[Congressional Record Volume 162, Number 55 (Tuesday, April 12, 2016)]
[House]
[Pages H1624-H1630]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
A TALE OF TWO CITIES
The SPEAKER pro tempore. Under the Speaker's announced policy of
January 6, 2015, the gentleman from Pennsylvania (Mr. Murphy) is
recognized for 60 minutes as the designee of the majority leader.
General Leave
Mr. MURPHY of Pennsylvania. Mr. Speaker, I ask unanimous consent that
all Members may have 5 legislative days within which to revise and
extend their remarks and include extraneous material on the subject of
my Special Order.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Pennsylvania?
There was no objection.
Mr. MURPHY of Pennsylvania. Mr. Speaker, this is the tale of two
cities--not the tale about the cities, but about two examples of
America's great embarrassment and failure to treat a brain disease
called mental illness, especially serious mental illness. It is also a
tale of Congress' repeated failure to address this.
Despite the cries of millions of Americans to do something about it,
what we here in Washington tend to do when we hear of another tragedy
that has occurred somewhere in the Nation, the tragedies we know by the
names of Sandy Hook Elementary School, or Columbine, or Aurora,
Colorado, or Tucson, or Santa Barbara, what Washington tends to do is
we have a moment of silence. But the people want and Members of
Congress want moments of action, not moments of silence.
Let me elaborate on this tale. In this building, the U.S. Capitol,
back in the 1990s, two police officers were killed when Russell Weston
came into the Capitol seeking a red crystal and ended up shooting these
police officers. Under his diagnosis of paranoid schizophrenia, he was
pushed, with his delusions and hallucinations, to take action. It ended
up in tragedy.
There was also recently, over the break, another man, Larry Russell
Dawson, who has been seen around this Capitol and has once, allegedly,
disrupted proceedings in this Chamber and, allegedly, also suffers from
some level of mental illness. When he was entering the Capitol Visitor
Center, a pistol was seen going through the x-ray. When he grabbed that
pistol, police officers shot and wounded him.
First of all, it is amazing to me that people did not die. We know
that the entrance to the Capitol Visitor Center is a highly secure
environment with many, many Capitol Police officers. These brave men
and women who put themselves between danger and Members of Congress and
the public showed tremendous restraint and judgment at that moment.
I might add that, many times, when a mentally ill person has a
conflict, a violent conflict with a police officer, where they may be
reaching into their jacket or may be pointing a pistol or approaching a
police officer with a knife, it is estimated between a quarter and a
half of those mentally ill people involved in a police encounter end up
dead. That is a few hundred each year.
Though that is the tale in Washington, D.C., why are we dealing with
mental illness as a violent threat instead of in treatment? We deal
with it because, in this Nation, sadly, when someone with mental
illness has reached that level or they become violent, we call the
police.
The rules are, which we will look at tonight: prevent people from
getting treatment; we do not have enough providers; we don't have
enough places to put people, so we call the police.
Now, I should start off by saying the mentally ill are no more likely
to be violent than the non-mentally ill; except when you look at those
with serious mental illness such as schizophrenia, bipolar, and other
illnesses such as that, they are 16 times more likely to engage in an
act of violence than someone who is in treatment.
Again, a person who is seriously mentally ill and not in treatment is
16 times more likely to engage in an act of violence than someone who
is in treatment.
On the West Coast, in Seattle, another tragedy was brewing. A man
named Cody Miller climbed a tree, a giant sequoia tree in downtown
Seattle, and it created something of a furor.
First, I want to read parts of an article that appeared in The New
York Times on March 29 that describe this to show you how out of touch
we are as a society when dealing with mental illness.
It said: ``For more than 24 hours last week, Cody Lee Miller perched
in a giant sequoia in downtown Seattle, pelting people and cars with
pine cones and tearing off branches.''
Investigators were investigating how much it would cost, using some
``complicated formula that goes far beyond the value of natural
beauty,'' the article said.
``A Seattle tree expert . . . said Mr. Miller caused $7,800 in
damage, according to court documents released this week. Investigators
took into account the tree's age, its potential life span and how much
of its lush foliage was denuded.
``The formula, created by professional foresters, goes like this. The
trunk is 34 inches in diameter at breast height, an investigator's
report said. The tree has a `95 percent species rating,' a `100 percent
condition rating' and a 100 `percent location rating' . . . The
sequoia's pre-damage value was put at $51,700. But after Mr. Miller's
arboreal escapade, the tree lost 15 percent of its value, the documents
show, and is now worth only $43,900 . . .`The damage to the tree was
extensive,' the report said.
``Mr. Miller was charged on Monday with first-degree malicious
mischief and third-degree assault. He was also ordered to stay away
from the tree by observing `no unwanted contact' ''--I repeat, ``by
observing `no unwanted contact' '' with the tree.
Now, the story goes on to describe trees and sequoias, but not until
the very end of the article it mentions Mr. Miller's mother, Lisa
Gossett. She said that she had not talked to her son for some 5 years.
She saw it on the news and she barely recognized him.
See, what was happening is Lisa Gossett and her daughter sat in their
Alaska home watching this clip of the man perched in the tree. With
their hearts broken, with tears streaming down their faces, Lisa and
her daughter soon came to realize they were watching their son and
their brother become the latest Internet mockery of a mentally ill
person.
You see, when Cody Lee Miller climbed this 80-foot tree and sat there
for 25 hours, he was sporting a bushy beard and ragged clothes, and
most Americans were amused by this and they called it #manintree. It
was an international viral story overnight. But this was no joke; this
was no prank. This was the culmination of untreated mental illness
that, once again, our society turned into a joke.
