• There are no changes to optional services provided by Medicaid for the age, blind, or disabled categories
• The $2 M remaining bridge funding for those living in group homes has been carried over for this fiscal year
• The budget will not cut funding for the Wright School
• The budget does not make any changes to the LME-MCO system or how Medicaid is delivered
• Education for children in Psychiatric Residential Treatment Facility settings is a line item under the Department of Public Instruction (DPI) budget
• $2 M allocated for traumatic brain injury (TBI) services
• $2.2 M allocated for developing & reimbursing community crisis based facilities & services
• DHHS to study reimbursement for ambulances for transporting an individual experiencing a mental health crisis to a crisis facility


The Department is tasked with achieving $12 M in savings with mental health medications, 6 M to be achieved through prior authorization of mental health drugs. There are a series of things they can try, with escalating effects.

• There is an overall cut ($1.8 M) to LME/MCOs general operating fund of 5.6% with the intention of the LME/MCOs consolidating to 7 LME/MCOs by June 30, 2015.

• $24.9 M overall cut to MH/DD/SAS budget for 2014-2015 fiscal year

• There will be changes to those receiving Special Assistance (SA), with the impact of a cut across the state of a $337,000. We are still analyzing what this means, but we know they backed off of eliminating the Medicaid eligibility that comes with qualification for receipt of SA.

Marianne Kernan Addresses the Moore County Board of Commissioners    Marianne Kernan

Marianne Kernan, Chairman of Linden Lodge Foundation, and Board Member, NAMI-MC, is scheduled to address the Moore County Board of Commissioners on Tuesday, July 16 beginning at 6 p.m. The concerns that she will be addressing are:

1.  To request a letter from the Commissioners to our State Legislators and GOV McCrory supporting the position of those educated in and/or having a loved one with a mental illness to NOT support the bill requiring ALL medications for mental health issues require pre-authorization and the reasoning behind rejecting this budget cut proposal.

2.   To propose the humane way of treating individuals with a mental illness and describe how they are currently picked up by police and incarcerated.  The reasoning behind why they should go to the hospital in lieu of jail – those that have Alzheimer’s and are aggressive are taken directly to Moore Regional Hospital and NOT to the jail.

3.  To propose that Moore Country Government provides limited financial support to a program under consideration by Moore County Presbyterians Churches to develop and operate a “club like” program for those with a mental illness.

4.   To ask the Moore County Commissioners to consider a one-time only cancellation of yard waste dumping fees at the local dump for LLF so that the adjoining property can be cleared at LLF expense without the normally charged yard waste fee by truck load.  This property will be used for a Disc Golf Park and open to anyone in the community but monitored by LLF and the Village of Pinehurst.

5.  To propose that non-profit organizations wishing to hold peaceful rallies on the grounds of the Moore County Courthouse (without entry to the building or use of the restrooms, etc.) not be required to pay a $50.00 non-refundable fee upfront for the use of the sidewalk.  The $200.00 refundable deposit is understandable but a fee to use taxpayer sidewalks is not.

Anyone interested in any of these issues and are supportive of these positions, please come and support an attempt to inform our local officials about the issues of mental illness.   Remember – there is power in numbers versus that of the “Lone Ranger”!


Linden Lodge Holds A Candlelight Vigil and Sleep-in, Lending Their Voice To Protest Cuts for the Mentally Ill

By Eric Dinkins Staff Writer for THE PILOT, Photos by Hannah Sharpe

(If you like this article, PLEASE Contact Eric Dinkins at edinkins@elon.edu or (910) 783-7575 and tell him he did great!)

Marianne Kernan outside the old historic courthouse in Carthage

Marianne Kernan outside the old historic courthouse in Carthage

The Linden Lodge Foundation held a candlelight vigil at the old historic courthouse in Carthage Friday evening to raise awareness for potential state budget cuts to group home programs for people with mental illnesses. After the vigil, participants walked over to First Presbyterian Church, where they spent the night to symbolize the thousands of people with mental illness who would be homeless if funding is cut.


