RESCHEDULED: Monday, December 14
9PM Eastern Standard Time
Mental Illness Policy Org invites you to a conference call with Dr. Stephen B Seager, author Behind the Gates of Gomorrah: A Year with the Criminally Insane.
Call this number (712) 775-7031
Enter this Access Code:715-149
He will talk about his book and about a psychiatric parole program in California, Forensic Conditional Release (CONREP) that is like an enforceable version of Assisted Outpatient Treatment (AOT) for prisoners that should be made available in other states.
SHARE THIS. IT IS A PUBLIC EVENT
(This call was previously scheduled for 12/7, but a problem at Sprint prevented the moderator, and some participants for calling in, so it has been rescheduled. Our apologies to those who tried to call in and the original time and could not participate)
Unbiased information on serious mental illness (not "mental health") for media and policymakers. Includes info on violence and mental illness, involuntary treatment, involuntary commitment, assisted outpatient treatment, AOT, Not Guilty by Reason of Insanity, NGRI
Wednesday, December 2, 2015
Thursday, November 12, 2015
DeBlasio Mental Health White Paper Ignores Serious Mental Illness
The new white paper on mental health issued by the De Blasio administration November 12, 2015, shows it intends to continue the policy of ignoring the most seriously mentally ill and focusing on all others. For example, the report identifies HS students who feel sad as a priority, but not the homeless psychotic who are eating out of dumpsters. Following are data points and solutions ignored by the White Paper and the administration. Let us know if you need help reporting on this.
- 4% of NYC adults have serious mental illnesses that profoundly affect their functioning. They are not mentioned in the report which only addresses people who need mental health improved.
- 93,000 city residents who suffer from the most serious mental illnesses, including schizophrenia and severe bipolar disorder, received no treatment in the past year.
- NYC adults with serious mental illness are more likely to report not getting needed medical care in the past year than those without SMI (21 percent vs. 11 percent)
- While the number of people incarcerated in NYC jails has gone down since 2010, the percentage of prisoners with mental illness shot up 30 percent from 2010 to 2014.
- An estimated 4,000 city residents should be in Kendra’s Law but New York City has helped fewer than 1,400 get in. (State figure divided by half)
- Kendra’s Law reduced homelessness, arrests, incarceration, and hospitalization by about 70 percent each in people with serious mental illness. It saves taxpayers 50 percent of the cost of care.
People with serious mental illness in NYC need to be prioritized, not ignored. (Full recommendations)
- Make access to city hospitals easier for the most seriously ill
- More robustly implement Kendra’s Law
- Provide greater scrutiny of patients involuntarily admitted to hospitals before they are discharged.
- Make greater use of Conditional Discharge from hospital
- Provide greater scrutiny and evaluation of inmates who received mental health services while incarcerated before they are let go from incarceration.
- Support and expand Fountain House
Tuesday, September 29, 2015
Call Rep. Fred Upton at 202 225 3761 & urge him to pass HR2646
We need everyone to contact Representative Fred Upton, Chair of the House Energy and Commerce Committee and urge him to bring a strong "Helping Families in Mental Health Crisis Act (HR2646)" to a vote now.
HR2646 is a bipartisan bill proposed by Representatives Tim Murphy, (R., PA) and Eddie Bernice Johnson (D., TX), that forces the mental health industry to stop shunning people who are the most seriously mentally ill. Because the bill focuses on helping the most seriously ill, rather than all others, some in the mental health industry are trying to prevent it from passing.
HR2646:
- Creates an Asst. Secretary for Mental Health to coordinate mental health policy and encourages the use of evidence-based practices that help the seriously ill, rather than politically correct and profitable practices that help all others.
- Encourages states to use Assisted Outpatient Treatment as a more humane and inexpensive alternative to inpatient commitment and incarceration.
- Helps end federal financial discrimination against psychiatric beds so the most seriously ill who need hospitalization aren’t sent to jail instead.
- Allows parents who provide care, housing, case management for mentally ill children out of love, to get the same information from doctors paid providers receive if it’s needed to protect health, safety, and welfare.
- Stops federally funded P&A lawyers from suing against care for our loved ones
Here's why the Helping Families in Mental Health Crisis Act is important
Rep.