And we wonder why there is a stigma, when newspapers like The New
York Times write a mocking story like that towards a man who has a
disease. Would they have written an article like that if it was about
someone with cancer or diabetes or AIDS or any other disease? My guess
is no. But somehow, in our society, it is okay to mock a person who is
suffering from schizophrenia.
[[Page H1625]]
When he was younger, he was clean-cut and rambunctious, loving and
happy. Those are the words his friends used to describe him. At a young
age, he was diagnosed with attention deficit hyperactivity disorder;
however, other than excess energy, like any child, he didn't sport any
behavioral issues. But then, 6 years ago, his mother began to notice an
unusual shift in her son's behavior as he grew increasingly paranoid.
Let me note here that serious mental illness, about 50 percent of the
time, emerges by age 14, and 75 percent of the time by age 24. It is
very, very difficult to predict; although, we have now indicated some
108 genetic markers of schizophrenia and bipolar illness. Still, the
issue is many parents have a loving and caring child, then something
changes.
{time} 1945
His behavior changed when Lisa would find knives stored under her
son's pillow. And when confronting Cody about her discovery, he would
simply respond: It is just to keep us safe.
As time passed on, Cody's mental instability progressed. He refused
to enter certain stores downtown. When making an exception, Cody would
cover his face with a hood, convinced people were constantly staring at
him.
Following this enhanced paranoia came the emergence of night terrors
and constant crying and shouting for his mother during the night. Cody
would shriek in fear of the ``evil presence'' surrounding him.
This worrisome behavior continued to escalate as Cody spiraled out of
control. He could be found walking down the street in high socks and
clown glasses spreading deer bones on the road.
He hit a man with a flat tire and began to have dreams of killing his
grandmother, going so far as setting her wood shop on fire. At that
point, his grandmother said she could no longer handle him and sent him
out.
He was caught in the revolving door of the United States'
embarrassing and shamefully broken mental health system. He was
constantly shuffled between homelessness and incarceration.
Lisa pleaded for others to help her son and appealed to the Alaska's
Governor's office, mental health evaluators, and probation office for
assistance.
But despite her efforts, Lisa's attempts to get her son proper
treatment seemed hopeless due to the bureaucratic morass that is our
mental health care system, which is not really a system at all.
She was sidelined from helping her son due to the inefficient system
and forced to sit by and watch as Cody eroded over time.
We pretend in our own deluded state that all the seriously mentally
ill are fully aware of their symptoms and welcome treatment. The fact
is many don't.
Forty percent of individuals with schizophrenia and bipolar disorder
don't even recognize that the delusions and hallucinations are not
real. This is a medical condition called anosognosia.
Anosognosia is also something you see in people with dementia or
Alzheimer's or stroke. It is very real. The person is not aware of
their own problem.
But somehow we come up with this anthropomorphism which says, well,
they can decide for themselves. They cannot decide for themselves when
they don't even know who they are, that they exist, or what planet they
are on.
They see things differently. They hear things differently. They smell
things differently. They encode information differently into their
brain. They process it and recall it differently. So for us to say that
they just don't want treatment is a fool's errand on our part.
Can you imagine if we said that, again, to someone with cancer? ``You
don't understand your disease.'' Diabetic? ``We are going to dismiss
you.''
What if a person clutched his chest in a heart attack and laid
unconscious in the street? Would we tell that person ``We are not going
to help you until you wake up and tell us to treat you''?
Worse yet, will we say to that person ``We are not going to treat you
until you are an imminent danger of killing yourself or killing someone
else''? No. But that is what we do with the mentally ill.
The Energy and Commerce Committee's Oversight and Investigations
Subcommittee that I chair had a couple-year study paving the way for my
bill, the Helping Families in Mental Health Crisis Act.
With 187 cosponsors from both sides of the aisle, my bipartisan
measure addresses the shortage of psychiatric beds, clarifies HIPAA
privacy laws so families can be allowed to have some compassionate
communication and be part of frontline care, and it helps patients get
treatment well before their illness spirals into crisis.
My legislation has been endorsed by dozens of publications and
newspapers, including The Washington Post, The Seattle Times, The San
Francisco Chronicle, The Wall Street Journal, and the Pittsburgh Post-
Gazette.
Each day I hear from countless families from across the country that
we are experiencing a mental health crisis, and they are counting on
our efforts to bring positive changes to the mental health system. We
cannot let these families down. Lives are depending upon it. We cannot
wish this away, and denial is not a treatment.
But let me tell you what Americans have to say about this because, as
we are dealing with this issue, Americans are wondering why Congress is
not acting. Why is Congress being so passive? Why aren't we doing what
we need to do?
I want to tell you about a story that I posted on my Facebook page
and this picture that I posted as well.
This is Cody Lee Miller in court. Look at his hair. Look at his
beard. This is a man that obviously has not been taking care of
himself.
He is in shackles on his ankles and his wrists, chained at his waist,
and led by two police officers wearing their purple gloves so they are
not at risk of infection while a judge sits in the background. This is
a man who was diagnosed with schizophrenia being treated like a
criminal.
Now, I wrote on my post this: ``Friends, you really can't make this
stuff up.''
A man who is diagnosed with paranoid schizophrenia, #ManInTree, ``who
desperately needs psychiatric care is brought in shackles before a
judge because he has been charged with first-degree malicious mischief
and third-degree assault. What was the outcome? The judge ordered him
to stay away from the tree, but he first needs to make his $50,000
bail.
