Send us a textTim Murphy, former congressman and psychologist, shares his journey advocating for mental health reform through the Helping Families in Mental Health Crisis Act and highlights the systemic failures in America's approach to serious mental illness.• Serious mental illness requires different treatment approaches than general mental health concerns• Current Medicaid restrictions only allow 15-day hospital stays with a 190-day lifetime limit• HIPAA laws often prevent necessary communication between doctors and families of mentally ill patients• Approximately 40% of prison inmates have serious mental illness, with jails becoming de facto psychiatric facilities• SAMHSA (Substance Abuse and Mental Health Services Administration) lacks accountability for billions in spending• Schizophrenia alone costs America approximately $380 billion annually across healthcare, criminal justice, and social services• Assisted Outpatient Treatment provides court-ordered care for those with severe mental illness who lack insight into their condition• Mental health advocacy requires specific, actionable requests to legislators rather than general appeals• Reform needs include lifting hospital bed restrictions, modifying HIPAA laws, and implementing stronger program accountabilityVisit drtimmurphy.com to read articles with plans for advocacy and reform in mental health policy.https://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)
Chapter 1: Who is Tim Murphy and what inspired his mental health advocacy?
Great question. So as a psychologist, I worked on issues involving mental health for my whole life, even when I was on the staff at Children's Hospital Pittsburgh. And there I go to Harrisburg and our state capitol and work on even awareness among legislators. And what I kept finding, I think they wanted to do well, but they just didn't know what to do. Everybody likes the idea of mental health.
Quite frankly, it can be kind of scary for a lot of folks and other folks aren't quite sure. And there's some folks who just have a prejudice towards it. I'm not talking about stigma. I mean, a prejudice towards it. Some people think it's a weakness until they start really digging into it and understanding there's a biological, neurological basis for much of this.
As a state senator, how did your experience differ between the state senate and the House of Representatives, especially in your goals of improving mental health?
What happened was I ran for state senate in the 1990s. There I worked a number of health care reforms, and among them making sure that people could get access to care and insurance would pay for it in a general sense. In Congress, it was a much deeper dive. There I was chairman of a subcommittee of oversight and investigation in the Committee on Energy and Commerce.
And Energy and Commerce has jurisdiction over mental illness and health in general. But in that, what happened was right after the terrible shooting in Sandhook Elementary School, the majority leader tasked me with the idea, says, we've got to do something about this. I know a lot of the human cry was, well, let's ban guns or let's restrict guns. I always knew it's not what was in their hand.
It was what's in their mind that was the big issue in this. So we really had a year or two of just investigation. We had many, many witnesses come forth, dozens and dozens of parents, hundreds and hundreds of letters, millions of social media hits telling us the problems that were occurring. And it was on several levels. We did not have enough trained providers.
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Chapter 2: What challenges exist in treating serious mental illness in the U.S.?
When you refer to trained providers, could you provide more detail about what specific qualifications, expertise, or roles you have in mind?
No, I don't just mean counselors. I mean providers trained to deal with serious mental illness such as schizophrenia, psychosis, bipolar, and the more severe autism spectrum disorders. We had lots of people who were going to deal with some of the milder things, you know, the people with general angst or anxiety or mild depression, but the more serious ones we didn't have.
The second thing is we had restrictions in the law. Medicaid only pays for two weeks at a time, 15 days stay, or a lifetime limit of, what, 190 days in the hospital? That's a problem. Or they didn't want to have more than 16 beds in a hospital. That's a problem. So it was these artificial limitations on serious mental illness, particularly when you're dealing with schizophrenia and psychosis.
15 days is not enough. I mean, it takes that much time to get off of one medication and stabilize on another one. Your time is up before you know it. And this 190-day lifetime limit, I was thinking, boy, can you imagine if we did that with cancer? And said, I'm sorry, we're not going to give you any more days on this.
There's other things with insurance companies more recently come to light, and that is that insurance companies have a tendency, when you start to get better, they stop payment. In other words, well, you don't really need this inpatient stay anymore because you're improving, so we're going to stop payment, which means before the person's even stabilized, they're out on the street.
