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Coercive Mental Health Legislation Threatens Rights of People With Disabilities

The Murphy Bill uses people with mental illnesses as scapegoats for gun violence while threatening civil liberties.

Republican Congressman Tim Murphy introduced the Helping Families in Mental Health Crisis Act. The most troubling provision in the bill is the expansion of involuntary or mandatory outpatient commitment, which consists of court-ordered medication, therapy, drug testing and case management. (Photo: James Byrum / Flickr)

Between headlines of racist police atrocities, on July 6, 2016, the US House of Representatives quietly passed the Helping Families in Mental Health Crisis Act by a vote of 422-2. If made law, this legislation, also called the Murphy Bill, would be the most significant reform affecting mental health care since the Community Mental Health Act of 1963 ushered in the era of deinstitutionalization.

Hailed as a rare bipartisan victory, the Murphy Bill lets politicians falsely claim progress against gun violence while stigmatizing people with mental illness, undermining civil liberties and diverting attention away from institutionalized racism and structural poverty. Actually, it does nothing to increase access to vital resources or address the pandemic of police violence against people with mental illness.

One quarter to a half of people killed by police are experiencing an emotional crisis — about one every 36 hours, disproportionately people of color. Just since this legislation cleared the House, police responding to a 911 call about an apparently suicidal person sitting in a Miami street shot the man’s Black caregiver who was attempting to protect him. At the same time, the media have attempted to attribute the retaliatory attacks on police in Baton Rouge to the shooter’s post-traumatic stress disorder.

The Murphy Bill was introduced by Republican Congressman Tim Murphy following the mass shooting at Sandy Hook Elementary School. Murphy, a clinical psychologist with thorough right-wing credentials, believes patients’ civil liberties are a barrier to effective treatment and has made clear that his goal is to empower not people with disabilities, but our parents and caregivers. The bill has many powerful supporters, including dozens of nonprofits, lobbyists and health industry trade groups.

Supporters claim to be remedying the broken system left in the wake of deinstitutionalization — the widespread closure of state-run psychiatric hospitals, which was viewed as progressive in its time but, due to lack of funding for replacement services, in effective moved millions of people with psychiatric disabilities onto the streets and into prisons. Today, the three largest psychiatric “treatment” facilities in the United States are jails, where abuse, squalid conditions and violence are routine.

One of the Murphy Bill’s most troubling provisions is the expansion of Assisted Outpatient Treatment (AOT). AOT, also known as involuntary or mandatory outpatient commitment, consists of court-ordered medication, therapy, drug testing and case management. While 46 states already have AOT laws, they are not widely utilized. Supporters of AOT tout it as an alternative to the more expensive options of hospitalization and incarceration, but there may be no benefit at all. One systematic review of studies found “no significant difference in service use, social functioning or quality of life compared with standard care.”

In the hands of a racist and classist criminal legal system, AOT has become another tool for enacting violence against marginalized communities. Black people in New York state are five times more likely to experience court-ordered treatment than white people.

At its worst, AOT allows abusive family members and biased judges with zero mental health competence to force treatment on individuals supposedly too sick to recognize they need help. The Western Massachusetts Recovery Learning Community, a peer-to-peer mental health support group that describes itself as largely funded through grants from the Department of Mental Health, reports on its website that what “treatment” can entail under AOT rules varies highly from state to state, but in some states has included the following:

Taking your prescribed medication; Electroshock Therapy (ECT); Attending all therapy and psychiatry appointments; Attending day programs, vocational programs and/or drug and alcohol treatment programs or groups; Submitting to regular drug testing; Living in a residential program.

If you fail to comply with treatment requirements on your outpatient commitment order, you can be immediately picked up and taken to the hospital whether or not you appear to be doing well overall.

