Help End A Discriminatory Law Denying Treatment and Fueling the Homeless and Addiction Crises

The U.S. is facing one of the worst public health crises in history–and we’re not referring to COVID-19. News reports say the country is in the midst of a mental health crisis. While many are just now learning about the lack of access to psychiatric services, the truth is, this crisis has been going on for decades, and it’s far worse than most people realize. 


Lack of Access to Psychiatric Services Affects Everybody

This inability to access psychiatric services has consequences for everybody, not just people suffering from illnesses. City streets, neighborhood parks and freeway offramps across our country are filled with the homeless - many of whom have serious brain disorders, commonly referred to as serious mental illnesses. Hospital emergency departments are overcrowded with people in crisis who have nowhere to go. There simply are not enough psychiatric beds. As a result, people with serious brain disorders, including children, sometimes wait in emergency rooms for days and even weeks at a time. 

Recently in New York, two people were shoved onto subway tracks in separate instances by individuals with a history of psychiatric symptoms. Preventable tragedies occur regularly because people with serious brain disorders do not receive the necessary medical care they need.


From the Treatment Advocacy Center:

Prevalence and Treatment Rates*

8.3 million adults with schizophrenia or bipolar disorder mental illness (3.3% of the population)+

5.5 million – approximate number with severe bipolar disorder (2.2% of the population), 51% untreated+

2.8 million – approximate number with schizophrenia (1.1% of the population), 40% untreated+

3.9 million – approximate number untreated in any given year (1.6% of the population)+


Consequences of Non-treatment* 

169,000 homeless people with serious mental illness**

383,000 inmates with mental illness in jails and prisons

50% – estimated percentage of individuals with schizophrenia or bipolar who attempt suicide during their lifetimes

44,193 suicide deaths in 2015

10% – estimated percentage of homicides involving an offender with serious mental illness (approximately 1,425 per year at 2014 homicide rates)

29% – estimated percentage of family homicides associated with serious mental illness

50% – estimated percentage of mass killings associated with serious mental illness


The Solution

A bill sponsored by California Congresswoman Grace Napolitano  introduces sensible and long overdue solutions. The "Increasing Behavioral Health Treatment Act" (H.R. 2611) would repeal a discriminatory law known as the IMD Exclusion that prevents access to medically necessary treatment for people with serious brain disorders.  

The bill would also require state Medicaid programs to improve patient access to outpatient and community-based behavioral health care, expand crisis stabilization services, and facilitate care coordination between providers and first responders.


What Is the IMD Exclusion and Why Must It Be Repealed?

The IMD Exclusion prohibits federal payment under Medicaid for medically necessary treatment for adults in Institutes of Mental Diseases–which are psychiatric hospitals and residential treatment facilities with more than 16 beds. It bars Medicaid enrollees with “mental diseases” from receiving the same level of care that enrollees without severe mental illness receive for other illnesses such as cancer and heart disease. 

In doing so, the exclusion denies equal protection under the law to the very group of people it is supposed to help. The IMD Exclusion is blatant discrimination against people with serious brain disorders like schizophrenia and bipolar disorder. 

As a result of this law, many psychiatric hospitals and residential treatment centers have closed, while others limit their beds to 16. The need for treatment beds far exceeds this artificial cap. 

Some states have sought Medicaid demonstration waivers that allow them to bypass the IMD Exclusion. However, this is a piecemeal approach to a national problem, and to date only eight states have an approved waiver. 

We must end the suffering by bringing about parity and a right to treatment under Medicaid/Medicare. It is inhumane and unjust to deny medical treatment to those in need and leave them abandoned, criminalized or left to die in our streets. 

Not only is it unjust, billions of tax dollars are wasted, which the National Shattering Silence Coalition refers to as the #CostOfNotCaring.


Who Supports the Repeal?

In addition to the National Shattering Silence Coalition, the following nationally recognized organizations support the full repeal of the IMD Exclusion:

NAMI
Manhattan Institute
National Association of State Mental Health Program Directors
Mental Illness Policy Org
Treatment Advocacy Center
Schizophrenia & Psychosis Action Alliance
National Association of Medicaid Directors 
National Association for Children's Behavioral Health 

To date, the "Increasing Behavioral Health Treatment Act" is supported by the following legislators:

Rep. Grace Napolitano (D) - California (sponsor)
​​Rep. Alan Lowenthal (D) - California
Rep. Karen Bass (D) - California
Rep. Salud Carbajal (D) - California
Rep. Ted Lieu (D) - California
Rep. Maxine Waters (D) - California
Rep. Lucille Roybal-Allard (D) - California
Rep. Nanette Diaz Barragan (D) - California
Rep. Tony Cárdenas (D) - California
Rep. Susan Wild (D) - Pennsylvania
Rep. Linda T. Sánchez (D) - California
Rep. Mike Levin (D) - California
Rep. Earl Blumenauer (D) - Oregon


Overcoming Misguided Objections

Some fear that, by repealing the IMD Exclusion, we are going to regress to the days when everyone with a serious brain disorder (and even some without) were locked away forever in horrible institutions where they were tortured and experimented on. No one wants to go back to those days. Our goal is to provide a hospital bed when needed, a continuum of care in the community, and #HousingThatHeals so people with serious brain disorders will have every opportunity to live their best lives.

In addition to increasing the number of hospital beds, repealing the IMD Exclusion would allow for increased reimbursement for inpatient care and all facilities at various levels of care, including access centers and longer term #HousingThatHeals. 

Having higher levels of reimbursement will enhance services in all of these levels of care, including more work with psychologists, and multidisciplinary teams so that the models can move away from just a pill and a bed to more comprehensive care. We absolutely do still need many other things, including comprehensive community based care. Repealing the IMD Exclusion would help with both acute care treatment as well as with those who need longer term treatment all along the continuum of care. 


Take Action 

We need many more representatives to support this bill. We also need someone from the Senate to introduce a bill mirroring H.R. 2611 in the Senate.

You can help by taking the following actions today:

Visit our National Shattering Silence Coalition Campaign to End the Discriminatory IMD Exclusion page and click on the two “calls to action” on the right side of the page.

1) Email your representative using the online form and ask them to co-sponsor H.R. 2611

2) Email your senator using the online form and ask them to introduce legislation that mirrors H.R. 2611 in the Senate. 

3) Call your legislators to schedule a meeting to discuss the bill and ask for their support.

Background and talking points are provided on the webpage. For more information on why the IMD Exclusion must be repealed, please see NSSC’s IMD Exclusion Position Statement.


Tips for Effective Meetings With Legislators

• For excellent guidance on effective meetings with legislators, please watch NSSC's video on “Advocating for Repeal of the IMD Exclusion: Some Tips for Effective Meetings With Legislators.”
• If you are able to schedule a meeting with your legislator, please let us know at coordinator@nationalshatteringsilencecoalition.org. We are tracking the effectiveness of this campaign and need all of your input to do so.
• If your meeting is via Zoom and you would like one of us to attend the meeting with you, just ask. We are happy to help. 

Please take action today! Help us to gain access to #abedinstead of a jail cell, homelessness, or death. 

If you are as passionate about the need to build a more compassionate world for those suffering from serious brain disorders and their families, please join our coalition. Together, we can change the world.


#justiceforSBD #righttotreatment #HIPAAhandcuffs #lifelongcare4SBD #parityforsbd #fundingequity #abedinstead #treatmentbeforetragedy #ShatteringSilence

* Numbers and percentages of US adults 
+National Institute of Mental Health, 2016
**2015 Annual Homeless Assessment Report