Yes, insurance is certainly a challenge, and releasing them back onto the streets often does more harm than good. Were you able to identify or develop any alternative solutions that could better support these individuals?
Another aspect we discovered was that there's this concept of this practice called assisted outpatient treatment, different from assertive community treatment. The community treatment is one where basically services are provided, people can talk to the person with severe mental illness with the belief you can talk them into getting care. And that can work in a lot of cases.
It does not work when someone is so compromised. with their self-awareness, with a condition called anosomnosia. They don't even know that they're not sick. They do not have that self-awareness. It's like the blind person who doesn't even know that they're blind. Those are people who resist treatment, who become very paranoid about treatment.
And of course, in the throes of their psychotic or schizophrenic crisis, they can easily become paranoid because they think, well, you're part of the group that's plotting against them or trying to force them into treatment.
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Chapter 3: How do Medicaid and insurance policies impact mental health care?
And they can keep it together long enough, quite frankly, to see you and say, I'm fine. I'm not going to kill myself. I'm not going to harm myself. I'm really good. Because they know that they conceptualize, at least, if they're paranoid that something's wrong with you, then you're trying to talk them into this care and they don't want it.
They've also probably had a lot of bad experiences anyways where the police have been called and they're afraid of those things. So what happens is the disability rights groups oppose a lot of these things where we're trying to have assisted outpatient treatment where the judge could order using what's basically the black robe effect saying, no, you need to get care. It's compassionate.
But it sure is different from the police grabbing the person, handcuffing them, taking them to jail. They get in a fight with the prison guard. They're given another penalty. They get in a fight with somebody else. They get another penalty. Fight with somebody else. Before you know it, they're in solitary confinement. The worst possible thing you can do in a jail with someone there.
Jail is not a place to treat schizophrenia. It never was. And eight out of 10 people in the jails get no treatment for that. So, and what is about 40% of people in prison have a serious mental illness. About 90% have something. And among the homeless, the numbers are similar too.
Given that there are numerous hospitals distributed across the country, are there enough facilities with adequate resources to effectively support those in need? How does the availability and the capacity in these hospitals influence the broader situation, particularly in terms of accessibility, quality of care, and overall outcome?
So what has happened in America is as we close these hospitals down from 550,000 in the 1950s to about 38,000 today, we provided nothing else for them in terms of having enough hospital beds. In terms of assisted outpatient treatment, there's people who oppose having a judge say, no, you've got to go in the hospital, you've got to send your medication. And we still have a shortage.
And we also have people who just do not engage families. HIPAA laws are extremely important to protect someone, but they have gone too far in the sense that doctors are tied up and not being able to communicate with families when they know what's going on. I'll give you an example. Let's say a young woman, maybe in her early 20s, has a suicide threat. She's taken to the hospital.
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Chapter 4: What is assisted outpatient treatment and why is it controversial?
Two in the morning, she's able to tell the doctors, look, I'm not going to kill myself, really. I was just kidding about that. And the doctor's thinking, well, we don't have a bed. We don't have a place to put. We don't have a psych ward. What are we going to do? We'll trust her to go on the street and say, well, can we call someone to help you out?
And if she says, don't call my parents because I don't get along with them, then that's it. They literally open the hospital doors and say, go on, find a ride home, do something. But what if the doctors know the family? What if the doctors say, Mary, I know your folks. Come on, we're all in the same community. Let me call them. They'll get your ride. Well, under HIPAA laws, you can't do that.
And also under HIPAA laws, when you know someone is in the throes of deep psychosis and they're in crisis and they're fighting and they don't want help, if the doctors could call the family and say, we need some background history on this. Can you give us more background? And find out, oh, this person's had multiple times before. They're prescribed this medication. They don't want to take it.
Whatever else goes with that, it's important to be able to have that information too.
Access to that kind of information could enhance a physician's ability to provide effective care. Are there any exceptions or methods to circumvent those restrictive guidelines, or are the medical professionals bound to adhere to them in all circumstances?