In addition to expanding AOT, the Murphy Bill attacks privacy rights of people diagnosed with mental illness. According to the Congressional summary, the bill

requires the caregiver of an individual with a serious mental illness to be treated as the individual’s personal representative with respect to protected health information, even though the individual has not consented to disclosure of such information to the caregiver, when the individual’s service provider reasonably believes it is necessary.

This would exempt people diagnosed with mental illnesses from federal privacy laws, giving sensitive information on patients’ diagnoses, medications and medical appointment dates and locations to families, spouses or social workers under the guise of “compassionate communication.” For example, this information could “out” transgender people to transphobic family members, or be exploited by abusers against women with disabilities, who are 40 percent more likely to experience intimate partner violence than non-disabled women.

The Murphy Bill also seeks to undermine the Substance Abuse and Mental Health Services Administration (SAMHSA), creating a new mental health czar and prohibiting SAMHSA from establishing its own independent programs and terminating existing programs “not explicitly authorized or required by statute.” One potentially threatened program is the National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC), which “works to eliminate the use of seclusion, restraints, and other coercive practices and to develop the knowledge base on trauma-informed care.” Other at-risk programs include those serving vulnerable and marginalized populations, such as LGBT people, Native communities, people experiencing homelessness and Spanish-speaking communities. Rep. Murphy and his allies have repeatedly attacked SAMHSA for supposedly wasting taxpayer money on a recovery model that allows patients to be co-creators of their own treatment plans.

This is a victory for right-wing organizations like the Heritage Foundation that have been calling for the abolition of SAMHSA, as well as a loosening of federal privacy laws, for years. Conservatives have criticized SAMHSA forits willingness to collaborate with organizations led by mental health service users and its focus on prevention and coping practices over what they call “evidence-based practices,” which involve strictly medical responses.

All this is proceeding under the pretense of violence prevention, despite the fact that, according to the US Department of Health and Human Services, “only 3%-5% of violent acts can be attributed to individuals living with a serious mental illness” and “people with severe mental illnesses are over 10 times more likely to be victims of violent crime than the general population.”

Around 20 percent of Americans have a mental health diagnosis in a given year. If we count only “severe” mental illnesses, this number is still well above 5 percent. Legislation, such as the Murphy Bill, claims to reduce stigma while doing the opposite, perpetuating the false narrative that people with psychiatric disabilities are dangerous.

It would be convenient to think if Sandy Hook shooter Adam Lanza or Isla Vista shooter Elliot Rodger had been forced into treatment, their victims would still be alive. Perhaps in a few cases that’s even true. But we should not scapegoat all people with psychiatric disabilities or punish people for “thought crimes.” Giving more power to hospitals, courts and families holds too much potential for abuse.

Violence is more closely linked to poverty than to mental health diagnoses, yet this is not being addressed. The Murphy Bill contains no increase in funding for housing, food stamps or disability benefits — services that could improve the health of people with psychiatric disabilities as well as reduce overall violence. The legislation does not decrease the cost of treatment, nor does it help people who need intensive care but can’t afford to take time off work.

To be sure, the Murphy Bill contains some positive elements, such as making it easier for Medicaid to bill for mental health treatment. The law attempts to address the shortage of psychiatric beds, track data on mental health and use tele-psychiatry for rural populations. It also makes vague commitments to fund youth suicide prevention initiatives. However, the efficacy of these measures remains to be seen.

Finally, the proposed law would also increase crisis intervention training for police. These trainings could possibly help to reduce violence, but trainings will never solve the racism and violence inherent in the US criminal legal system. If we truly care about preventing violence, a good place to start would be disarming — or disbanding — police, not giving them more resources.

The bill now moves to the Senate, where a vote is expected by September. The continued focus on disabled people as perpetrators rather than victims of violence hides deeper crises facing this country, and is unlikely to end until people with disabilities and our allies organize for real, revolutionary change at every level of society. We need our basic needs met, alternatives to calling police when we are in crisis, and community support services that allow people with disabilities to live independently — not more court orders.

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