``Just look at this picture and tell me our mental health system
isn't a mess. It is unbelievable. Recall that for 24 hours last week,
Cody Lee Miller remained atop a giant sequoia tree in downtown Seattle.
Since that time, there has been a greater outpouring of concern over
the tree than the plight of this young man who is so clearly in the
throes of a psychotic break.''
I make reference here to that article from The New York Times being
far more concerned about the tree than a human being.
I wrote further: ``He is ordered to have `no unwanted contact' with a
sequoia, yet no concern about getting him into treatment. Such a sad
indictment against an abusive system that would order no contact with a
tree, yet remains silent on getting the mentally ill into care.
``Cody's mom talks about his downward spiral and has made it her
mission to be a voice for families who desperately want to help their
loved ones but are blocked by Federal and State laws that make it
impossible to help mentally ill family members. Meanwhile, Congress is
still stalling my Helping Families in Mental Health Crisis Act, H.R.
2646.''
This posting must have hit a nerve. Members of Congress follow
Facebook pages and Twitter, and we have our social media. Many times
when we post something we may hear from a few thousand people. As of a
few minutes ago, this posting has led to 1.8 million hits on my
Facebook.
What is also compelling is, as sad as this story is about this man
treated like a prisoner, like a common criminal, instead of getting
treatment, are the heart-wrenching comments made by the families. I
want to read some of them to you. These are people from around the
world, really, who have commented on what is happening here.
Holly Huntley Perron wrote: ``I agree with Cody's mom. The real
culprits are
[[Page H1626]]
the State and Federal laws that prevent loved ones being able to help
family members in trouble.''
By that I reference laws which say that, unless you are in imminent
danger of killing yourself or someone else, no one is going to force
you into treatment or laws that say, if this person says that they
don't want help, you can't make them get help, or if the person in the
midst of a delusion says: Don't tell my mother or my father because
they are a part of the CIA or they are a Martian and they are planting
thoughts in my brain, the doctors cannot tell the family members when
is the next appointment, what is the medication, what is the diagnosis,
and how should they treat him. They may say to take him home when the
family says: What should I do?
We have heard of cases where the doctor says: We can't tell you
because he doesn't want us to. But the family says: But I am taking him
home. What should I do? We can't tell you.
One family member has said to the doctors: Let's just have a
supposition. Just pretend that there was a case where someone with
schizophrenia is going to my house. What should I do? And they say: We
are not going to tell you.
These go on to happen where family members may be in court pleading
in tears with the judge: Tell me where my son is. Tell me where my
daughter is. Where is my father? My mother? My brother? My sister? Tell
me so I can do something with them.
A caseworker may be sitting in the courtroom knowing full well where
the person is and knowing there are problems, but they say: I can't
tell you.
Because we believe their delusions are a reality, that they somehow
have a right to be sick instead of a right to be well.
James Sobczak wrote: ``My guess is that he will get some mental
health services in jail. Evaluate him and see if they can petition him
to a psychiatric hospital. This is a process.''
Here is the problem. When we take the mentally ill people into jail,
80 percent of them get no treatment. Eighty percent of people taken to
jail get no treatment.
And of those in jail, 40 to 60 percent of those in jail have some
level of mental illness and many are severely mentally ill. What
happens instead is a person is 10 times more likely to be in jail than
in a hospital if they are mentally ill.
Once there, they don't get treatment. They oftentimes are subjected
to abuse by other prisoners. They may get in fights with prison guards
and then charged with another crime.
Because of all these problems, a person with mental illness tends to
serve a sentence four times longer for the same crime than a person
without mental illness. When you discharge them, they don't get
treatment. So they get involved in this revolving door.
But why? Why, in heaven's name, is jail the right place to send
someone with a brain disease? Why is it that Congress doesn't wake up?
Instead of passing so many silly bills all the time, we are willing
to let people continue to die, by the way, at a rate of about 10 people
an hour.
Last year in the United States 41,000 deaths by suicide, 45,000-plus
deaths by drug overdose, somewhere between 200 and 500 deaths of a
mentally ill person confronting a police officer.
Thousands--and we don't even know accurately how many--are people who
are homeless and die. One person in Los Angeles died every day who was
homeless. And about 200,000 of these homeless people are severely
mentally ill people.
But we have gotten ourselves accustomed to stepping over them, to
ignoring them, and to treating them as an invisible class that doesn't
exist and somehow saying that that is what they want to be when they
are not even aware. We think it is comfortable for them to live in
filth and squalor.
If you add the numbers up, the total number of mentally ill who died
last year in this country, it is probably well over 85,000, maybe
100,000, maybe 120,000.
I might add that even that lowest number is far greater than the
total United States' combat deaths in the entire Korean war and Vietnam
war combined for the length of those wars.
In 1 year in America, that is how many died, and what we do here is
we throw them in jail or, quite frankly, many of them die in jail as
well.
Another comment. Jim Holden wrote: ``The `system' is the problem. We
can't help these people because `personal choice' is championed over
their health and well-being. People on the streets need to be a danger
to themselves or others before we can offer much-needed help. As a
social worker I have always found this frustrating.''