The Rev. Robert Whitehouse and Sharon McDonald sing during the vigil

The Rev. Robert Whitehouse and Sharon McDonald sing during the vigil

About 45 people gathered around the old historic courthouse in Carthage Friday night to raise awareness of possible statewide budget cuts to homes that provide care for patients with mental health problems. Moore County’s National Alliance on Mental Illness (NAMI), and the Linden Lodge Foundation hosted the event, which included a candlelight vigil, and a camp-out demonstration at the First Presbyterian Church in Carthage. Marianne Kernan, chairman of the Linden Lodge Foundation and the privately owned group home in Pinehurst, organized the event and was joined by the home’s staff, residents and supporters.

“People are unaware,” said Ann Akland, co-president of Wake County’s NAMI organization. “It really helps when you can start at the grassroots level.” Akland and her husband Jerry drove from Raleigh to participate in the vigil. They organized a protest in front of the North Carolina Legislative Building a couple of weeks ago, which about 100 people participated in. After a brief rally at the courthouse, the group walked over to the church for its sleep-in on the grounds. If the issue isn’t addressed by the General Assembly’s 2013 budget before June 30, group homes statewide will lose eligibility for some clients to receive Medicaid funding, meaning as many as 1’500 patients could become homeless.

Mental health care supporters want more than a temporary solution

Mental health care supporters want more than a temporary solution

Group homes will receive Medicaid coverage based on the number of residents at the end of 2012. Group home residents as of Jan. 1, 2013 will not be accounted for in the funding. “They can’t pay their staff and that means they have to close. But if they stay open, they’re going to be understaffed,” Kernan said of the facilities. Advocates are concerned about housing options that combine the elderly in facilities with those who are suffering from mental illness. They would prefer the state fund separate housing for those with mental illness. The Rev. Fran Stark, associate pastor at the Chapel of the Pines in Seven Lakes, pointed out that many eligibility issues stem from the lack of exclusive housing options that individually cater to elderly patients and mental health patients. “It doesn’t always work well, because the staffing is there for the elderly,” Stark said. “It’s a difficult combination for the staff to work with effectively.” Kernan also said that mental illnesses “have nothing to do with age.” Linden Lodge houses patients as young as 22 years old.

Advocates are concerned about housing options for those who are suffering from mental illness.

Advocates are concerned about housing options for those who are suffering from mental illness.

The state House last week approved the new budget, and it now goes to the Senate for consideration. The Senate budget includes a pilot program that addresses group homes, but that program only addresses a handful of counties, according to other media reports. But mental health care supporters want more than a temporary solution. “You can’t use short-term solutions for a long-term problem,” said the Rev. Robert Whitehouse, pastor at McDonald’s Chapel in Pinehurst, and Program Director at Linden Lodge. “Without guidance, they can’t be at their best.” Imani Johnson, a clinical therapist and licensed social worker with Sierra’s Residential Services in Lillington, works with adolescent boys.

“Do they (legislators) know what it feels like to be with a client one on one?” she asked. Johnson said that there’s a “disconnect,” or a “bridge” between those who are making policies and those affected by the policies. Kernan said that the state has plans to create housing for 300 mental illness patients over the next two years, and is considering building another facility on Dorothea Dix’ campus in Raleigh.

Marianne Kernan turns candle lights on for sleep-in participants to light the way

Marianne Kernan turns candle lights on for sleep-in participants to light the way

 “Options are great, but they have to be well thought out and good, and none of these are good,” Kernan said. “There is an underserved population that never has lived by themselves, and they never will. That’s who we need to protect.”

More photos to come…..

NAMI-NC’s Deby Dihoff discusses housing for people with mental illness in the wake of the U.S. Department of Justice’s settlement with the state

Deby Dihoff, Executive Director of NAMI-NC, did a radio interview for NC Policy Watch, a progressive, nonprofit and non-partisan public policy organization. NC Policy Watch is an independent project of the NC Justice Center, North Carolina’s leading private, nonprofit anti-poverty organization.

Click HERE to listen

On the Record: Group home crisis

WRAL News anchor David Crabtree goes ‘On the Record’ about a looming crisis for people in North Carolina’s group homes. If the government doesn’t step in, thousands of state group home residents could be out on the street by January.

Click HERE to Watch WRAL TV’s “On the Record”

Guests are Rep. Nelson Dollar, Co-Chair of the Blue Ribbon Commission on Trainsitions to Community Housing and Ann Akland, Past President and Advocacy Chair, NAMI Wake County.

The show  includes a video response from the Governor.

