The lobbying efforts by the Arizona Psychiatric Society (APS) paid off last month when Governor Jane Hull (R) vetoed a bill designed to eliminate "nonscientific" mental health treatments.

The Arizona bill (SB 1538) called for the creation of an advisory committee to decide which "behavioral" treatments are effective based solely on citations in scientific journals. The state department of health would have been required to review its funding of behavioral treatments based on the same criteria, according to the bill.

The bill also required the same advisory committee to study the use of psychotropic medications in children. Burdensome provisions in the original version required physicians to meet several conditions before prescribing psychotropic drugs to children, including recommending a pediatric examination.

Due to the intense lobbying efforts of the Arizona Psychiatric Society, those cumbersome requirements were stripped from the final version that the legislature passed, according to APS lobbyist Joseph Abate.

Hull was urged to veto the bill by APS and the Leadership Council for Mental Health, Justice, and the Media, a not-for-profit organization made up of respected scientists, clinicians, educators, legal scholars, journalists, and public policy analysts, according to its president, Paul Jay Fink, M.D. Fink, a former APA president, is senior consultant to Charter Fairmount Behavioral Health System in Bala Cynwyd, Pa.

In an April 19 letter to Hull, the leadership council said that "the bill’s stipulations about what constitutes acceptable treatments are vague and ultimately take therapy out of the hands of consumers and their providers and places it in the hands of the legislature and the court system."

The council also called the oversight of mental health professionals discriminatory. "Most states are recognizing the ongoing discrimination against people with mental illness and are supporting parity legislation. The changes called for in this bill would be regressive. . . ."

Hull agreed with the leadership council’s arguments. In her April 24 letter to the Arizona Secretary of State, she said, "I cannot support a provision to recommend a plan for the department of health services to review the use of public monies for behavioral health treatments in Arizona that are not scientifically substantiated.

"Simply put, this is not sound medical practice, and I am also concerned that the provision discriminates against the mentally ill."

State Senator David Petersen, a Republican, who introduced the bill, told Psychiatric News that in spite of the veto, he hopes to proceed with establishing a 24-member commission to study the use of psychotropic drugs in children and whether unsubstantiated treatments should be paid for by the state and thus taxpayers.

"From day one, my intent has been to inform the patient about whether there is any proof that the therapy being recommended is effective," said Petersen.

He said that his constituents, mainly parents, have expressed concern about children removed from their care based on a diagnosis of Munchausen by proxy syndrome and parental-custody decisions based on the Minnesota Multiphasic Personality Inventory (MMPI).

"The vast majority of complaints," he said, "came from parents and teachers concerned about Ritalin being prescribed in the schools after a 10-minute psychological evaluation."

Petersen said he was very impressed with psychologist and lawyer Christopher Barden, who testified before the legislature. The leadership council was not, however. That group complained to Hull that Barden, an attorney who specializes in suing therapists who work with victims of sexual abuse, wrote a bill introduced by Petersen in February. The bill, known as the Mental Health Practices: Consumer Protection Act, died in committee, but because SB 1538 initially had informed-consent provisions, the leadership council claimed that the bill "was a back-door attempt to enact the consumer protection bill."

Barden told Psychiatric News that he commended Petersen’s efforts to set up a committee "to study the most efficient way to use taxpayers’ dollars for mental health treatments."

Barden is the author of a model bill titled the Truth and Responsibility in Mental Health Practices Act, which has been introduced in various forms in Texas and Arizona. Barden states in the bill’s overview, "Much of the rapid growth in the use of untested and hazardous mental health practices is the result of inappropriate financial reimbursements by state, federal, and private insurance systems."

He mentions that untested, dangerous treatments include hypnosis used to help patients uncover memories of sexual abuse.

Requiring scientific evidence for proposed therapies "creates an incentive for the mental health field to use safe and appropriate treatments and to eliminate the injurious ones. Otherwise, they are wasting the taxpayers’ money." Other provisions in the model bill require mental health professionals to inform patients of the benefits, risks, and hazards of the proposed treatment and alternative treatments and sending insurers the signed informed consent.

Criticizing "the irresponsible and unethical testimony by mental health practitioners in the courts," Barden proposes that expert witnesses be required to disclose fully the limitations of any tests and procedures used in court cases.

"The HMO industry and government have been surprisingly quick to adopt aspects of the model bill," Barden told Psychiatric News. But so far, no version has been enacted in any state. He conceded that widespread reform may be slow.

"It takes years to reform any industry with a powerful lobby—just look at the auto and tobacco industries," said Barden.