In the Senate, there is no shortage of bills attempting to reform the mental-health system, which is why Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander has scheduled a hearing at the end of the month to examine how they can best be consolidated.
Mental-health-care reform has been on the HELP Committee’s radar all year, but pressure to act has increased after a violent summer with several tragic mass shootings. No witnesses have yet been confirmed for the hearing, but the panel is hoping to hear from the Obama administration.
“My goal in the committee is to take the renewed interest in mental health, a lot of which came from the recent gun violence, and take the best ideas we have in the Senate and get them into a bill, so when it comes up on the floor we’ll be ready,” Alexander said in an interview in his office.
Although there is bipartisan agreement that mental-health reform is important, several practical and ideological obstacles stand in the way of bills becoming law: Different measures fall into different committee jurisdictions, busy committee and floor schedules leave little room for other issues, and the link between mental-health policy and gun-control debates threaten to shatter the bipartisan consensus.
But there are signs of movement beyond the scheduled hearing. A bill sponsored by Alexander and ranking member Patty Murray with several bipartisan cosponsors passed through committee last month. The bill extends programs aimed at youth-suicide prevention, helps prepare the nation’s health care system to support children and families after traumatic events, and equips teachers to recognize and understand mental illness.
“Experts in the field of mental health all agree on at least one thing: the earlier they identify mental health problems in an individual, the better the chances are of that person being able to overcome or at least manage it. This legislation would help give doctors, researchers, teachers, and parents the tools they need to recognize mental illness earlier,” Alexander said in a statement after the bill’s committee passage.
A second, more comprehensive mental-health-reform bill also has been introduced by two members of the committee, Republican Sen. Bill Cassidy and Democratic Sen. Chris Murphy. The bill currently has 10 cosponsors, five from each party. It would integrate mental and physical health, designate an assistant secretary for mental health and substance-use disorders, establish new grant programs for early intervention, reauthorize successful research and grant programs, enforce mental-health-parity rules, and improve mental-health services within Medicare and Medicaid.
For Murphy, a major threat to meaningful mental-health reform is its price tag.
“What I’m worried is that a mental-health-reform effort won’t end up putting any resources into the system,” he said in a phone interview. “I know it’s hard to find money for worthy causes these days in Congress, but it’s going to be hard to say you’ve made substantial fixes to the mental-health system without putting in more money.”
Outside of the committee, Majority Whip John Cornyn has introduced a mental-health-reform bill that also aims to identify and treat mental illness, but it falls under the jurisdiction of the Judiciary Committee. No action has yet been scheduled on the bill.
The bill currently has only Republican cosponsors, and Democrats are reluctant to support any legislation that would substitute for what they say are common-sense gun-control policies. Although other mental-health bills have avoided being drawn into the partisan gun debate, any progress on them requires walking a very delicate line.
“If we get a substantive mental-health-reform bill to the floor, it would be a nice problem to have to fend off gun amendments, in that we would have a bill on the floor,” Murphy said. “I don’t think this will be an issue in committee. I’m hoping to work with Senator Alexander and Senator Murray to move our bill out of committee without any debate over guns.”
But, he added, “I have no interest in allowing Republicans to check a box on addressing gun violence simply by passing a mental-health bill. There’s more work to do.”
Sen. Susan Collins, a Republican cosponsor of the Cassidy-Murphy bill, said she supports both strengthening background checks—as Cornyn’s bill does, although it is limited to mental-health records—and mental-health reform, but combining the two might be tricky because of the multiple committees involved.
“It would be very difficult to do that at the committee level, but that might be an option on the floor,” Collins said. “From my perspective, I would like to see both mental-health reform and background checks pass this year, and if they pass separately, that’s fine. If they pass together, that’s fine.”
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Caitlin Owens is a health care reporter at National Journal. Her work has previously appeared in the Los Angeles Times, The News & Observer and The Charlotte Observer. She is a graduate of the University of North Carolina at Chapel Hill.