Recently the president signed the 21st Century CURES Act, the first major mental health legislation in over 40 years. Originally proposed by Representative Tim Murphy (R-PA) and with bipartisan support, the Act represents a new direction in mental health care.
It elevates the director of the Substance Abuse and Mental Health Services Administration (SAMHSA) to Assistant Secretary level in the Department of Health & Human Services, placing greater emphasis at the federal level on this critical field. It also incorporates a number of key provisions to improve mental health services.
Orange County has led the way in Assisted Outpatient Treatment (AOT). The Act expands and strengthens these programs on a national basis. With this also comes greater emphasis on Assertive Community Treatment teams, an evidence based practice which provides intense wraparound care at home and in the community for individuals suffering from severe mental illnesses.
It also requires the states to expend a minimum of 10 percent of their federal block grant funding on early detection and treatment regardless of age. Early diagnosis and treatment are critical to better outcomes.
Another provision is to create databases of psychiatric beds, crisis stabilization units, and residential treatment programs. Currently, emergency room providers, CAT teams and others must call around to find beds, which are often not available. Access to these databases can speed treatment and have a significant positive effect on recovery.
De-criminalization of much mental illness is a significant component of the Act. The CURES Act will address some of the mental health issues for individuals engaged with law enforcement. It will provide for more crisis intervention training for first responders and for treatment opportunities before incarceration. It also provides continuing funding for mental health courts and crisis intervention teams.
Upon release from incarceration, persons with serious mental illnesses will also have greater access to treatment and housing. The revolving door between crisis and the streets, hospitalization, and incarceration costs billions of dollars per year and our jails and prisons are our largest mental health warehouses. Addressing these issues will help reduce this cycle of hopelessness.
Another key provision requires the Department of Justice to investigate the effects and costs of mental illness related to law enforcement activities and incarceration including serious crimes such as assault and murder.
One of the most difficult issues facing individuals with severe mental illness (SMI) and their families relates to the HIPAA privacy laws. These laws, meant to protect individual privacy, sometimes conflict with the need for caregivers to support and care for their family members. The CURES Act requires the Secretary of Health & Human Services to issue guidance clarifying the circumstances under which healthcare providers can share and provide information about a loved one to family members.
The Act also addresses many of the issues related to parity of mental health care with other forms of health care. It requires federal guidance on parity compliance, and the Government Accounting Office has been ordered to conduct a study on parity enforcement to improve access to care.
The CURES Act will also provide for better funding for suicide prevention, screening and intervention. The suicide rate in the United States has risen by over 24% since 1999, a 30 year high. According to the American Foundation for Suicide Prevention, almost 43,000 people die by suicide per year.
There is no substitute for more beds and more compassionate treatment, but the CURES Act goes a long way towards addressing some of the fundamental issues in mental health care. Orange County is leading the way and together, we can help provide better outcomes and a more resilient system.
Matt Holzmann, Chair – Government Relations, National Alliance on Mental Illness – Orange County Affiliate
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