Upton is on our side, but those who get federal funds and don’t serve the seriously ill are putting intense pressure on him to not use federal funds for the seriously mentally ill and not to use federal funds for evidence based practices. They want the funds used to "improve behavioral wellness" rather than help the seriously ill. It's outrageous that federal funds are being used to lobby against better care for the seriously ill!
As chair of the Energy and Commerce committee, Rep. Upton can bring the HR2646 to a vote with the important provisions above intact. He needs to hear from you.
Call Representative
Fred Upton at 202 225 3761 and urge him to pass a strong HR2646.
MAKE
THE CALL! SPREAD THIS TO FRIENDS, NAMI GROUPS, ANYONE WHO CARES ABOUT THE
SERIOUSLY ILL. THANK YOU.
Monday, September 28, 2015
New Report: $4 to $8 billion of mental health funds lost to fraud, waste, and excess profits
Unbiased Information For Policymakers + Media
50 East 129 St., PH7 New York, NY 10035
News Release
September 28, 2015
Contact: Lead Author, Dr. E. Fuller Torrey
September 28, 2015
Contact: Lead Author, Dr. E. Fuller Torrey
torreyf@stanleyresearch.org
301-571-2078
New report suggests that $4 to $8 billion in public mental
health funds are being lost to fraud, waste, and excess profits.
These funds
are sufficient to provide significant psychiatric services to most of the
estimated 216,000 individuals with serious mental illness who are homeless as
well as the 350,000 who are in jail or prison. (Full report)
(New
York. NY) Public mental illness services have markedly deteriorated over the
past three decades. The “mayhem du jour” includes mentally ill individuals
carrying out mass killings; overflowing jails and prisons; being kept in
emergency rooms for days while awaiting a psychiatric bed; being killed by law
enforcement officials; and taking up permanent residence on the nation’s
sidewalks and other public spaces. It is widely assumed that the cause of the
problem is a decrease in public funds for mental illness treatment programs,
when in fact the funds available to state mental health agencies in constant
dollars have increased modestly since 1982. So where does the money go?
A new
report, “Fraud, Waste and Excess Profits: The Fate of Money Intended to Treat People with Serious Mental Illness”, suggests a partial answer. Between $4 and
$8 billion, which is 10 to 20 percent of the $40 billion spent annually by
state mental health agencies, is being lost to fraud, waste, and excess profits
to for-profit managed care companies. For example:
1.
In 2014 we identified 18 media accounts of mental
health Medicare and Medicaid fraud, totaling approximately $1 billion. A nurse
in Iowa submitted more than 6,000 false claims; a social worker in North
Carolina submitted claims for 64 hours of therapy in a single day; and a mental
health center in Louisiana submitted $258 million in false Medicare claims for
partial hospitalization.
2.
California voters in 2004 approved a special tax
to generate new revenue for providing services for individuals with serious
mental illness. The tax produces over $1 billion each year. However, some of
the MHSA funds have been wasted by being diverted to activities such as yoga,
line-dancing, therapeutic drumming, and community gardens.
3.
For profit managed care companies are commonly
allowed to keep up to 20 percent of state contracts for administrative costs
and profit. In Florida WellCare was given a contract to provide mental health
care to the state’s Medicaid population. A WellCare vice-president was recorded
as claiming that the company was keeping 50 percent of the contract. Three
WellCare executives were subsequently convicted of fraud and sentenced to
prison.
Such
findings suggest that Richard Kusserow, the former Inspector General of the
Department of Health and Human Services, was correct in 2014 when he claimed
that “many healthcare fraud investigators believe mental healthcare givers,
such as psychiatrists and psychologists, have the worst fraud record of all
disciplines.”
The
present report also makes several recommendations. The federal Health Care
Fraud Prevention and Enforcement Action Team (HEAT Task Force) should be
significantly expanded since it has been shown to pay for itself. State mental
health agencies should exert active, assertive oversight over community
programs. This oversight should include vigorous examination of Medicaid and
Medicare claims; unannounced audits of community mental health programs looking
for fraud and waste; and a prohibition on the use of for-profit managed care
companies. Such corrective actions are unlikely to happen unless mental health
advocacy groups and the public in general demand it.
In
commenting on the report, lead author Dr. E. Fuller Torrey, Associate Director of the Stanley Medical Research Institute noted: “The core
problem is not how much money is being spent, but rather how much money is
being misspent. Until we mental health professionals clean up our act, just
throwing more money at the problem is not going to solve it.”