Another woman, Jilly Aliska White, writes: ``My brother-in-law was
just arrested for doing something during a psychotic break from his
textbook schizophrenia. My husband's mom thinks he is finally going to
get the help he needs now that he is in the system. Yeah. Right. He is
not going to be any better off. They don't give a rat's when they can
just shuffle him through the corrections system. It breaks my heart to
explain this to them but look at the track record of them `helping.' ''
Deb Smith writes:
Unfortunately, our jails and juvenile centers have become
mental health facilities. While a person has mental health
problems, they also may commit crimes for which they can be
arrested and held. This is a very difficult and often a very
dangerous situation for everyone involved. It is never as
simple as get them treatment, nor is it as simple as just set
them free if they commit a crime. The judge has to look at
all sides, including the safety of both sides, but for the
individual and the citizens in the community and what risk
the person may have of further harm to himself or others if
released.
Cindy Irvin writes: ``There is still a shame and embarrassment about
mental illness that totally we don't understand. And then you have the
people who believe that mental illness is a myth. Until these attitudes
change--probably by some respected celebrity having a psychotic break--
mental health care will stay in the shadows.''
Beverly Di Mele wrote: ``The problem is the mentally ill have rights,
and if they choose not to seek treatment, they have that right. The
treatment given to them prior to 1970s was forced and inhumane. They
were locked up for decades, medicated, isolated, and restrained. This
doesn't happen much anymore, thank God. They had procedures done on
them like prefrontal lobotomies and were subjected to shock therapy. It
was cruel and unusual treatment for humans that didn't happen to see
the world as `normal' people did. How would you like to see this
treatment forced on your parent, child, or loved one?''
I agree with most of that. We don't want those treatments again,
except, when she writes ``This doesn't happen much anymore, thank
God,'' she is wrong. We should never allow again to bring back our
asylums with its horrendous treatment.
But we have gone from a time of 550,000 psychiatric hospital beds in
this country in the 1950s to less than 48,000 now. In the 1950s, the
population of the United States was 150 million. Now it exceeds 316
million.
There are about 10 million people with severe mental illness, and 40
percent of them--4 million or so--don't have any treatment. And what
happens to them is they go to jail.
When we closed these asylums, people didn't all of a sudden get
better. Some got better because of medication. But we traded that
psychiatric hospital bed for the prison cell. We traded that
psychiatric hospital bed for the emergency room gurney when a person is
given a five-point tie-down and sedation.
We traded that psychiatric hospital bed for the streets and subway
grates for the homeless, and we traded that psych bed for the county
morgue where many of them die as paupers waiting to be claimed.
Lori Welander writes: ``I suffer from major depression and had to do
10 days in jail. While there, they refused to give me my antidepressant
medications. This seems to be the norm in my county's jail. It is
pretty sad. This man needs people who care about humanity, not to be
treated like this.''
Rhoda Robinson Brown writes: ``How about when our addicts beg the
judges for treatment and get put into prison for years? Most think at
least when they are in prison they won't be able to use drugs. Ask any
addict that has been in county prison how easy it is to still get
drugs. You will have people say they don't want their tax money paying
for an addict's treatment. Don't they realize it costs more to keep
them
[[Page H1627]]
in prison for years? Our justice system is so broken.''
{time} 2000
Indeed, a study done in Arkansas for their legislature found that it
cost 20 times more to put a person with mental illness in jail than in
an outpatient treatment--20 times more.
Listen to this one. Sylvia Blanchard writes:
As the mother of a bipolar son, my heart goes out to his
family because there is no hurt that hurts as much as
watching someone you love have this happen in their own life.
My son passed away 3 years ago, and I still ache. I have a
child who is in the same situation. He needs mental help,
then he needs to get treatment to deal with issues in his
life that he ignores and uses drugs to hide from it. In and
out of jail almost each week. Nothing a parent can do when
it's an adult child. So sad for our system. All States need
to look at what Ohio Governor did with his State to turn
mental health and drug abuse around.
Heidi Meyer writes:
This all stems from a bigger problem in that there are too
few beds in mental health facilities for children. There is
nowhere to get help for them when they're young and it just
leads to messed up adults.
This is a problem caused by the Federal Government. I told you that
we have too few psychiatric beds. One of the biggest culprits of that
is Medicaid. For people who are low-income between the ages of 22 and
64, if you have a psychiatric problem--I can't make this nonsense up,
it is true--a person cannot go to a private psychiatric hospital with
more than 16 beds.
So where do they go?
They put them in an emergency room, they put them in a general
hospital psych bed, thinking they are going to save money.
But here is what happens. If a person is in a psychiatric hospital
bed, it costs about $500 a day. If they go to an emergency room, it
could be $3,000 or $4,000 a day. If they go to a general hospital psych
unit, it could be $1,000, $1,200, $1,400 a day.
The State of Missouri actually did a study on this and found it saved
40 percent of Medicaid dollars by allowing people to go where the care
is to a psychiatric hospital to understand that medications can work.
I yield to the gentleman from Georgia (Mr. Carter) on this issue of
medications to elaborate on this. Buddy Carter from the First District
of Georgia, from Savannah, Georgia, knows well what medications can do
when properly prescribed and properly followed to help treat someone.
Mr. CARTER of Georgia. Mr. Speaker, I thank the gentleman for
yielding.
Mr. Speaker, as the gentleman has stated, this is a serious problem.
This is a problem that I have dealt with as a professional pharmacist
for many years. I have dealt with it in my retail setting in my
pharmacies, as well as a consultant pharmacist in a long-term care
facility in skilled nursing homes. I have seen the advances that we
have made in medicine over the years. I have seen us go from only
having the original antipsychotics, Haldol, which was always
accompanied by a prescription for Cogentin to mask the side effects
that the Haldol was going to have. I have seen the evolution of the
atypical antipsychotics, which, while they do have some side effects
themselves, are nowhere near the side effects that the original
antipsychotics had.
