NYAPRS Note: Wednesday’s Congressional hearing on the implications of a Government Accountability Office report finding that “interagency coordination for (federal) programs supporting individuals with serious mental illness is lacking once again underscored the need for careful evaluation and the degree to which personality and partisanship are playing a role in these evaluations. See https://www.youtube.com/watch?v=gwDh63jIMdQ to watch the entire 2+ hour hearing.
The hearing continued the attack on SAMHSA by those, led by House Energy and Commerce Subcommittee on Oversight and Investigations chair Tim Murphy, who believe that that agency isn’t doing enough to address the needs of those with the most serious needs and that, moreover, it should have been coordinating efforts across 112 separate programs within 8 federal agencies.
In response, HHS Ass’t Secretary for Planning and Evaluation Richard G. Frank emphasized the importance of coordination of services on the ground that address each individual’s medical, mental health, addiction, housing and other social needs, referring to new health home initiatives that are a centerpiece of national and state healthcare reform. In his remarks, NY Congressman Paul Tonko echoed this focus on state implementation of the Affordable Care Act, an initiative overseen by the federal Centers for Medicare and Medicaid Services, the agency that most directly touches the lives of Americans with the most serious conditions, a point apparently lost in the GAO report.
Sparks Fly At Murphy Hearing: Cheap Shots, Personal Attacks and Traps Alleged
By Pete Earley February 11, 2015
Colorado Democratic Representative Diane DeGette said she was “appalled” by the brutal questioning of SAMHSA Director Pamela Hyde during a House subcommittee hearing Wednesday. DeGette’s irritation was aimed at two House Republicans who verbally attacked Hyde and her agency, one personally belittling her as a witness.
Representatives Markwayne Mullin (R-Okla.) and Chris Collins (R-NY) irked DeGette, the ranking minority member of the House Energy and Commerce Subcommittee on Oversight and Investigations, when they grilled Hyde about agency priorities and her leadership.
Mullin led the two-punch attack during the hearing that was called by Rep. Tim Murphy (R-Pa.) the committee chair, who last year asked the General Accountability Office to investigate SAMSHA. It issued its report last week.
You can watch Mullin interrogate Hyde by going to 1:36.37 on the YouTube video.
After posting a snapshot of a SAMHSA website called Building Blocks For A Healthy Future on a television monitor, Mullin explained the webpage was designed to teach small children about substance abuse by having them sing songs about healthy living to the tune of Old McDonald and Yankee Doodle Dandy. “It’s for substance abuse for young children between the ages three to six and… I’m sure there’s a high number of substance abuse among three year-olds,” Mullin said sarcastically.
When Hyde began to defending the website, stating that studies showed the earlier prevention is taught, the better the outcome, Mullin cut her off and demanded to know how much the website had cost taxpayers. Hyde didn’t know, so he told her: $436,000.
“I got a three year old and I couldn’t keep her attention for no time at all on that,” he complained.
He said the website only had 15,000 visitors with an average viewing time of three minutes.
“Do you think that’s using tax money wisely?”
When Hyde began to talk about how SAMHSA was going through its website looking for waste, he again cut her short. She buckled, saying that he was not letting her answer at which point, Mullin explained that $436,000 in Oklahoma would provide 176 outpatient service visits for a full year.
“We are here to help,” Mullin declared. But instead of admitting that SAMHSA has a problem, he said Hyde was getting “defensive.”
After being chastised by Mullin, Hyde came under the crosshairs of Collins who began by asking her to rate her and SAMHSA’s performance on a scale of one-to-ten with ten being the best.
When she replied that her agency was a 10, he rebuffed her for being “arrogant” and proceeded to belittle her with a string of questions, adding after each one that she was acting more like an 8 or 7 or even lower on the scale. (See 1:47:53.)
His relentless questioning drew Rep. DeGette’s ire at one point. She demanded that Collins let Hyde answer.