Well, that also is something that runs into a barrier. And a lot of doctors operate at this idea that, well, the confidentiality of sacrosanct, I won't do that. You know what? But they don't always do that. For example, if someone has Alzheimer's and is wandering the streets in the snow, it's two in the morning. And grandma's out there in her bare feet.
They don't say, let's let her go because she doesn't want to be picked up and she thinks she's on her way to second grade. They say, let's call the family. Let's take care of this. Well, quite frankly, that is a personal anosognosia. And someone else who we ought to put in the same category of many people with schizophrenia in a crisis to say, we need to get this person help.
It's not against their will because they don't have a free informed will. So where does all this go? When I was doing my investigations in 2014-2015, we finally introduced a bill to do several things. Make some tweaks to HIPAA laws, allow what we call compassionate communication. Lift the 16-bed rule. Expand the number of days someone could get care.
Fund assisted outpatient treatment and push states to do more of that.
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Chapter 5: How do HIPAA laws affect communication between doctors and families?
Earlier, you mentioned homelessness and how that overlapped with mental health and schizophrenia. Can you expand on that some?
What also is occurring in terms of the homeless area, in terms of the number of homeless that have increased dramatically in this country, we've had a system that has been strained far beyond its capacity. It's already beyond strains. when you have several million immigrants come to this country and they have no place to go.
So they've shoved people out of homeless shelters and put the immigrants in there, which puts a homeless on the street again. Last year in 2024, HUD just released information from a January assessment done, January of 2024. But they didn't release it until Christmas week, the Friday after Christmas in December of 2024, that homelessness actually grew about 18% in the United States.
Chapter 6: What are the consequences of reducing psychiatric hospital beds?
Absurd that they waited 12 months to give that. Cruel that they waited 12 months to do that. True, because Congress can't do anything without data. But then they say things like, oh, look, someone is getting better. They've got some cities have reduced homelessness. And that's silly because what happens is they reduce homelessness by helping those who can easily adapt to help.
Like some people just don't have an apartment or they don't have the money or they miss payments. All right, we'll get them into temporary housing and they'll move towards getting a job in permanent housing.
But even if they reduce homelessness in those towns by 10 or 20 or 30 or 40 percent, well, that's expected because that's the people who are mentally much better and some of them pretty okay and with some assistance they can do better. But it doesn't address the chronically seriously mentally ill people with major problems. And so that gets ignored.
Do they have any assisted housing or anything that can help the homeless that might have some mental illness happening to get them off the streets?
There's something pretty cool called assisted housing, where it's not a huge apartment building. Maybe there's only 30 units or something like that. But there's a nurse at the front desk. So as you're coming and going, she checks, hey, Bob, did you get your medication? Rebecca, did you take your pills today? Make sure you got an appointment today.
That little checkup for some people who can function with that is great. But the ones who have more serious problems, just checking up on them isn't enough. In fact, parents will tell you when they check up on them, it may end up in a violent or heated altercation.
So when I put my legislation in it, as I said, it was to make some of those changes, also to create the position of the Assistant Secretary of Mental Health. I wanted to elevate the issue and have someone in there who could do that. And also we wanted something called ISMIC, which is the Interdepartmental Serious Mental Illness Committee and Coordinating Committee.
And that was to take all these federal agencies from HUD and HHS and everywhere else and say, you have to coordinate your services. Make sure we're evaluating on a government-wide level exactly what's going on.
That seems like it was a real good program. What came from that?
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Chapter 7: How do homelessness and incarceration relate to serious mental illness?
And there we look at direct medical costs, direct treatment costs, criminal justice costs, family costs, unemployment costs, costs of not being in the workforce, and disability costs, a whole host of things. And just for schizophrenia, our best estimate of the costs for the year 2024 is about $380 billion. $380 billion for one disease entity.
That is indeed a ton of money. I guess my next question is, is it working and helping the ones that need the help?