The other authors
of the report are D.J. Jaffe, Executive Director of Mental Illness Policy Org.; Dr.
Jeffrey L. Geller, Professor of Psychiatry at the University of Massachusetts
Medical School; and Dr. Richard Lamb, Professor of Psychiatry at the University
of Southern California Keck School of Medicine.
The
complete report is available at http://www.mentalillnesspolicy.org/national-studies/wastereport.pdf
Tuesday, September 22, 2015
Join Dr. E. Fuller Torrey Teleconference October 6, 7PM EST.
SAVE THE DATE: October 6 at 7pm EST.
Books by Dr. E. Fuller Torrey
Article about Dr. E. Fuller Torrey's search for schizophrenia cure
Dr. E. Fuller Torrey Testimony on Failure at SAMHSA
Dr. Fuller Torrey's CV
Thursday, July 16, 2015
Mental Illness Policy Org statement on James Holmes Colorado Verdict
Jurors could have found James Holmes "innocent," "not guilty by reason of insanity" or "guilty". None work. Mandatory treatment does.
Our hearts go out to James Holmes, his family, his victims and families of the victims. All could have been better served if Colorado allowed James Holmes to plead "Guilty Because of Mental Illness" (GBMI).
Sentencing to Mandated and Monitored Treatment is the Answer
If the cause of the crime was lack of treatment for mental illness, individuals should be found GBMI and sentenced to mandatory long-term mental illness treatment—including medications—so they never become violent again. The sentence to treatment should be as long, or longer, than the maximum sentence that would be imposed had the person been found guilty. If this change were adopted, incarcerating the mentally ill would rarely be needed.
Their treatment could take place in an inpatient setting on a locked ward if that is what is needed to keep society safe. But, if the sentenced patient progresses—and the crime not too serious—their treatment could be continued on an outpatient basis. Over time, it would most likely be both. Under GBMI, the sentenced patient could be moved from inpatient care to outpatient care when doing well and instantly back to inpatient with no further court hearings needed if they started to deteriorate. In either case, the individual would be closely monitored by a case manager to see that they stay on their violence preventing medications. That's the solution that keeps the public safe, avoids wasting resources, and eliminates the dilemma of incarcerating those we should be treating.
Methods for monitoring patients to ensure they take their medications exist and have proven successful. New York's Kendra's Law, for example, allows courts to order treatment and monitoring of dangerous mentally ill individuals. According to a 2005 New York State Office of Mental Health Study, patients under court-ordered treatment had an 83% reduction in arrest and 87% reduction in incarceration compared to the three years prior to participation. A Columbia University study found that "individuals given mandatory outpatient treatment—who were more violent to begin with—were nevertheless four times less likely than members of the control group to perpetrate serious violence after undergoing treatment."
DJ Jaffe is Executive Director of Mental Illness Policy Org.
Thursday, June 11, 2015
ANALYSES HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT 2015 HR 2646
On June 4, 2015, Rep. Tim Murphy (R. PA) and Rep. Eddie Bernice Johnson (D. TX) introduced the Helping Families in Mental Health Crisis Act of 2015 (“HFMHCA”, HR 2646) which updates the 2013 version which did not pass (HR3717) It contains numerous provisions that will help those with the most serious mental illnesses.
Following is a summary of what Mental Illness Policy Org. considers the most important provisions of HFMHCA and a discussion of others. We did not analyze provisions related to children or technology.
SAMHSA Replaced by an Assistant Secretary of Mental Health and Substance Use Disorders
Background: It is well known that the Substance Abuse and Mental Health Services Administration (SAMHSA) has failed to focus it’s efforts on serious mental illness as mandated in the enabling legislation, use science to develop policy, hire anyone with medical expertise, or focus on reducing important metrics like rates of homelessness, arrest, incarceration, suicide, violence or hospitalization in people with mental illness.
The Helping Families in Mental Health Crisis Act replaces SAMHSA and it’s administrator with Assistant Secretary for Mental Health and Substance Use Treatment who must be a licensed Psychiatrist or Clinical Psychologist. This raises the profile of mental health in the government org chart and ensures that the lead policy official for mental health policy knows something about mental illness. The Assistant Secretary will administer responsibilities formerly administered by SAMHSA.
