Bazelon Center Mental Health Policy Reporter

Welcome to the Bazelon Center Mental Health Policy Reporter. Available exclusively online and to our email subscribers, the Reporter supplements the Bazelon Center's Action Alerts by providing a periodic bulletin on significant policy developments that affect people with mental illnesses.

Volume VII, No. 6, August 6, 2008

Congress Adjourns for Summer Recess

Now Is Your Best Chance to Press Key Issues

In this issue

• Take Mental Health Parity Over the Finish Line
• Renew Criminal Justice Collaboration Programs
• College Students’ Access to Mental Health Services
• ADA Amendments Are Ready to Roll
• Increase in Supportive Housing Proposed
• Juvenile Justice Reauthorization Would Fund Behavioral Care
• Medicaid Access for Juvenile Offenders upon Release

Newsbytes

• Principles for Healthcare Reform
• State Appeals Court Rules on Outpatient Commitment
• Bazelon Center Newsletter

With Congress in its annual August recess, constituents have an excellent opportunity to press the issues that need a lift over the finish line. The legislators will return to Washington soon after Labor Day. That leaves only a few weeks before the 110th Congress adjourns in early October—in time to campaign for the 2008 congressional and presidential elections on November 4th.

Now is the time to thank your lawmakers again for their recent votes enacting mental health parity in the Medicare program, approving a fix for the Americans with Disabilities Act (see also this Reporter) and delaying harmful Medicaid regulations on rehabilitation and case management services.

However, much work is still needed on critical issues that can’t wait until the next Congress. These include ending employer-sponsored group health insurance discrimination and improving grants to help mentally ill offenders caught up in the criminal justice revolving door.

Don’t let your lawmakers off the hook this summer. You can find their state or district offices on their websites or visit http://www.congress.org and click on “contact.”

Don’t let your grassroots energy fizzle—make it sizzle!

Help Boost Mental Health Parity over the Finish Line 

A final lift to enactment is desperately needed for the bipartisan mental health parity legislation (S. 558, Mental Health Parity Act/H.R. 1424, Paul Wellstone Mental Health and Equity Addiction Act). Sponsors of the House and Senate bills worked hard to forge a meaningful compromise (see June 18 Alert) and it would be tragic for it to die at the end of the session. Constituents have waited long enough and faced far too much discrimination in health insurance, with restrictive limits on care and financial disparities in obtaining treatment.

The cost of parity is estimated at $3.6 billion over 10 years and reaching compromise on the financial offsets to pay for it has been the last obstacle to enactment. Recently the compromise legislation was added to a tax and energy bill (S. 3335) sponsored by Finance Committee Chairman Max Baucus (D-MT), which failed to garner the votes needed to move to approval on the Senate floor.

What You Can Do

Contact your Senators and Representative while they're at home and urge them to pass mental health parity legislation when they return in September.

Time is running out. Whether the parity compromise is added to another bill or is a stand-alone measure, it must not get derailed this year.  

Time to Renew Criminal Justice Collaboration Grants

Time is also running out on efforts to renew the Department of Justice program funding mental health and criminal justice collaborations aimed at breaking the cycle of recidivism among offenders with mental illnesses. The Mentally Ill Offender Treatment and Crime Reduction Reauthorization and Improvement Act (H.R. 3992/S.2304) has passed the House but needs Senate approval (see the February Mental Health Policy Reporter).

The grant program helps states and localities address the growing rate of incarceration of people with mental illnesses by providing the flexibility to develop collaborative mental health and criminal justice responses to offenders with mental illnesses. Grantees may seek to create or expand programs that intervene at any point in the continuum of criminal justice contact (pre-booking, post-booking, mental health courts and other court-based approaches, re-entry and transitional programs), including funding crisis intervention teams and providing law enforcement training. 

What You Can Do

Contact your Senators through their state offices and urge them to pass S. 2304 so that states and localities can expand and improve effective alternatives to arrest and incarceration of people with mental illnesses who come into contact with law enforcement.

College Students’ Access to Mental Health Services

Senator Richard Durbin (D-IL) introduced the Mental Health on Campus Improvement Act on July 23. The bill (S. 3311) provides competitive grants to colleges and universities to fund a range of services, including expanding mental and behavioral health services, improving outreach and identification of students in need of services and creating a public health awareness campaign to reduce the stigma associated with mental illness. The legislation would also establish an interagency working group on college mental health to coordinate a national effort.

The Mental Health on Campus Improvement Act will help address the growing demand for mental health services on college campuses and improve the ratio of counselors to students. The bill has been referred to the Senate Health, Education, Labor and Pensions Committee. Senate co-sponsors are needed to elevate the importance of this legislation.

What You Can Do

Contact your Senators and ask them to co-sponsor the Mental Health on Campus Improvement Act (S. 3311).

See Senator Durbin’s press statement for more information about the bill.

Americans with Disabilities Amendments Ready to Roll

Following overwhelming approval by the House of the ADA Amendments Act (see Bazelon Center July 25 Alert), 66 Senators have signed on to  S. 3406, introduced on July 31st by Senators Tom Harkin (D-IA), Orrin Hatch (R-UT) and 54 other original co-sponsors.  Both versions aim to reverse Supreme Court holdings that had deprived many people with disabilities of the Americans with Disabilities Act’s vital protections. 

