Thank you for coming today. I am a resident scholar here at aei. Our discussion is on the role of and the role of the government and Mental Health policy. We typically think of Mental Health as a state responsibility. Extent it is. The federal government can have a very influential role in shaping services and policies for mentally ill patients. There are huge gaps there which fallen toll patients the street and into gel. It is heartbreaking situation. Have representative tim murphy. The Panel Discusses helping family and Mental Health crisis act. It addresses persistent problems in Mental Health care systems, among them the shortage of psychiatric beds. There are is just a hearing two days ago on that. Education ofe evidencebased treatment. Small problem of violence and mentally ill, outdated, involuntary commitment laws and the questionable priorities of the lead Agency Within hhs that is responsible for funding the services for the nations mentally ill. Everyone on the panel will respond to his comments are patiencedicated to the and to the families who love them. I will first introduce representative murphy. I will introduce everyone. Fuller byuch countries biographies at your desk. I will be brief. Then i will begin. Revisited murphy is currently and has six term in congress, representing the 18 district of pennsylvania. He is a former psychologist, i still au are psychologist, with three decades of experience. The chairman of the oversight subcommittee of the energy and commerce committee. The cochair of the Mental Health rockets and Founding Member of caucus. Res he authored the seniors access to Mental Health act which ended the practice of charging copayments to seniors on medicare antiintroduced and passed into law the Mental Health security act for americas families and education which was instrumental in Getting College students who are suffering from depression or psychosis the help they need before a tragedy strikes. Next will be dr. Jeffrey lieberman who was the chairman of psychiatry at Columbia University college of physicians and surgeons, also the dreck sure of the new york state psychiatric institute. His expertise has been in schizophrenia and psychopharmacology. Sure he is a president of the American Psychiatric association. Next is patrick j kennedy, the cofounder of one mind for research. He served 16 years in the house of representatives and was the author and lead sponsor of a and theealth parity, addiction equity act of 2008. Finally, the professor of psychiatry at the uniformed services. He is specializing in orizophrenia or policy Infectious Disease and schizophrenia which is a very interesting theory. He is the juncture of the family medical research institute. He has coauthored numerous papers and 20 books. Panel. Our distinguished we will start with mr. Murphy. In q3 much. Thank you very much. Is convenient. Thank you, sally. I didnt know how to get the slides working. It is anybody . Anybody know what we can do here . We will move into 21st Century Technology in just a moment here. Good morning. Thank you. It is an honor to be part of this distinguished panel. Credits for this. That would be nice. We will move forward. 3713. To talk about hr parentsmmitted to be from sandy hook elementary that we would have this bill introduced before the anniversary of that tragedy. Nation has been rocked by several of these tragedies. Although those with mental not of the vast majority likely to be violent, it is an area of grave concern. Some of these have been committed by someone with untreated Mental Illness and that we need to deal with these things. Lets see if i can make this work. Some is going to have to sit there and make it work. I have no idea how to do this. It does look fancy nonetheless. Ok. All right. Let me keep talking here. Let me give you some numbers. Without this, nothing else is going to make sense to you. Are about 60 million americans, about 20 of our population or so, with some degree of Mental Illness. From the mild, transient acute problem of anxiety or sadness to severe Mental Illness. About 9. 6 americans have a serious Mental Illness. About 3. 6 million are without treatment. It is extremely important to understand what happens when someone is without treatment. Without treatment they can be more likely to exhibit some violent aggressive tendencies. When they are in treatment, there is a 15 fold decrease in the likelihood that they may become involved in violence. Some with Mental Illness have about three to four times more likelihood that they will be victims of violence, rape, assault, robbery. Someone is imprisoned on the street or at home, independent, whatever that might be. Children who are mentally ill, three times more likely to be victims a sexual abuse. That should move us toward action. The problem is the actions that have been taken are very much wasteful, are mr. Did, and we and we mr. Wrecked it are not given the services we needed. The federal government arty spend about 125 billion to work until ms. Toward Mental Illness. Most of that is for disability, medicaid. Very little is for research. Very little is forgetting out in terms of early treatment and access. What seems to happen however is where these people go. About twitter Percent People in our prisons are mentally ill. If you look at the next life you will see that as we close the hospitals, particularly in the 550,000nd 1960s, with beds for a population of 150 million. As they close down we now have about 40,000 hospital beds but where have the patience gone . We have filled our systems. While state budgets are bursting at the seams and paying for growth and expansion and overpopulation and small residents, it is no wonder why it is not the crime that is expanding. It is that we have traded the hospital bed for a prison cell. With all