I do thank the gentleman for bringing this important issue to light,
and I do have a few comments that I would like to make.
First of all, medication plays a major role in the treatment for many
mental illnesses. With the growing burden of mental disorders
worldwide, pharmacists are ideally positioned to play a greater role in
supporting people with a mental illness. There is a growing amount of
evidence to show that pharmacist-delivered services in mental health
care help address the barriers that are hurdles for the broader mental
healthcare team.
Pharmacists have three roles they can play in helping our country
address the mental health crisis.
First, pharmacists can play a major role in the multi-disciplinary
teams addressing health care and can support early detection of mental
illness. With more pharmacists coming out of school with greater
clinical experience, pharmacists can work in new roles, such as in case
conferencing or collaborative drug therapy management.
These new roles would also benefit from increased pharmacist
involvement, such as the early detection of mental health conditions,
development of healthcare plans, and follow-up of people with mental
health problems.
Secondly, pharmacists can play a role in supporting quality use of
medicines and medication review, strategies to improve medication
adherence and antipsychotic polypharmacy, and shared decision making.
Pharmacists would have a large impact regarding medication review
services and other pharmacist-led interventions designed to reduce
inappropriate use of psychotropic medicines and improve medication
adherence.
Finally, pharmacists can help address barriers surrounding the
implementation of mental health pharmacy services with a focus on
organizational culture and mental health stigma.
Over the years, the relation between the pharmacist and the physician
has become more collaborative and cooperative. With this new
relationship, pharmacists can work with physicians to develop
strategies to change the attitudes and stigma surrounding mental
health.
As my colleague from Pennsylvania, Representative Murphy, continues
to fight for this cause, I hope he will consider me and the profession
of pharmacy as a friend and collaborator so we can fight to end the
mental health crisis in this country.
Again, I want to thank the gentleman for yielding me this time and
for bringing this most important subject to light.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank the gentleman for
his comments and his dedication to this issue.
Mr. Speaker, I yield to the gentleman from Oregon (Mr. Blumenauer),
who has been absolutely steadfast in his compassion and caring for
this. Also, it shows a bipartisan nature of our legislation. He has
been instrumental in helping me understand other aspects of this. We
made a number of modifications to this bill and will continue to work
on these issues together, so I thank my friend.
Mr. BLUMENAUER. Mr. Speaker, I thank Mr. Murphy. I appreciate his
courtesy in permitting me to speak with him this evening.
The Sun is setting on our Nation's Capitol. Many of our colleagues
have returned to Washington, D.C. They are at dinner, they are with
their families, they are meeting with their constituents. I appreciate
his being here on the floor this evening to highlight a critical area
that he has been so committed to and has worked on so hard because it
is something that each and every American needs to address and needs to
focus on because we are all in this together.
I will say that earlier in my career as a child State legislator, I
was part of the deinstitutionalization movement. It made a lot of
sense. As my friend has said, we have had over a half million
institutional beds. Some of the conditions were not what they should
have been. Some of the treatment certainly is nothing that we would
accept today.
The notion of allowing people to be helped in a deinstitutionalized
setting made sense for a lot of people. It is sad to say we didn't do a
good job of implementing it. The institutionalization worked if we were
there supporting the people who were deinstitutionalized with
medication, with counseling, and with housing. And sadly, when we hit
some choppy waters economically in my community and others around the
country who followed what was in theory a good model, we found that
there were too many people out on their own.
Sadly, today, we can see evidence of the failure to do
deinstitutionalization right on the streets of virtually every
community large and small from coast to coast.
I appreciate his efforts to help refocus the Federal partnership.
Certainly there is a role for State and local government, there is a
role for the private sector, and there is a role for individuals and
families. The Federal Government provides resources, provides a
framework, provides a legal setting, and we need to make sure that the
Federal framework reflects the lessons we have learned and the
realities today.
I have been pleased that he has been so patient with me and others
who
[[Page H1628]]
have carried to him some of the questions and concerns that we have
picked up from people in our communities who care about it. He has
tackled an area that is complex, it is controversial, and there is room
for give and take. I feel in the hours and hours that we have talked
about this exchanging information, I have seen that he has done just
that. He has drilled down, he has listened, he has incorporated, he has
asked more questions, and I appreciate that because I think he is
establishing a framework here with a number of our colleagues on a
bipartisan basis that will enable this Congress to be able to make real
progress that is long overdue.
In my community, we are going to open a facility in September. We
call it the Unity Center. It is a collaboration between four major
hospitals to have a place where we can take people with mental problems
out of emergency rooms where they can't be appropriately treated and
where it is costly. All we can do is stabilize them, and then turn them
back out on the street until their condition deteriorates where they
pose a problem to themselves and others.
As he has referenced, too much of our mental health service in this
country is to be found behind bars. That is not the appropriate
setting. It is not cost effective and it is not humane.
We are making a small step in our community where these institutions
have come together and have established a memorandum of understanding.
They realize they are still going to lose money, but they are not going
to lose as much. They are going to be able to give better care to a
population that is very much in need.
I am hopeful, Mr. Speaker, that we will be able to, as a result of
the work that he is doing with this legislation and others who he is
working with, that we will be able to focus that Federal partnership
yet this year, to be able to have more assistance to our communities to
make sure that the Federal programs are tailored to the needs of today
and the experience that we have acquired.
I am hopeful that we will be able to develop more tools for one of
the most important ingredients in this equation, and that is the
families who are too often prevented because of the regulatory
framework we have. Some of this is understandable, but it shouldn't be
a barrier for families who, in some cases, are the only people who
really know the individual, who care about them, and who are equipped
to be a vital partner with the mental health system.