~ O ~

Please read the “Heard in the Halls” message below to read what is being considered in our State. I cannot believe what the NC legislature is proposing when it comes to medications to treat mental illness – try the cheapest one and if that DOESN’T WORK, then we will consider allowing you a psychotropic drug that you may have been on that you knew worked.  Help…..we can’t allow this to happen!  It is just plain wrong and inhumane to make individuals with a brain illness suffer needlessly and put themselves and others in harm’s way due to a foolish cost savings measure.  Too many individuals have already been through the trials and tribulations of being on a variety of medications until they came across the one(s) that worked………we just can’t ask them to go through this pain again.

I am asking you to write and/or call Governor McCrory and the legislators for our district, and Dr. Wos, the NC Secretary of DHHS and let them know how wrong this is.  If you are a doctor or mental health provider, I would ask that you tell the staffer that and let them know the impact this measure could have.  If you are in the media, I would ask that you either print a column, article, or air it on your show to let the public know that once again those with a mental illness are being given second class treatment.  Please help!!!

 Only together can we make a difference!
Marianne Kernan
Chairman, Linden Lodge Foundation


What is the Issue?

 North Carolina has an exemption from requiring people on Medicaid to go through an authorization process to get the drugs that they need to treat their mental illness.  This may change!!  The state is trying to limit overall drug expenditures.  This may mean just saying no to a drug that works for you or your loved one.  It may mean failing first on a cheaper drug before you can get back on a drug that has worked.  It is hard on the doctors who must complete much more elaborate paperwork, it is hard on those living with a mental illness, and it is hard on their families.

We need to work to continue protecting these vital medications; we need to continue the exemption.  Do not balance the budget on the backs of those with mental illness.


Important Points:

  1.     Drug expenses in NC have actually decreased by $153M from 2009 to 2012 due in part to increased rebates
  2.     We must preserve the Doctor-Patient decision making authority; drugs work differently on everybody.  Don’t limit the number of products available, as you may not have access to the one that works for you.
  3.     Studies show that this idea for balancing the budget doesn’t work well.  In Maine, they found a 6% greater likelihood of a gap in medication occurring from prior authorization, and an 18% greater risk of a person going 30 days or more without medication when they made this policy change.
  4.     A study in Alabama with medicaid claims data around ER visits found that admissions related to behavioral health could have been avoided if people were able to consistently take their medications.  Consequently, they showed an increase in hospital costs of over $264M
  5.     There are better ways to be smart about money but not endanger those with mental illness. There is the A+ Kids program, and a similar one for adults which works on safety monitoring of antipsychotics prescriptions that may not be consistent with FDA requirements.  We need more focus on these educational programs to help doctors get the dosage and match of medication right.   Much money can be saved with this approach without imposing prior authorization requirements.

In short- this approach will balance the budget at the expense of people with mental illness, making it harder to get well and stay well.  We know from other states who have gone this way that it may in the short run save money, but it will end up costing more when adverse events occur:  people landing in the emergency room, in hospital beds, even in homeless shelters, jails, and prisons.  It costs our society much, much more than keeping people on the medications that keep them well.

 Act Now.. Do it Today! We can Make a Difference…

1.  Call the Senate Chairs of Appropriations to tell them not to remove the medication exemption and not to balance the budget based on cutting medication costs:

Senator Ralph Hise (Mitchell)  919 733 3460 Ralph.Hise@ncleg.net

Senator Louis Pate (Wayne) 919 733 5621 Louis.Pate@ncleg.net

Senator Harry Brown (Onslow) 919 715 3034  Harry.Brown@ncleg.net

Senator Pete Brunstetter (Forsyth)  919 733 7850  Peter.Brunstetter@ncleg.net

Senator Neal Hunt (Wake)  919 733 5850  Neal.Hunt@ncleg.net

2. Call your local legislator and inform him/her about this issue.    Click here to find your legislator (you will need to enter your address in the search box in the top right corner of each interactive map to find your district)

3.  If you are involved in CIT in your community, get your stakeholders to write a letter opposing the removal of the exemption.  Click here to see a sample letter.  Except for families and those living with mental illness, no one knows better than law enforcement the effect that this will have in disrupting the lives of those who need these medications.  Ask law enforcement or your local hospital administrator to send a letter or make a call.

