How the big biomedical bill advances U.S. mental health care

HARI SREENIVASAN: Most of the attention around the big biomedical bill signed by President Obama today has focused on faster drug approval and new money for research, but it's a huge piece of legislation.

And one key part that's received less attention is the attempt to improve mental health care in the U.S.

William Brangham has a look.

WILLIAM BRANGHAM: Advocates say this part of the legislation is the most significant step forward for mental health care in nearly a decade.

The law promotes a range of mental health initiatives, including more evidence-based early intervention for young people. It expands outpatient mental health care. And to coordinate it all, it creates a new assistant secretary position.

For more on this, I'm joined now by the lead author of the legislation, Congressman Tim Murphy, Republican of Pennsylvania. He's also a practicing psychologist.

Welcome.

REP. TIM MURPHY (R-Pa.): Great to be with you.

WILLIAM BRANGHAM: Before we get into the specifics of the legislation, I wonder if you could just give me an overview of what you see where we are failing in our treatment of mental health care in this country.

REP. TIM MURPHY: Well, in any given year, 60 million Americans are affected by some level of mental illness, from the very mild to the very serious, 10 million with very serious mental illness. Four million get no treatment at all.

States spend an enormous amount of money, in the federal government about $130 billion spread across 112 agencies, although most of that is just disability payments. And we're not doing a good job, because what has happened is, over the years, when we have seen a dropping of death rates for cancer, it's gone down, diabetes, infectious disease, lung disease, AIDS, all declined, increasing for suicide, increasing for substance abuse.

And when we closed all those big asylums, those big hospitals that were out there for a century or so — we needed to close them down — but we didn't provide outpatient care. So what do we do? We have filled our jails with them.

The majority of people in jails, the state and local jails, are people with a mental illness disorder, too. Eight out of 10 people in an emergency room have some related mental health disorder. Five percent of the people on Medicaid are responsible for 50 percent of all Medicaid spending.

And those are people with a concurrent mental illness. So, you see, in terms of costs, in terms of the costs of lives, 959 a day, 350,000 in this country last year, related to mental illness, primary, secondary, that's more deaths in one year than the entire combat deaths of World War I — of the United States in World War I, Korea, Vietnam, Bosnia, Desert Storm, Afghanistan, and Iraq, in one year. It's a serious problem.

WILLIAM BRANGHAM: Really some startling numbers there.

So, let's talk about some of the specifics. You create an assistant secretary for mental health and substance use disorders. I know that is something that was very important to you. Why that?

REP. TIM MURPHY: Because we needed someone to take the helm.

What we found in the GAO, General Accounting Office, reports, they said there was no accountability for the grant programs. And, oftentimes, we were funding really embarrassing silly grant programs, such as a Web site that had a special hot line you could call if you were upset about the snow in New England, if you had snow anxiety, how to make a fruit smoothie if you were upset, making collages, masks, interpretive dancing, a $20,000 painting hanging in someone's office about mental health with two people sitting on a rock.

Total waste of money. We had to put someone in charge who can take the helm of these 112 federal agencies, work with them, with the VA, with DOD, and others, and start to coordinate evidence-based care directed towards those who need it, work on prevention, work on those with serious mental illness, but someone with the clout behind their name to do that.

WILLIAM BRANGHAM: One of the things we often hear about is there are simply not enough beds for people who need them and not enough practitioners to help those who need help.

What does this legislation do to address that?

REP. TIM MURPHY: Well, regard to the practitioners, half the counties in America have no psychiatrist, no psychologist.

WILLIAM BRANGHAM: Half?

REP. TIM MURPHY: Half — and no clinical social worker.

And of those that do have psychiatrists, but we have 9,000 child and adolescent psychiatrists. We need 30,000. And, by the way, serious mental illness, half the cases emerge by age 14, 75 percent by age 24. But you can't get care. It's not there.

So, we invest about $50 million to help with the new work force to build that up. And in the bed issue, we also work with Medicaid that, right now, they had a 16-bed limit, which is absurd. If you're between the ages of 22 and 64, you can't any in a private psychiatric hospital that has more than 16 beds. That's not enough.

So, we make them homeless or we put them in jail. So, this lists that and says 15-day average length of stay per month. That's not enough, I know. It's not going to address everything. But it sure is better to be in a hospital bed than laying on a park bench in the cold or being in a jail cell.

WILLIAM BRANGHAM: Just as you mentioned, obviously, one of the first-responders that often are interacting with people who have mental health crises are our police forces all over the country. And they're not really well-equipped to deal with this.

Do you tackle that in this legislation?

REP. TIM MURPHY: We do.

We put a few million dollars into that. It's called crisis intervention training. I think, two years ago, The Washington Post did a story and reported there was 250 deaths from police encountering someone with a mental illness who then attacked the policeman, came in with a knife or a gun or something. And that's too many.

What we do is fund the programs, which are very, very effective in training policemen when they know someone has a serious mental illness or they're in crisis or they can kind of identify from the situation. They learn techniques to calm the person down, and so that it's not a confrontation, and it will save some lives, and get the person in treatment.

WILLIAM BRANGHAM: You have supported repealing the Affordable Care Act.

And some of your Democratic colleagues, who laud this legislation, say that, if you repeal the ACA, which has a lot of provisions to care for the mentally ill, that you're shooting your legislation in the foot.

REP. TIM MURPHY: Yes.

WILLIAM BRANGHAM: What's your response to that?

REP. TIM MURPHY: Well, I fought too hard for this. I have worked in this field for 40 years.

I welcome the teamwork of my colleagues on the other side of the aisle to say we have to make sure we preserve this. The reason it's so important is, if we're going to find cost savings in retooling and reforming health care, a lot of it comes from the integrated care of the mentally ill, with mental illness, behavioral illness, and physical illness.

When you find someone with a chronic illness, they're twice the rate of depression among them. And untreated depression doubles their health care costs. When you hone in and treat both at the same time by integrating behavioral and physical medicine, when the physician takes charge, when you have capitated plans, so it's incentive for the doctors to do all that, you actually can reduce spending for those people by about 40 percent to 50 percent, while you're providing better care.

So, this is a lesson I want to make sure my colleagues to know. This is the thing what we ought to be doing. It's good with compassion. It's good morally. And it saves money.

WILLIAM BRANGHAM: But do you worry that if the ACA is repealed, that a lot of what you're trying to do, lauded work here, is going to get thrown out?

REP. TIM MURPHY: You're talking to someone who has spent the last four years in the trenches fighting for this, and a lot of members who were part of this team, too.

I don't see us just throwing this out. We will work together to make sure these provisions stay in. And even so, part of that concern is what states are going to do with Medicaid money, with block grants.

WILLIAM BRANGHAM: Right.

REP. TIM MURPHY: When states got block grants, you saw a number of states, like Rhode Island and Ohio, they just pulled the money out.

WILLIAM BRANGHAM: All right.

Representative Tim Murphy of Pennsylvania, thank you very much.

REP. TIM MURPHY: Thank you.

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