Should Involuntary Mental Health Treatment be Expanded to Increase Care and Lower Crime?
Not only can those with mental illness cause pain for others, but they are also more likely to be the victim. For instance, someone with a mental illness is three to four times as likely to be a victim of violence or sexual assault.
“It’s extremely important to understand what happens when someone is without treatment,” he said. “When someone is without treatment, they can exhibit some violent or aggressive tendencies.”
In contrast, there is a 15-fold decrease in the likelihood of violence when someone is in treatment, Murphy said.
Last year, Virginia State Sen. Creigh Deeds was stabbed multiple times in the head and chest by his 24-year old son. His son, Gus, then committed suicide outside the family’s home. Less than 24 hours before the stabbing, Gus had undergone an evaluation by mental health professionals while he was under emergency custody order. Officials reportedly had to release Gus because no psychiatric bed was available and an individual could only be held under emergency custody for up to six hours.
The Murphy bill would work to fix the shortage of inpatient beds by changing the “16-bed rule.” Medicaid currently will not reimburse for psychiatric care in any hospital that has more than 16 psychiatric beds.
A similar shortage of psychiatric professionals – especially for children – has meant the average time between a first episode of psychosis and initial treatment can be 110 weeks. Currently, there is only one child psychiatrist for every 7,000 children with a mental illness or behavioral disorder.
The bill addresses this by advancing tele-psychiatry to link pediatricians and primary care physicians with mental health professionals in areas where patients do not have access to these services.
Health Insurance Portability and Accountability Act (HIPAA) and the Family Educational Rights and Privacy Act (FERPA) provisions have become another barrier for parents trying to help their loved ones. As these laws currently stand, families and caregivers are often unable to share information with a physician about a patient’s medical history.
“You can’t get permission from someone who doesn’t even know where they are, someone who is so severely involved in paranoia and psychosis,” Murphy said. “That’s wrong and it’s a misinterpretation of the law. If you’re in an auto accident and are in a coma, they don’t wait until you’re out of the coma to treat you. Why is it that way for mental illness?”
The bill would clarify the HIPAA and FERPA laws, allowing parents to share and receive information about a mentally ill loved one.
Murphy identified some key areas that needed significant change, including addressing the shortage in inpatient treatment, finding alternatives to institutionalization, and proactively providing quick and appropriate treatment to all mental health patients.
“The plight that these patients face, and the turmoil that their families feel about handling this has got to change,” Murphy said. “Our system is far away from helping people get better to recover, to get jobs again, and to get independent housing."
Mental health advocacy groups are among the bill's supporters and detractors.
Mental Health America said in a statement the group "rejects the expanded use of involuntary treatment—ignoring the rights of persons with mental health conditions to make decisions concerning their treatment or minimizing the dignity, autonomy and self-determination of persons affected by mental health conditions."
"We believe that involuntary treatment should only occur as a last resort and should be limited to instances where persons pose a serious risk of physical harm to themselves or others."