MENTAL
HEALTH
ASSOClATlON
Legislative Testimony for Hearing on Mental Health
To: Health and Human Services Committee of the PA House of Representatives
From: The Mental Health Association of Southeastern Pennsylvania
October 15, 2013
Hello, I am Jake Bowling, the Director of Advocacy at the Mental Health Association of
Southeastern Pennsylvania. Thank you so much for the opportunity to testify today. Despite our
opinions during today's conversation about mental health services, we can probably agree on
some values that most of us, in this room, hold. First, no individual or family should have to
experience a mental health crisis without getting the help they need. Second, people with
mental health conditions- which constitute 26% of individuals in any given year in Pennsylvaniashould be able to get support they need to live full live in their communities, like everyone else.
Third, no individual or family should have to experience a mental health crisis if there is some
way our mental health system could have intervened to prevent the crisis. Finally, if people can
get the help they need without force, coercion, and court orders, they should be able to get itand forced treatment should be a last resort.
As a mental health advocacy organization and service provider, the Mental Health Association
of Southeastern Pennsylvania (MHASP) has three recommendations for this committee that will
impact the lives of people with mental health conditions and their families: ensure that the
implementation of the Mental Health Procedures Act is consistent across the state, ensure
sufficient investment in the mental health system, and expand access to mental health
coverage.
Implement the Mental Health Procedures Act Consistently
Before making changes to the language of the Mental Health Procedures Act (MHPA),
OMHSAS needs to review whether it is being implemented consistently statewide. MHASP
strongly agrees with the recommendations of the Disability Rights Network (DRN), which we will
reference in this section of the testimony. Currently, OMHSAS does not collect data about who
or how many individuals in our system are experiencing involuntary commitment, voluntary
commitment, or assisted outpatient treatment. OMHSAS is responsible for the entire mental
health system, and should be collecting this data.
Also, an independent study should take place to see how counties are interpreting and thus
implementing the MHPA. Inconsistent application of the MHPA means that in some places in
Pennsylvania, even if someone meets the commitment threshold, he or she is not being
committed. Therefore, it makes sense that if the interpretation and application of this statute is
inconsistent across the state, causing people to not get the help they need, that this
inconsistency should be addressed before any language is changed in the statute.
In addition, MHASP has serious concerns about lack of training required of mental health review
officers (MHROs) and judges responsible for deciding whether an individual can be committed.
These individuals have no minimum training requirements and are not required to have current
knowledge of the mental health system (and possible alternatives to hospitalization). MHROs
and courts should be well-trained to ensure consistent interpretation, application, and best
practices when dealing with individuals and families in crisis.
Adequately Invest in Mental Health Services
Mental health advocate and former Senator Patrick Kennedy says that if we treated diabetes
like we treated mental health, we would wait until someone had an amputated leg or is blind
before we initiated treatment. Unfortunately, the more under-funded our system becomes, the
more dependent on crisis services we become. The dearth of services in the community- like
peer support, assertive community treatment, and other outpatient services- can create a
situation where people must reach a crisis point before they can gain entry into our mental
health system. Instead of the revolving (and expensive) door of crisis services, people should
get what they need in the community.
Study after study suggests that the accessibility of services in the commur~ityand assertive
community treatment- not court orders-. is what helps prevent mental health crises' and what
helps people during mental health crises, even those with the most severe mental health
conditions and functional impairments2.Studies also demonstrate that these services are shown
most effective when they, "are not coercive [and] do not rely on compulsory order^.^" Thus,
force and coercion are not necessary ingredients to helping people in crisis; assertive
community treatment, peer support, and other services can be just as effective as forced
treatment.
Services should be committed to people before people are committed to services. Thus,
tinkering with the Mental Health Procedures Act after many years and millions of dollars of
devastating cuts to the mental health system in Pennsylvania will not solve the issue at hand.
Instead, mental health services in the community can prevent people from reaching crisis and
help them during crisis, without court orders and without the cost of hospitalization.
Expand Medicaid and Continue HealthChoices
Finally, every Pennsylvanian should have access to mental health services, and this year we
have an unprecedented opportunity to expand coverage. Currently, people who have insurance
through their employers and people who are on Medicaid can get mental health services
covered by their insurance. However, people who are considered the "working poor"- people
who work hard to support their families but do not have insurance through their employerscannot afford coverage and may not qualify for subsidies that could cover life-saving mental
health care. Medicaid Expansion would enable people to participate in mental health services.
In addition, any conversation about Medicaid expansion should also include the reality that what
we do have in our mental health system that really works can partly be attributed to our
HealthChoices program. HealthChoices has increased the nurr~berof people served by our
system, improved quality, managed costs, created local decision making ability, developed a
larger array of services, and even garnered savings that could be re-invested into the mental
health system. These savings can be used for housing initiatives, prevention programs, and
even programs like Mental Health First Aid that reduce stigma and train community members on
how to connect individuals with mental health support.
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1
Malla & Norman, 2002;Melle, et al., 2004
http:/lwww.bazelon.or~/LinkClick.aspx7f3d&tabid=324
htt~://www.rehab.research.va.nov/iour/07/44/6/~df/rosen. ~ d f
Conclusion
Thank you for the opportunity to submit testimony on this extremely important topic. We share
your belief that every person and every family, no matter where they are in recovery or where
they live in Pennsylvania, should get the help they need from the mental health system. We also
believe, and research demonstrates, that we can prevent and mitigate crises through services in
the community and that every person should have access to those services. In addition, we
echo DRN's recommendations and assert that before any changes to state law occur, OMHSAS
should streamline the interpretation and implementation of the MHPA to ensure that people in
every county across the Commonwealth get the help they need. Thank you.