21st Century Cures Act Becomes Law, Improves U.S. National Mental Health Efforts

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This article has been re-shared from it’s original source, PsychCentral.com

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When President Obama signed the 21st Century Cures Act on December 13th, he signed into law one of the most sweeping efforts to provide additional programs and funding for health conditions and innovation in America, including cancer, Alzheimer’s disease, opioid addiction, medical devices, access to new drugs, and mental health. The Cures Act includes the major provisions of the Senate mental health compromise bill, Mental Health Reform Act of 2016, as well as a few additional provisions from the House’s over-reaching Helping Families in Mental Health Crisis Act of 2016 bill.

While the bill goes a long way in helping fix certain components of mental health care in the nation, it does little for the vast majority of people who suffer from mental health concerns and receive outpatient treatment. Here are the highlights of what just became law.

Assistant Secretary for Mental Health and Substance Use & Chief Medical Officer

The old Senate S.2680 bill declined to burden the system with even more federal bureaucracy by creating a new Assistant Secretary for Mental Health and Substance Use. The bill that was just passed, however, does create such a new position, though — largely replacing the Administrator for SAMHSA. This was an unfortunate change that takes away control of SAMHSA from the experts and instead gives it to politically-appointed leaders. Time will tell whether this actually strengthens mental health leadership in this country, or simply makes it more political.

The Mental Health Reform Act of 2016 did include a newly-created position of Chief Medical Officer, and this position is included in the Cures Act. The chief medical officer must be a physician who is licensed to practice medicine. Unfortunately, this limitation will likely result in the emphasis of the psychiatric perspective over a more balanced biopsychosocial approach.

Interdepartmental Serious Mental Illness Coordinating Committee

The new law establishes a coordinating committee of 23 individuals in order to provide “a summary of advances in serious mental illness and serious emotional disturbance research related to the prevention of, diagnosis of, intervention in, and treatment and recovery of serious mental illnesses, serious emotional disturbances, and advances in access to services and support for adults with a serious mental illness or children with a serious emotional disturbance.” It will also seek to determine what impact federal programs have on “rates of suicide, suicide attempts, incidence and prevalence of serious mental illnesses, serious emotional disturbances, and substance use disorders, overdose, overdose deaths, emergency hospitalizations, emergency room boarding, preventable emergency room visits, interaction with the criminal justice system, homelessness, and unemployment.”

Oddly, only two representatives of the committee will be patients (up from one patient representative in the Senate bill), while the rest of the committee members will be taken up by mental health professionals and federal bureaucrats. This seems like a token for this important interdepartmental effort.1

National Mental Health and Substance Use Policy Laboratory

In the law that was passed, this existing Office of Policy, Planning, and Innovation was changed to that of a “laboratory,”2 a none-too-subtle effort to imbue “science” into whatever this office does.

The newly-named Laboratory also has an additional new mandate — to identify programs the agency administers that are not “evidence-based” and to “promote innovation” (as well as evidence-based programs). This is the effort to defund peer-support programs that have long been a mainstay of SAMHSA grants. Unless, of course, they do more research to prove their scientific validity.

I’m all for evidence-based programs. My objection to this is the same one I noted years ago — medicine is generally not held to the same evidence-based standard that is now being required for mental health programs. This is yet another example of the unequal treatment given to mental health concerns.3

 

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