I look forward to further progress. I look forward to bringing back
to you more information from Portland, Oregon, where we are going to
have another round table discussion with concerned individuals in
government, in the medical profession, and advocacy groups to make sure
that the input from my community is completely reflected in this.
Let me just say how much I appreciate his time and his effort, being
a partner with him in this. I am looking forward to seeing the result
before the final gavel comes down on this Congress.
Mr. MURPHY of Pennsylvania. Mr. Speaker, I thank the gentleman from
Oregon, and truly my friend.
I think when people look at Congress and wonder if people can work on
issues in a bipartisan way, I am sure if someone looked at our voting
record on other issues, we would probably be a bit different. That is
okay. What still stands is that we are able to come together with a
common issue.
I have no idea if this man is Republican, Democrat, registered to
vote, nor should that matter to us. I have never asked a patient in my
40 years of practicing. I know he is the same way, too. We do this
because compassion dictates. Sometimes we are our brother's keeper, and
we need to do the right things.
{time} 2015
I do value your input on this bill. We have made a number of
modifications. I know that, in committee, Democrats have offered
several amendments which I want to incorporate and which look at
specific funding for a number of things. We need more psychiatrists and
psychologists. We just have to have them. We have to put money into
that. We need more programs in there. We need to bolster community
mental health services. We need to make sure that there is oversight
over what States are doing with those dollars in order to make sure
they are putting dollars into effective programs and not into frivolous
ones. That is one of the roles Congress has is to be the watchdog over
that.
I am proud to say, in front of the Nation, that you have been awesome
in this, and I want to continue to work with you. We will solve this
will issue.
Mr. BLUMENAUER. If the gentleman would yield, I just want to say that
one of the areas that is most contentious deals with when people, like
the gentleman that you have pictured behind you, are going to be
compelled to have treatment. You have been open to being able to refine
the protections to make sure--and this is something that varies across
the country--that under the auspices of your bill that we have
appropriate safeguards to make sure that the rights of the individual
are respected but that we acknowledge the fact that, in some cases, the
right for people to self-destruct is illusory.
Mr. MURPHY of Pennsylvania. Exactly.
Mr. BLUMENAUER. It is dangerous to them; it is dangerous to society;
and it is heartbreaking for their families.
I have appreciated our conversations on that, going back and forth,
and what you have tried to do to be able to make sure that the balance
is struck. I am confident, before we are through, that we can make sure
that the other areas that require that give-and-take can, in fact, be
met. I would like to thank you for allowing me to speak on behalf of
it, and I look forward to the next steps.
Mr. MURPHY of Pennsylvania. I thank the gentleman.
Mr. Speaker, what the gentleman is referring to is also something
called assisted outpatient treatment. That is a program whereby 45
States and the District of Columbia--maybe 46 States now--have this.
When people have a history of incarcerations, of arrests, of violence
and when they are not in treatment, a judge protects their rights and
may review their cases in terms of saying they can be put in inpatient
care. If the judge says they do not meet the standard of imminent
danger of harming themselves or someone else, assisted outpatient
treatment is what may be warranted for them, which means the judge
simply says: You are going to stay and continue to take your
medication. You will continue to see your therapist and work on this.
That being the case, when New York State did this, it found a
reduction in incarcerations and homelessness by some 70 percent. It was
pretty dramatic. It found satisfaction by over 80 percent, and it found
costs go down by 50 percent.
It is something on which we in Congress need to continue to work. We
did pass legislation, which puts the appropriations of $15 million to
help States do that, but we have a long way to go. It is a long way to
go based upon what I said. I think it is 1,820,000 people so far who
have commented. They have seen this on my Facebook page and have
commented on it. I want to read some more comments--some heartbreaking
lessons--people are making.
One is by the name of Kari Butler, who wrote on my Facebook page:
They are falling through the cracks. Easier to just put
them in jail with high bail. They do make medication for
people like him, my nephews, which is to say one is in jail
now since November--no release until August--mostly because
he didn't follow up like he was supposed to. The prosecutor
did a mental evaluation on him to see if he could withstand
court, and he concluded he could; but something is not right
here. He has assaulted officers and has been tased three
times and has not been affected. Five police officers, it
took, to get him into the back of a car. They tased him in
Walmart--once in front of the whole store.
On it goes. There are many people with mental illness out there.
This person writes:
I don't believe public servants have been trained properly
to treat mental illness. I don't know what to do to help
people who get the help they need to be productive.
One might say one of the aspects of our bill is to provide training
for police officers--what is called emergency treatment for them. When
police officers have been trained in that, we have actually seen--and
the police officers like this, too--that they can quickly identify, if
this is a mentally ill person
[[Page H1629]]
in crisis, what they can do to deescalate the situation and prevent it
from becoming harmful or deadly.
Here is another point that has been written by Amethyst Lees:
First off, the health system is horrible, and I worked
inside a mental institution and saw firsthand what it is
like. Depending on where I was, the people were not getting
their needs met or were being ignored. I even saw an incident
where a man was waiting for 15 minutes for two staff members
to stop talking about football just to ask for some ice. He
never got his ice because he lashed out for being ignored,
and, of course, he was restrained in a chair for an hour for
getting angry.
Marianne Kernan writes with regard to Cody Miller:
Talk to him. Our mental health system is shameful. I know,
as I work daily with this population, many times, their
treatment is inhumane. Some with dementia or Alzheimer's
wouldn't be treated this way if they had a break with
reality. It is a sad commentary on our lack of knowledge
of dealing with serious mental illness.