We expect to see a budget in the Senate next week so it is vital that you TAKE ACTION.  Let’s overwhelm them with calls and emails.  This is IMPORTANT.  Make the call!

  ¤═══¤۩۞۩ஜ ஜ۩۞۩¤═══¤

Below is the link to an article that appeared in the Charlotte Observer on 30 June.  In the photograph is Deby Dihoff, the Executive Director of NAMI-North Carolina, addressing the crowd – please note that the 2 individuals in the forefront are NAMI-Moore County individuals from Linden Lodge (Emily Loew and Chris Picard). We had 11 folks that we took up to represent ALL in Moore County with a brain illness.

 Click here:   Charlotte Observer – 6-30-2013

After reading this article, I hope you will do your part and take the Letter to Physicians below to your medical team (s) requesting their support – it matters not what their specialty is.  Once again, if we do not put up a fight, it will be us receiving the short end of the stick and I cannot do it alone.  Please get your medical/psychiatric provider to sign this letter and either mail it back to me or scan and E-mail.

My intention is to gather together the ones that I have and present them to Representative Boles personally (after making copies of them, of course, lest they get lost before they get to the entire legislature).  The letters that have been returned to me to date have NOT been from NAMI-MC members.  Thank you in advance for your consideration in participating in this effort.

We urge all the visitors to our page, and Friends of the LLF, to make this  Letter of Consideration available to every Health Care Professional they can. As you all know only too well, this is a matter of urgency, that affects each of us personally, in one way or another:

Download and print: An Open Letter to Health Care Professionals


Mental health advocates hold walk at Dorothea Dix campus

NAMIwalk! 2013

Trying to make sure the mentally ill in North Carolina receive the attention and support they need, more than 1,500 people gathered on the Dorothea Dix campus Saturday for an annual walk and fundraiser.

Sponsored by the National Alliance on Mental Illness, Saturday’s walk was part of an effort to raise more than $150,000 for mental health services many families need, but can’t afford.

Many in attendance cited recent mass shootings and spending cuts as two reasons the state and nation’s healthcare systems are at a crossroads.

“Services are being cut. It’s harder to get services. You wait longer,” concerned mom Lisa Jennings said.

Vickie Carpenter agreed.

“We were totally lost,” Carpenter said of how the cuts impacted her family. “I felt like I had just fallen into a black hole.”

NAMI helped Carpenter get on track with support groups and free education classes when her son was diagnosed with schizophrenia.

“I think my son is alive today because of what I learned in that class about mental illness,” she said. “[I learned] about how to take care of someone who has a mental illness, and how to take care of myself.”

Organizers of Saturday’s walk also pointed to ongoing discussions in the General Assembly about the City of Raleigh’s deal with the state to transform Dorothea Dix into an urban park and business center.

The state Senate voted three weeks ago to pull back from a deal signed by Gov. Bev Perdue during the last days of her administration. The agreement, say Republican senators, gives the property too cheaply, starting at $500,000 per year. They also complained that Perdue, a Democrat, rushed through the deal at the last minute, ignoring calls to study the state’s options more thoroughly.

Backers of the park deal, including the Raleigh Mayor Nancy McFarlane, said the state should not go back on its word and note that a park has been the topic of discussion since the state began making moves to shut down the state mental hospital there a decade ago.

NAMI believes that state should renegotiate the lease with the city for fair market value with a percentage of the proceeds directed to mental health.

“We need to fund wellness and recovery,” NAMI NC Executive Director Deby Dihoff said. “That is what this event is about, it’s celebrating that recovery is possible. But it helps to have a few bucks to put towards it.”

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Sebelius: Bring mental illness out of the shadows

Kathleen Sebelius2:59p.m. EST February 4, 2013

President Obama following lead of John Kennedy 50 years ago on improving access to care.

U.S. Secretary of Health and Human Services Kathleen Sebelius speaks during the opening plenary of the National Health Policy Conference organized by The AcademyHealth February 4, 2013 in Washington, DC.(Photo: Alex Wong, Getty Images) 

Story Highlights

  • When untreated, condition takes a heavy toll on our society.
  • Part of improving care, is ending the stigma.
  • The president seeks a national dialogue to get more young people to seek help.

 Fifty years ago Tuesday, President John Kennedy shattered the national silence when he delivered a message to Congress in which he called for a bold new community-based approach to mental illness that emphasized prevention, treatment, education and recovery.