The Helping Families in Mental Health Crisis Act requires the Asst. Sec to focus on important metrics like rates of suicide and attempts, emergency psychiatric hospitalizations, emergency room boarding; arrests, incarcerations, victimization, and homelessness. The bill dramatically tightens the definition of evidence to be used in determining the efficacy of programs. It establishes a coordinating committee to advise the secretary that includes significant representation from criminal justice.
Mental Health Block Grant Applicants Required to Address Serious Mental Illness
Background: Mental Health Block Grants (MHBGs) are roughly $500 million in federal funds allocated to SAMHSA to distribute as “block grants’ to the states. Both SAMHSA and the Block Grants are supposed to serve people with Serious Mental Illness, but SAMHSA gives guidance to the states to divert the money from people with serious mental illness.
The Helping Families in Mental Health Crisis Act requires states applying for block grants to “include a separate description of case management services and provide for activities leading to reduction of rates of suicides, suicide attempts, substance abuse, emergency hospitalizations, incarceration, crimes, arrest, victimization, homelessness, joblessness, medication” and other important outcomes.
Assisted Outpatient Treatment Programs Receive Modest Funding
Background: Assisted Outpatient Treatment (AOT) allows judges to order a small group of seriously mentally ill who already accumulated multiple episodes of arrest, violence and hospitalization as a result of failing to comply with treatment to stay in mandated and monitored treatment while in the community. This has reduced their incarceration, arrest, homelessness and hospitalization by 70% each and saved money for taxpayers by reducing the use of expensive jails and hospitals. In 2013 Rep Murphy inserted a provision in the 2014 Protecting Access to Medicare Act (a/k/a “SGR” or “DocFix”) that provided $15 million annually for AOT.
The Helping Families in Mental Health Crisis Act of 2015 ups the amount provided to states for AOT by $5 million to $20 million annually and extends the grants through 2018. (20% to existing programs and 80% to new programs.) Further, states with an AOT law on their books will receive a 2 percent increase in their block grant funding. (Roughly $10 million annually split between them)
The Helping Families in Mental Health Crisis Act requires the Asst. Sec to measure outcomes in states with AOT which will help strengthen the evidence for it. Relatedly, states with a need for treatment standard will also receive a 2 percent increase in their block grant funding (about $10 million nationally).
HIPAA/FERPA Regulations Slightly Modified to Allow Helpful Disclosures to Caregivers
Background: Parents who provide case management, housing, income support and other services out of love to their children, are prohibited by HIPAA and FERPA from getting information about diagnosis, medications and next appointments of loved ones. Therefore they can’t make sure prescriptions are filled, transportation to appointments arranged and help facilitate compliance. Doctors and mental health programs also falsely claim that HIPAA prevents them from receiving information from family members.
The Helping Families in Mental Health Crisis Act allows an entity normally required to maintain patient confidentiality to share some limited information with “caregivers”. HIPPA disclosure is limited to information about the diagnoses, treatment plans, appointment scheduling, medications, and medication related instructions, but does not include any personal psychotherapy notes. The Helping Families in Mental Health Crisis Act does not put a limit on which FERPA-protected information may be disclosed.
The Helping Families in Mental Health Crisis Act defines “caregivers” as “an immediate family member; someone who assumes primary responsibility for providing a basic need of such individual; a personal representative; someone who can establish a longstanding involvement and is responsible with the individual.”
The Helping Families in Mental Health Crisis Act provides that HIPAA protected information may be disclosed only if the patient is over 18 and has “serious mental Illness” diagnosed by a doctor that results in functional impairment of the individual that “substantially interferes with or limits one or more major life activities of the individual.” HIPAA protected information for people without serious mental illness may not be disclosed. FERPA protected information can be disclosed without those limitations.
Disclosure of information can only be made if all the following conditions are met for HIPAA protected information or the first condition only is met for FERPA protected information.
• Such disclosure is necessary to protect the health, safety, or welfare of the individual or general public.
• The information to be disclosed will be beneficial to the treatment of the individual if that individual has a co-occurring acute or chronic medical illness.
• The information to be disclosed is necessary for the continuity of treatment of the medical condition or mental illness of the individual.
• The absence of such information or treatment will contribute to a worsening prognosis or an acute medical condition.
• The individual by nature of the severe mental illness has or has had a diminished capacity to fully understand or follow a treatment plan for their medical condition or may become gravely disabled in absence of treatment.
The Helping Families in Mental Health Crisis Act makes it clear that healthcare providers may “listen to information or review medical history provided by family members or other caregivers who may have concerns about the health and well-being of the patient, so the health care provider can factor that information into the patient’s care.”