Both bills provide that the measures people take to control the effects of their disabilities—such as medications—cannot be used against them in determining whether they are protected by the ADA. The bills would also make it easier for people with episodic impairments to be covered by the ADA.

The main difference between S. 3406 and the version passed by the House is the definition of how a disability “substantially limits” an individual. While both bills aim for the same result, the House bill defines “substantially limits” to mean “materially restricts” and explains that this change was made to signal Congress’ intent to depart from the demanding standard imposed by the courts. The Senate bill expresses the same intent without changing the language, stating that “substantially limits” must be read broadly and as a less demanding standard than the courts have applied.

The Senate bill also conveys that Congress expects the Equal Employment Opportunity Commission to revise its regulations defining “substantially limits.”  The EEOC rules contributed to this problem because the Supreme Court read these regulations to impose an inappropriately high standard of limitation for protection under the law.

Passage is likely this year, given the overwhelming support in both houses. The law would rescue people with psychiatric disabilities from the “Catch 22” in which the Supreme Court left them—that when medications reduce their symptoms, however temporarily, many no longer qualify for protection as “disabled” under the ADA. 

Supportive Housing Legislation Approved by House Committee

The Frank Melville Supportive Housing Investment Act of 2008 (H.R. 5772) was approved by the House Financial Services Committee on July 30. The legislation, sponsored by Representatives Christopher Murphy (D-CT) and Judy Bigger (R-IL) would make long-overdue reforms and improvements to the existing Section 811 production program—one of the Department of Housing and Urban Development’s most successful programs to create new supportive housing for people with disabilities—and spur the creation of thousands more new units every year.

Senate Judiciary Committee Approves Juvenile Justice Bill

The Senate Judiciary Committee, chaired by Senator Patrick Leahy (D-VT) has approved legislation to increase federal funding for prevention, intervention and treatment programs for juveniles with behavioral health needs and improve state juvenile justice systems. S. 3155, The Juvenile Justice and Delinquency Prevention and Reauthorization Act, was crafted by Senator Leahy with Senators Arlen Specter (R-PA) and Herb Kohl (D-WI). 

During the committee’s consideration of the bill, Senator Diane Feinstein (D-CA) introduced a successful amendment (18-1 vote) that expands the bills’ emphasis on providing needed mental health and substance abuse services in the juvenile justice system. Her mental health amendment is based on language spearheaded by Senator Edward Kennedy (D-MA), who recognized the need for a strong behavioral health components in reauthorization of the Juvenile Justice and Delinquency Prevention Act.

Senators Feinstein and Kennedy should be commended for their attention to the needs of juveniles with mental health and substance abuse issues.

Timely Access to Medicaid for Juvenile Offenders

Representative Hilda Solis (D-CA) introduced H.R. 6621, The Reinstatement of Enrollment for Medicaid Eligibility of Disadvantaged Youth (REMEDY) Act on July 24. The legislation would provide timely access to Medicaid and SCHIP benefits immediately upon release to juveniles who were beneficiaries prior to incarceration. The legislation would suspend, rather than terminate juveniles' Medicaid eligibility upon incarceration, thus avoiding eligibility delays by keeping youth on the Medicaid rolls and helping with continuity of care upon release.  

The bill has been referred to the House Energy and Commerce Committee.

Newsbytes

Principles for Inclusion of Mental Health in Healthcare Reform

The Campaign for Mental Health Reform, a coalition of 18 national mental health organizations (of which the Bazelon Center is an active member) has developed a set of principles for the inclusion of mental healthcare in overall healthcare reform. The Campaign believes that “mental health is integral to health, recovery is possible, and service systems must be coordinated to provide access to quality care.” 

State Appeals Court Overrules Outpatient Commitment, Supports Advance Directives

The New Mexico State Court of Appeals has overturned an Albuquerque ordinance patterned on New York’s “Kendra’s Law,” mandating outpatient treatment for people with mental illnesses who are determined a threat to themselves or others.

The August 5, 2008 ruling upheld a lower court's ban on enforcing the 2006 ordinance. Among other findings, it supports respect for an individual’s treatment preferences as expressed in an advance directive.  The court ruled that the city ordinance’s attempt to compel outpatient treatment conflicts with state law that “evinced an intent to respect the treatment decisions of individuals made while they have capacity, and if the individual lacks capacity, then to provide the specific protections of [state law] before treating an individual with mental illness.  It is the exceptional circumstance under which treatment can be required without consent.”

 The lawsuit was filed by New Mexico Protection and Advocacy and several individuals who had a history of noncompliance with prescribed treatment. The city argued that the P&A lacked organizational standing to challenge the ordinance. The appellate court disagreed.

In Brief: The Bazelon Center's Newsletter

The Bazelon Center's occasional newsletter, published for our supporters, is online and will be mailed soon. The Summer 2008 issue of In Brief (PDF) includes coverage of our "working luncheon" on the upcoming healthcare reform debate and how mental health will be included, the special education agreement in the District of Columbia, a new legal challenge to inadequate release planning for jail inmates with mental illnesses, our thanks to donors, and more.

If you find the Bazelon Center's Action Alerts and Mental Health Policy Reporter informative and useful, won't you consider making a donation online to help us advocate for children and adults with mental disabilities?