Here are some more stories.
Angie Geyser writes:
My 13-year-old daughter, Morgan, was in police custody for
19 months before she finally received treatment for her
schizophrenia. We had to pursue a civil commitment to make it
happen. Now she is back in juvenile detention where she has
no access to the outdoors and is not allowed to have physical
contact with her family. The treatment of the seriously
mentally ill by the criminal justice system is appallingly
inhumane.
Frede Trenkle writes:
Two weeks ago, a stranger that I have been married to for
13 years came into my home, sprayed me with pepper spray,
took a knife out in front of my two kids, and threatened to
cut his throat. The police took him away and put him in a
mental health hold. I chose not to press charges and just
requested that he get help. This was his second hospital stay
in a month. The hold was supposed to be for 7 days. Four days
later, he got out, and I am sure because he had a plane
ticket out of the State. He convinced someone out there that
I was the threat. He denied ever having a knife. He
manipulated the system. I received abusive texts before I
changed my phone number and he sent terrible emails. I only
wish he could get the help he desperately needs wherever he
is, but because of the unchecked mental illness, I now have
two beautiful girls, without their father, and both needing
their own mental health counseling. How do we help our system
on all ends?
Another woman writes:
If you want people like this young man to get help, we all
need to be okay with paying more taxes and closing privatized
prisons. The prison system has become the dumping ground for
the pervasive mentally ill.
Another one writes:
My uncle has schizophrenia. He disappears for months at a
time. I worry constantly about him being hurt by law
enforcement. He was living 50 miles away, in the woods, on
his father's property, in a camper, and was threatened with a
gun by a neighbor because he was walking in the fields,
talking to things only he can see. The cops were called, and
they showed up with weapons drawn. Then they took him away
and locked him up for a month. He is only 32, but the police
assumed he was on drugs. He was having a psychotic episode.
There is not enough education in the judicial system about
mental illness, and innocent people are being killed through
the ignorance.
Another woman writes:
My question is this: As the mom, where should we direct the
young people with schizophrenia? Hospital care is effective,
but it seems to be temporary: 6 months in and 2 years out;
repeat. Has anyone found or used or heard of any successful
treatment going on at treatment facilities?
The answer is yes. Actually, one of the programs in H.R. 2646, the
Helping Families in Mental Health Crisis Act, is for something called
RAISE, Recovery After an Initial Schizophrenia Episode. We have learned
that, since schizophrenia and bipolar illness and severe mental
illnesses are emerging in adolescent and young adult years, if one gets
to someone early, with a low dose of medication, with proper evidence-
based treatment, the prognosis is much, much better; but when we don't
treat someone, every time someone has what the lay public calls a
nervous breakdown or a psychotic break--a crisis--we have to understand
that, over time, these lead to neurological damage. These are not
harmless episodes. This is not just someone who gets upset. This is a
real psychiatric disorder that comes from the brain and leads to
problems, and that is why we see these problems grow.
Here is someone who doesn't quite understand the problem. A woman by
the name of Julie writes:
I am very much against the families of mentally ill
patients having the power to put their loved ones away
against a patient's will. Let the doctors determine if the
patient has a problem, not the family. Often, the family just
doesn't want to deal with the illness, so they want the
person to go away.
Someone by the name of Robin Duffey writes:
Julie, you don't know what you're talking about. There are
more of us that do care, but because of the mental health
laws, we are unable to make decisions for very sick family
members. People with schizophrenia don't realize they are
sick. They think their hallucinations are real, along with
the commanding voices they hear. So how can such an ill
person make a logical decision to get the help they need? The
answer is: they can't. The doctors have to follow the laws
that are in place, which is they cannot recommend committing
a person unless they are an immediate threat or danger to
someone or themselves. Yes, Julie. There are some families
that don't want to be bothered, but I was not one of them. I
highly recommend you to do research on the subject before you
spout your ideas. Read the Federal and State laws.
Indeed, that is what we are trying to do with H.R. 2646.
There are a couple of thousand more comments on my Facebook page, Mr.
Speaker, and I certainly ask people to go and read them. They are
heartbreaking. They are horrifying. They are tragic. They are true.
They go on and on because our Nation refuses to acknowledge this.
Until we pass this bill and start making changes--we can predict it--
in the time that I have been speaking here, there have been several
more suicides; there have been more homicides; there have been more
mentally ill people whom we have abandoned; there have been people who
have had chronic illnesses and who have died, because the people with
serious mental illness, for multiple reasons, tend to die 10 to 25
years sooner than the rest of the population because of the fact that
75 percent of those with mental illness have at least one chronic
illness, 50 percent have at least two chronic illnesses, and a third
have at least three chronic illnesses. I mean things like heart
disease, lung disease, infectious disease, diabetes. They get sick and
they, oftentimes, are not treated. Many times, they don't seek
treatment. We let them go in this slow-motion death spiral and ignore
them.
We have closed the hospitals. We have put them in prisons. If they
are out of control and if the police bring them to the emergency room
and if there are no beds available, they tie them down to the gurney,
where they may wait for days--or weeks, in some cases--where they are,
perhaps, given some sedative--a chemical straightjacket, if you will--
to calm them down. That is not treatment. That is abusive. That is our
Nation that is doing it, and Congress is culpable in this because we
refuse to act.