weve also traded the hospital bed for a mattress in the flophouse, homeless shelter for a blanket over some subway grates in our cities. It is inhumane. It is immoral. If it is in a third world status. Even when we do take some action such as a typical situation when a seriously mental a person is having some acute rate down, aggressive, threatening, the police are called. An emergencym to department. What happens . And ill staff emergency room, which is not designed to do with a mentally ill patient is brought here. They tied them by their wrists in their legs to a gurney, too hallway orthem in a a room surrounded by a sheet for some visible cover. If the person get out of control they sedate them. What could be more inhumane than putting someone in jail, leaving them in the street or physically or chemically handcuffing them to the bed and calling that treatment. It is wrong. Its about time our nation woke faced at the turmoil of the family feels about facing this has to change. In pursuit of this over the last year i held a series of hearings. Heres what we learned. We learned there is inadequate inpatient treatment options. Simply not enough beds. There is inadequate outpatient treatment, too. Away from is far, far helping people get better to recover, to get jobs again, to get independent housing. We know this can happen. The treatment has been out there. There are a number of supportive that canfrom health help. There are Community Wraparound services. Unfortunately, there is not enough of it. There is a huge shortage of psychiatrists overall, particularly those who treat serious Mental Wellness. When you talk about 7000 child psychiatrist for 15 million children, and we need 30,000, that is a serious problem. People cannot get help here it when there is no help there is no hope. When there is no hope people feel the stigma of going from place to pays, emergency room to emergency room. It is no wonder they feel a stigma. We are part of the society that maltreat those with Mental Illness. Another problem we found is that the Health Insurance privacy act is also the right to privacy act are subject to a great deal of confusion. They are supposed to be there to protect confidentiality of records. I agree. People are notat Getting School records and other records that do not need to be out there. What they have become is another barrier. Of releasingar something often released nothing. We have testified where parents were in a hospital trying to convince someone else i need to tell you about the history of my people sayhter and we cannot talk to unless we have permission. You cannot give permission for someone who does not know where they are. It is so severely involved in paranoia and delusions. They do not know who they are. Were telling people until we get their information we cannot tell you anything. That is wrong. It is a misinterpretation of the law. If youre in an auto accident and you are unconscious or you have a stroke and you are incoherent, no one says we have to wait until you get better before we make a decision to treat you. We do not do that. Why do we do that with someone who is in the middle of deep depression, deep bipolar disorder or psychosis . It is wrong. You cannot get the history. If you cannot get the history for a psychiatric disorder you cannot diagnose or treat it. It is akin to telling an Orthopedic Surgeon we want you to diagnose if there are any fractures but we are not going to give you any xrays. We have to provide access to information. We start to follow all the ethical rules of every profession. We also found that it is an imminent standard that has person hast said the to be in imminent danger to themselves or someone else. Then you can, without their authority, put them in inpatient care against their will. Again, the standard is to this level of someone has to be basically slitting their wrists am overdosing, holding a gun or knife to so elses throat before we believe they need help. Do we do that with any other medical illness . Do we wait for someone to say i cannot treat you until your cancer has advanced to stage four . I cannot do it to cardiovascular problems until you have a stroke . No. Withow we have this psychiatric illnesses. We have to wait until the person is completely deteriorated before we do something. We need to step in and help them. Prognosis ofter the system. It is also important that we have evidencebased treatments that really work. There are treatment out there. Lot ofppens as we see a federal dollars in state dollars going to work programs. It is more along the lines of many elected officials saying and you go fund this away. It is americas big secret. We say lets just fund these programs and no one asks the question. Does it work . In some cases, they do not work. Some of the money is spent on silly things that will make your loved boil as a taxpayer. Why is that federal dollars go to pay for a conference where literally the topics are such things as interpretive dancing or making a collage or getting in touch with your inner animal. When we see millions of dollars going toward those things and telling people we do not have enough people to provide help for you, that is wrong. We are not going to put up with that anymore. It goes to this point of federal dollars. What does it do . We empower parents and caregivers with making it very clear definition of refining the definitions that hit the malls laws are soa. Amily members know what the standards to be clearly defined. We want them to have access to history when they need it. It fixes the shortage of inpatient beds. Right now there is a 60 bed rule. How we figure out were not going to address you if you have more than 16 . Most have a critical bed shortage. This has to change. We also want to make sure theyre are alternatives to