Both Mullin and Collins had exited the hearing room when DeGette criticized them by name for making “cheap shots,” personal attacks on witnesses, and “traps.” (2:02:37)
One of the most compelling statements during the hearing came from Republican Morgan Griffith, a self-described street lawyer from Virginia, who talked about clients with mental illnesses whom he had represented. He became emotional when he spoke about how his wife was trying to help a young suicidal man without any support or help from the federal programs that SAMHSA oversees. (His comments can be found at 1:13:18.)
Chairman Murphy and his subcommittee have held a series of investigative hearings into mental health, and Hyde and SAMHSA have been a regular target. In legislation that Murphy introduced last year (before it died in committee), he called for much of SAMHSA’s funding to be stripped away and given to the National Institute of Mental Health. Hyde testified that the lion’s share of her budget goes to substance abuse and not mental health. (Read more about Murphy’s bill here.)
At Wednesday’s hearing, Murphy zeroed in, once again, on the case of Joe Bruce and how a Protection and Advocacy employee told Bruce’s son, Will, ways to successfully be discharged from a Maine mental hospital even though doctors said he was dangerous. Will went home and murdered his mother. Murphy has asked Hyde to provide him with information from SAMHSA about the role of federal Protection and Advocacy groups in that tragedy.
Murphy also raised questions about the practice of having SAMHSA funded programs evaluated by individuals who are paid to run them.
Before the hearing, Rep. Murphy released a statement about the GAO study entitled: Mental Health: HHS Leadership Needed to Coordinate Federal Efforts Related to Serious Mental Illness.”
GAO stated, “Although SAMHSA is charged with promoting coordination across the federal government regarding mental illness, its efforts to lead coordination – specifically on serious mental illness – across agencies have been lacking.”
“This GAO report is a much-needed wake-up call. The federal government’s approach to addressing mental illness is a convoluted and disjointed mess,” said Murphy, who is also a clinical psychologist treating soldiers with Post Traumatic Stress and Traumatic Brain Injury as a member of the Navy Reserve Medical Service Corps. “Shame on us if we don’t take action and work on fixing the system-wide failures identified in this report so that we can focus resources on helping those in desperate need of medical services for treatment of schizophrenia, bipolar disorder, and chronic depression.”
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Rep. Murphy Grills Federal Officials Over Report On Mental-Health Services
By Joe Smydo / Pittsburgh Post-Gazette February 12, 2015
As he prepares to reintroduce legislation to overhaul mental health care, U.S. Rep. Tim Murphy, R-Upper St. Clair, sharply questioned federal officials Wednesday over a new report critical of how they manage programs for those with serious mental illnesses.
The nonpartisan Government Accountability Office report criticized the Department of Health and Human Services and the Substance Abuse and Mental Health Services Administration, saying they do not adequately coordinate more than 100 programs across several federal agencies or study the effectiveness of key initiatives.
At a hearing Wednesday, Mr. Murphy, chairman of the Energy and Commerce Subcommittee on Oversight and Investigations, said the shortfalls mean the government isn’t properly serving people with mental illness, and they may turn up in jails, go homeless or attempt suicide without the right care.
“We are not talking simply about wasted dollars or lost program efficiencies,” said Mr. Murphy, a psychologist. “We are talking about lives ruined, dreams shattered and preventable tragedies.”
Although the agencies’ management lapses are bad, he said, their refusal to acknowledge or address deficiencies is more troubling.
“You can’t manage what you don’t measure,” said Mr. Murphy, whose Helping Families in Mental Health Crisis Act would create a high-level position at Health and Human Services to coordinate and evaluate services.
The GAO report said the management shortfalls could lead to duplication of services or gaps in care.
But Health and Human Services officials, who have weathered Mr. Murphy’s criticism before, played down the GAO report. Richard G. Frank, assistant secretary for planning and evaluation, said it focused on a relatively small number of programs and provided only a partial picture of the agency’s work.
In addition, he said service coordination takes place not only within and among federal agencies but among program staffers and service providers. “Coordination can be thought of in a number of ways,” he said.
Mr. Murphy’s bill, which he introduced in 2013, died last year with only a handful of provisions enacted. He plans to reintroduce the legislation, which aims to cut bureaucratic obstacles and increase access to care