Once again, there will be a tragedy somewhere. I shudder to think--
and I hope it is not anybody here who is injured--that, somewhere out
in America today, this is going to happen. Once again, we will gather
for a moment of silence; the gavel will come down; and we will go back
to our regular order of business. It is sad and it disgusts me, but
that is what we face: all of this closing of hospitals and not opening
up community mental health; Medicaid's saying you can't see two doctors
in the same day; Medicaid's saying you can't go to a hospital with more
than 16 beds; HHS' saying we can't tell parents anything, so they are
left in the dark; the Substance Abuse and Mental Health Services
Administration, which funds programs that teach people to make
collages, to do interpretive dances, to get off their medication, to
make masks and other things that have nothing to do with serious mental
illness.
We need to change the system, and that is what H.R. 2646 does. It
takes that office of SAMHSA and changes it so that the director of it
is the Assistant Secretary of Mental Health and Substance Abuse. That
person needs to be a doctor or a psychiatrist who is trained, either an
M.D. or an osteopath or a psychologist, but someone who understands the
field and not just someone who is saying: Well, let's just do these
other ``feel good'' programs.
The city of New York just did this, too, where the mayor put up
hundreds of millions of dollars for programs that were, supposedly, for
the mentally ill. They weren't for the mentally ill at all. They were
programs like parks and bike trails and ``feel good'' programs to
[[Page H1630]]
help people with sadness, not to deal with depression and serious
mental illness.
How long can we continue to fool ourselves?
As for this whole idea that says ``leave it up to them if they want
to choose; don't provide them the help; make it the most difficult for
those people who have the most difficulty,'' all of this, Mr. Speaker,
is more commentary and evidence of the grand experiment of stopping all
treatment under the misguided, self-centered, and projected belief that
all people who are mentally ill are fully capable of deciding their own
fate and direction, regardless of their deficits and disease, and that
they have the right to self-decay and self-destruction, which overrides
their right to be healthy. The most fundamental, dangerous, and
destructive hidden undercurrent of prejudice is the low expectation
that your disability is as good as it gets.
{time} 2030
The shift to consider changes in how we treat severe mental illness
is the pendulum that needs to swing the other way. The grand experiment
has failed in closing down all the institutions and care and stopping
all treatment and not allowing community mental health.
It is a principle that operated under the misguided, self-centered
belief that people are always fully capable of deciding their own fate,
regardless of their deficits and disease, and the right to self-decay
and self-destruction overrides this right to health.
In so doing, we have come to comfortably advocate our responsibility
to action and live under this perverse redefinition that the most
compassionate compassion is to do nothing at all.
It further bolstered the most evil of prejudices that the person with
disabilities deserves no more than what they are. Under that approach,
no dreams, no aspirations, no goals to be better can even exist.
Indeed, to help a person heal is a head-on collision with the bigoted
belief that the severely mentally ill have no right to be better than
what they are and we have no obligation to help them.
This is the corrupt evil of the hands-off approach in the
antitreatment model, and that perversion of thought is embedded in the
glorification that to live a life of deterioration and paranoia and
filth and squalor and emotional torment trumps a healed brain and the
true chance to choose a better life.
This is the movement of hatred and stigma toward the mentally ill
disguised as the right to let them be sick. That hatred may be embedded
in our own anger, our own resentment, and one's own past experiences
projected as blame or misattribution of the lives of others or maybe
our own fear and loathing of the mentally ill. Either way, the outcome
is tragically the same.
So we can have more moments of silence or we can have times of
action. I hope the Energy and Commerce Committee picks this up.
I hope that more Members of Congress will sign on as cosponsors of
H.R. 2646, the Helping Families of Mental Health Crisis Act. The day
that bill signs into law, it will begin to save lives. It will begin to
make a difference in people's lives.
Of all the other things we do down the road here for images or to
push polling--I can tell you this, that the polling on this bill is in
70s and 80s. As politicians, we think, wow, if something polls at 55
percent, vote for it.
My concern is: Will America wake up and look toward Congress here and
say: When we had a chance to do something to save lives, did we act, or
are we once again just caught up in moments of silence?
Thomas Jefferson said something along the lines of: ``Indeed I
tremble for my country when I reflect that God is just and His justice
cannot sleep forever.''
We are in that same position now. We can either have the courage to
stand up, take action, and help the mentally ill or we can sit in
silence. I hope this Chamber soon takes up H.R. 2646, the Helping
Families in Mental Health Crisis Act.
Mr. Speaker, I yield back the balance of my time.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise in support of
H.R. 2646, the Helping Families in Mental Health Crisis Act. Thank you
to Congressman Tim Murphy for hosting this important special order to
discuss our country's current mental health system.
For more than two years now, I have worked with Congressman Murphy on
H.R. 2646, a bipartisan piece of legislation that has garnered support
from patients, caregivers, psychiatrists, psychologists, law
enforcement, and even editorial boards. As two of the few mental health
providers serving in Congress, our bill reflects not only what we have
learned in our own careers, but feedback from stakeholders, families,
organizations, other members of Congress, and addresses many of the
policies that we can change now to help patients struggling with severe
mental illness and substance use disorders.
An amended version of H.R. 2646 passed the Energy and Commerce
Subcommittee on Health in November of 2015. Since then, there has been
no action. I have continued to talk with members of my community about
mental health issues and they demand action.
It is now April of 2016 and we must move forward on the issue of
mental health. The American people expect, deserve, and demand it. H.R.
2646 takes a strong step forward in mental health reform. As days pass
with no action, people are denied beds, denied care, and are floating
through the pervasive cycle of mental illness without attention.
Everyone deserves care. I truly hope that my colleagues will work with
me to pass this bill for the sake of those who truly matter.
____________________