In the half century since, we’ve made tremendous progress as a country when it comes to attitudes about mental health. But recent events have reminded us that we still have a long way to go to bring mental health fully out of the shadows.


The vast majority of Americans with a mental health condition are not violent. In fact, just 3% to 5% of violent crimes are committed by individuals who suffer from a serious mental illness.

But we know that some instances of mental illness can develop into crisis situations if left untreated, and those crises can lead to violence. More often than not, those with mental health conditions direct these violent acts at themselves. Tragically, there are more than 38,000 suicides in America each year, more than twice the number of homicides.

This is just one of many ways untreated mental illness takes a toll on our society. Bipolar disorder and major depression are responsible for more than 300 million days per year in lost productivity. As many as three in 10 homeless Americans have a serious mental illness. In total, mental health conditions place a greater burden on our economy than cancer or heart disease; and yet more than 60% of people with mental illness do not receive help.

The Obama administration has already made great strides in improving access to mental health care. Because of the Affordable Care Act and previous legislation making care on a par with other illnesses, 30 million Americans will gain access to health coverage, including up to 10 million who have mental health issues. Mental health care must also be covered in the new Health Insurance Marketplaces, which will open in every state this fall to help citizens find coverage that fits their needs and budget.

The president has proposed additional actions that will make it easier for young people to get mental health care. This is critical since three quarters of adult mental health conditions appear by the age of 24. His plan would train more than 5,000 mental health professionals to serve young people and advance new strategies to make sure young people and their families continue to receive support after they leave home.

But we know that lack of coverage and access to services are not the only reasons people go without the care and treatment they need. The truth is that while America has come a long way, we are still a country that frequently confines conversations about mental health to the far edges of our discourse.

We often fail to recognize the signs of mental illness, especially in young people. And when we do see those signs, our first reaction is often not to reach out, but to turn away. This is a culture we all contribute to. And it’s one that all of us — community leaders, teachers, pastors, health providers, parents, neighbors and friends — need to help change if we want to reduce the tragic burden of untreated mental health conditions.

That’s why President Obama has called for a national dialogue on mental health that will be kicked off in the coming weeks. This dialogue will seek to address the culture of silence and negative perceptions of mental illness that keep so many of our nation’s young people from seeking care. It will challenge each of us to do our part to create communities where young people and their families understand how important mental health is to positive development and feel comfortable asking for help when they need it.

The good news is that when people do seek help, we have much more effective treatments and supportive services than we did 50 years ago. The proof is the tens of millions of Americans with mental health conditions who are living healthy lives and contributing to their communities. But people will only take advantage of this progress if they are not afraid to seek help. Now is the time to work together to banish those fears and bring mental health out of the shadows once and for all.

 Kathleen Sebelius is secretary of Health and Human Services.

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We would ask that each of you watch the video of the rally in Raleigh organized by NAMI-Wake County regarding the dire group home situation that individuals find themselves facing. It will give you a better understanding of what those individuals residing in these homes are facing…….then read below what YOU can do to help correct the situation.

One thing came across loud and clear – legislators (and the general public) do not correctly distinguish between IDD (Intellectual Developmental Disability/MR) and mental illness. Those diagnosed with a mental illness have taken the back seat when it comes to services and funding for years and it is worse now than ever. After thinking about it, I frankly feel we have no one to blame but ourselves for not getting out there and fighting for the rights, services, and NEEDS for those with a mental illness as the families of those with IDD have successfully done. If you agree with us and want to do something about it such as organizing a rally or letter writing campaign, please contact me via E-mail. It will take more than just a few to effect the needed changes.

Just think if it was your loved one about to be put out on the streets!

Until there is a cure……
Marianne Kernan, Chairman, LLF
NAMI-MC Member

Click here to Watch Rally Coverage on
WTVD, our local ABC TV affiliate


Senator Richard Burr
Senate Dirksen Office Building
Suite #40C
Washington, DC 20510
Tel: (202)224-3154

Senator Kay Hagan
120 Russell Senate Office Building
Washington, DC 20510
310 New Bern Avenue
Suite 122
Raleigh, NC 7601

Representative Howard Coble
2102 N. Elm Street, Suite B
Greensboro, NC 27408-5100
Phone: (336)333-5055


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