islamization to institutionalization. Patient human has found to be extremely states. Very few states do appeared new york has found int incident putting people involuntary commitment, in new york were things work with the family members or the District Attorney or the judge and come up with an agreement on the patient to stay on medication and treatment. What they found that the costs fell 64 sonment overall. In many of the areas is as much higher. Some areas exceed 80 of those going into jail. Or homeless. It encouragese is states to adopt a need for treatment standard incident just waiting until someone is going to kill someone else or their cell. We look at the need for treatment as a statement standard. It reaches patients just be on the emergency room. The cms recently came up with the ruling that they were going to limit the type of medications available for someone with psychiatric illnesses. We had a rather emotional hearing a few days ago on this. From ems toldve us they would limit the type of drugs that were available. To read out loud a statement from the American Psychiatric association which clearly said the cms distorted the analysis. In that, one of the comment that was made was about ssris. I say can you tell me what it is . The response was i was not briefed on that. If you do not even know what youre talking about, it is clear that you will draw conclusions that have nothing to do with reality. I am understating my concern for the decision that was made. Havented out that they another standard with and that that says you are not perhaps if you are not rehospitalized it is ok to change it. They were limiting the type of drugs so severely that i thought it was going to greatly impaired physicians abilities to prescribe appropriate medication. 65 and you over age receive a diagnosis of chronic illness, you are twice as likely to face depression. You double your health care costs. Exacerbation of physical symptoms, less likelihood to comply with other treatments. When seniorsm that them douicide, 20 of it on the day of the doctor visit. 40 the week. 70 within a month of their last doctor visit. Recognizing that many of these antidepressant drugs take 26 weeks to become effective, to tie a physicians hand and say you cannot use this until you have tried other ones that have failed, it puts the patients life at risk. Im happy to say a couple of weeks after that hearing, cms refers to our decision. This bill would say we would not leave it up to the whims of whoever sitting in the chair but we will make it part of the law. Sameday billing issue is quite important. You cannot have to dr. Bills on the same day. Moreow that a family is likely to go to a pediatrician or internist when they are beginning to exhibit severe Mental Illness. We know the average is 112 weeks before a person has their first visit to treat mental ole miss. What happens is illness. What happens if a mother brings doctornage son i to a and the doctor says i am very concerned but we need him to see a psychiatrist now. That is right. You are on medicaid. Can he come back tomorrow . That is inhumane. Were not going to have it anymore. There needs to be allowance for sameday billing. More access to telepsychiatry. Physicians can access by calling a number or allow more telepsychiatrists. We know it is a very effective mechanism to do it. They can talk under a vehicle screen. It is in barriers to eliminate. Medical research is important. Incidentrized a brain to involve a lot of research on the brain, the last frontier of the human body. A very Effective Program for Early Intervention for these problems. We also want to integrate Mental Health and primary care. That is where the first appointment tend to take place. That hashis is a bill been put into the bill that was passed yesterday. I had also put in some funding in there which was approved yesterday and the house bill. I am sure the senate will do that too. To help with outpatient clinics. It is a cause for celebration. More Behavioral Health it, medical records are moving into the 21st century where they are electronic records. Not for behavioral medicine. Why would that be . We had to have an integrated care model where the brains functions are seen as part of the body and not distant from. Not something you put in jail or call the police for or kicked out of your office because you dont want to do it. Deal with it. Physicians can work as a team. Tother part of this bill is our Community Health centers, to care Mental Health professionals to volunteer. Heres another thing that is so absurd be federal government could come up with it. If you work in a Community Health center, marvelous places that provide Lowcost Services to underserved areas, you are covered by the federal tort claims act. Malpractice insurance is low. They can provide integrated care. They are all working together. Great. That is what you want. Of them arey, a lot understaffed. If you are employed there, you are covered by this. If you are at a free clinic and you volunteer there, you are covered by the act. If you are a Community Health center and you volunteer, youre covered. If you are the free clinic and paid you not covered. Wait a minute . People will give of their time a dayk at the centers, month, and afternoon a week in valuable. We will take away that barrier and allow people to be the good andritans, want to help out give up their time. Quite frankly, this will probably be about a billion dollars with free care in this country. Next is the department of justice reform. A lots of prisons is guesstimates. We still do not know a lot of what happened in the federal Justice System. We want to know what happens with serious Mental Wellness. It is a disjointed model. They may have some care. They may have a different kind of care in jail. We do not know i