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Rep. Murphy blasts Trump's pick for mental health post

Pittsburgh Post-Gazette - 4/25/2017

April 25--WASHINGTON -- She isn't who U.S. Rep. Tim Murphy had in mind when he crafted a new law creating the position of assistant secretary for mental health and substance abuse.

Elinore F. McCance-Katz of Rhode Island has been nominated for the job, which puts her in charge of the Substance Abuse and Mental Health Services Administration, an agency she worked for during a contentious period that fueled Mr. Murphy's reform efforts.

In an unusual break with Donald Trump, the Upper St. Clair Republican slammed the president's pick.

"I am stunned the president put forth a nominee who served in a key post at SAMHSA under the previous administration when the agency was actively opposing the transformative changes in" the congressman's mental-health reform bill, which ultimately passed, he wrote in a statement Monday. "The old regime at SAMHSA was incapable and unwilling to work with me and my colleagues in Congress to deliver the transformative changes needed."

Pittsburgher Michael Welner is rumored to have been in contention for the nomination. Dr. Welner is a forensic psychiatrist who helped write Mr. Murphy's Helping Families in Mental Health Crisis Act, which passed last year.

Besides creating the new assistant secretary position, the law expands Medicaid patients' access to in-patient psychiatric care, ties program grants to measurable outcomes, and makes it easier for caregivers to access treatment plans of patients with severe mental illnesses that impair their ability to make decisions about the own care.

SAMHSA fought the legislation when Dr. McCance-Katz was chief medical officer from 2013 to 2015. She now is chief medical officer for Rhode Island's behavioral health department.

"She was the key medical leader when the agency actively lobbied against any change or accountability including when the Energy and Commerce Committee -- indeed the entire Congress -- was aiming to fix our nation's broken mental health system," Mr. Murphy wrote in a scathing statement Monday.

Dr. McCance-Katz did not respond to a request for comment.

Last year she criticized SAMHSA in a commentary for the Psychiatric Times. In it, she said SAMHSA is failing to address the needs of the most vulnerable and that some agency employees considers psychosis to be a different way of thinking rather than a mental disorder. She said the agency should make treating the seriously mentally ill a priority over other programs, including creating hotlines for the suicidal, programs to teach about the warning signs of mental illness and integrated care programs that bring aspects of primary care to mental health service programs.

She wrote that she left SAMHSA in 2015 because the agency "refused to support evidence-based psychiatric treatment of mental disorders" and because her psychiatric perspective -- including assessment, diagnosis and treatment with psychotropic medication and psychosocial intervention -- was "a poor fit for the agency."

Mr. Murphy, who worked as a psychologist before his election, blasted SAMHSA's history of "silly, feel-good, anti-scientific, redundant and wasteful actions" and its "anti-medical approach to mental illness and addiction" under Dr. McCance-Katz.

He pointed to a congressional investigation showing that during her tenure, SAMHSA had questionable hiring practices, a lack of accountability for grants and an anti-medical approach to treatment.

He proposed the assistant secretary position to improve accountability, coordinate 112 mental health programs across government, develop a strategy to increase the mental health workforce, and improve access to care.

"We must have someone reliably and resolutely committed in word and deed for these critical changes to our nation's dilapidated and deadly mental health and substance abuse care," Mr. Murphy wrote. "The lives of millions of Americans depend on it. And I will be satisfied with nothing less."

Mental health advocate JD Jaffe said Dr. McCance-Katz is the right person for the job.

"This is a great appointment," said Mr. Jaffe, founder of Mental Illness Policy Org in New York City, which seeks to focus funding on treatment of the most serious mental illnesses. He expects opposition from providers and grant recipients who want continued funding without proving their programs work.

"SAMHSA needs to be headed by a change agent, someone who in their heart wants to help the seriously mentally ill and is tough enough to force the agency to change," he said. "This is a great choice by President Trump."

He pushed back against Mr. Murphy's criticism of Dr. McCance-Katz.

"Blaming her for the failure of SAMHSA is like blaming Murphy for the failure of Congress," Mr. Jaffe said. "She's wonderful. She tried to fix SAMHSA while she was there."

Besides leading the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Dr. McCance-Katz is a professor at the Alpert Medical School at Brown University. She was previously medical director of the California Department of Alcohol and Drug Programs, professor at the University of California and Virginia Commonwealth University, and chief operating officer of the Virginia Health Practitioners' Intervention Program.

She has a medical degree from the University of Connecticut and a doctorate from Yale University.

Washington Bureau Chief Tracie Mauriello: tmauriello@post-gazette.com, 703-996-9292 or on Twitter @pgPoliTweets.

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(c)2017 the Pittsburgh Post-Gazette

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