Now, that is pretty remarkable, that amount of money. And you think that would shake up the federal government to say, where does it go? Is it doing any good? Well, the money is spent. And governors and mayors will say, well, we're spending money. We have these programs. We have social workers out there. And the question should be, are people getting better? Are you tracking them?
Do you track the individuals or you just tell us how much money you spend? And the answer is they tell you how much money they spent. And they'll give you some general numbers. But every time there's a mass murder or some other crime committed by someone, you can pretty much bet if it's a person with mental illness, they're not on treatment. Case in point.
A couple months ago, the event that took place in the New York subway, where the man who was in crisis ended up being restrained in a chokehold by a former Marine, Daniel Penny. So everybody got on Penny and said that he was terrible, cruel, and racist, went to trial for manslaughter. He was acquitted.
The sad thing is the victim in this case wasn't just a homeless street performer that the media tried to portray him as. He was a man with severe mental and schizophrenia, and he wasn't taking his treatment. There was another case around the same time, a man who went through New York with a knife and killed three people, stabbed them, and they called him homeless. Well, he was homeless.
But he was also a man with schizophrenia that wasn't in treatment. These are terribly sad stories that are taking place. When I was in Congress, I tried to wake people up to understand and say, many of these cases are treatable, preventable, but you've got to have someone be the grown-up in the room to say, these are folks who need to get them help.
Don't just say, well, if they don't want help, we're going to leave it at that. We wouldn't do that with a child who doesn't want to go to school. Let's not let them go to school. Well, some parents might, but... He's pretending he's sick. Let's let him stay home. But we have to understand these are lives worth saving, and they can be saved if we treat them. It's a massive burden on parents.
Their hearts break every day across the nation. Some groups like Mad Moms of Arizona, and there's one in Colorado, too, are fighting back. I love it.
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Chapter 8: What reforms did Tim Murphy propose to improve mental health care?
The assistant secretary needs to lead and say, I get what you're concerned about, but what you're concerned about does not apply to everyone. Everything else that takes place, when your only tool is a hammer, everything looks like a nail.
And I tell people, well, gee, if you have a problem in your house with, I don't know, pick anything, a broken light bulb, you don't send the road crew in to pave your driveway. You know, that's not the same thing. You wouldn't do that. You have to work very refined on that. And in the field of medicine, we don't treat every diagnosis the same.
And with mental illness, we should not treat every diagnosis the same. And the subcategories of diagnosis based upon the symptoms. A lot of what I do now, for example, I work with people with very serious post-traumatic stress disorder.
which can have very, very major consequences from moments, severe depression, severe anxiety, debilitating levels of that, psychotic behaviors from massive stress, but you don't treat them all the same. And what we can do is help a lot of people with PTSD.
So two, it is with psychosis, we can help a lot of people, but it's going to take a leader within SAMHSA, that assistant secretary coming in and say, no, we're not doing everybody the same way. And two, we're going to stop the goofy programs. Absolutely stop them. There's no more room for grants for yoga classes or for art classes or anything like that.
You want to do that, go somewhere locally for that. Go to your local community center and get people some art classes. It's valuable, but it's not mental illness treatment. And say the money we have, the very limited money we have, we're going to spend on these things. For example, I think this year's cyclic grants, I think it's something like 15 to 20 million nationwide for AOT. You kidding me?
A couple of counties could eat that up. In Pennsylvania, they passed a law in 2018 that said they gave counties wherewithal and permission to do AOT. One county is doing it so far and not very much. Major counties like Philadelphia and Allegheny, they're not doing it. So it is this level that the assistant secretary has to hold states accountable. Say, what are you doing?
And when states say we need more money, it says, tell me what you're doing. We want to see your plan of action and give evidence that what you're doing makes sense. Give us some accountability numbers and don't just tell us it's improving by a percent of points. That's in general what has to happen, but it really is going to take someone.
The way I word this, it has to be the tenacity of Teddy Roosevelt and the compassion of Mother Teresa to combine those two. Neither one of them would take no for an answer. Neither one. And both of them improve the world.
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