IMD Exclusion Slightly Ameliorated to End Discrimination Against Seriously Mentally Ill who Need Hospital Care
Background: IMD’s are “Institutes for Mental Disease” colloquially known as state psychiatric hospitals. Likewise any facility, like an adult homes with more than 50% mentally ill are also IMDs. The IMD provision of Medicaid prevents states from getting reimbursed for people 18-64 who need long-term care in these IMDs. That is why states lock the front door of hospitals, open the back, and kick patients out of the hospitals and into the community where Medicaid will pick up 50% of the cost of care. Many of these individuals cannot live in the community and end up in jail or homeless. Rep. Eddie Bernice Johnson (D. TX), and a former head of psychiatric nursing at a VA hospital has been a stellar proponent of eliminating the IMD Exclusion and helping people with the most serious mental illnesses.
The Helping Families in Mental Health Crisis Act allows states to get Medicaid reimbursement for care of adults in IMDs where the facility-wide average length of stay is less than 30 days. It also provides language preventing residential facilities from being declared IMDs. (CK) I believe this only allows amelioration of IMD is GAO scores it cost neutral. (CK)
PROTECTION AND ADVOCAY (P&A, PAIMI, Disability Rights) Returned to Original Mission of Protecting Mentally Ill from Abuse and Neglect
Background: The Protection and Advocacy for Individuals with Mental Illness (PAIMI/P&A) program was set up by Congress with the noble purpose to establish 50 state organizations to protect institutionalized individuals from neglect and abuse. (These frequently go by name of “Disability Rights [Name of State]). The programs moved beyond that purpose and used other language in the legislation to take on the mission of stopping treatment for the seriously ill, lobbying for laws to close hospitals, kicking people out of adult homes and opposing AOT. Many a state mental health director who has tried to improve care, and families of the seriously ill who have tried to facilitate it have found these federally funded lawyers opposing them.
The Helping Families in Mental Health Crisis Act returns PAIMI to it’s original mission of protecting patients against “abuse and neglect.” Outside the legislation “abuse” and “neglect” are defined.
42 USC § 10802:
(1) The term “abuse” means any act or failure to act by an employee of a facility rendering care or treatment which was performed, or which was failed to be performed, knowingly, recklessly, or intentionally, and which caused, or may have caused, injury or death to an individual with mental illness, and includes acts such as—
(A) the rape or sexual assault of an individual with mental illness;
(B) the striking of an individual with mental illness;
(C) the use of excessive force when placing an individual with mental illness in bodily restraints; and
(D) the use of bodily or chemical restraints on an individual with mental illness which is not in compliance with Federal and State laws and regulations.
(5) The term “neglect” means a negligent act or omission by any individual responsible for providing services in a facility rendering care or treatment which caused or may have caused injury or death to a [1] individual with mental illness or which placed a [1] individual with mental illness at risk of injury or death, and includes an act or omission such as the failure to establish or carry out an appropriate individual program plan or treatment plan for a [1] individual with mental illness, the failure to provide adequate nutrition, clothing, or health care to a [1] individual with mental illness, or the failure to provide a safe environment for a [1] individual with mental illness, including the failure to maintain adequate numbers of appropriately trained staff.
The Helping Families in Mental Health Crisis Act requires those who get PAIMI contracts to agree to refrain from “lobbying or retaining a lobbyist for the purpose of influencing a Federal, State, or local governmental entity or officer; and “counseling an individual with a serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of such individual’s caregiver.” Importantly, it also adds a grievance process so state mental health directors, family members and consumers who feel PAIMIs are violating their mission and impeding care can be reported to a third party for investigation.
Eliminates Discrimination in Medicare Against Mentally Ill who Need Long-term Care
Background: Medicare discriminates against those with serious mental illness by imposing a 190 day lifetime cap on inpatient psychiatric hospitalizations.
The Helping Families in Mental Health Crisis Act eliminates the 190 day lifetime cap on inpatient psychiatric hospitalization in Medicare.
Requires Medicaid to Allow Two Services Within Same Day
Background: There is a proscription against Medicaid paying for two services in the same day for certain individuals. So those who go to a clinic can’t see their primary physician and psychiatrist on same day, a particularly bothersome provision in rural areas where people have to travel.
The Helping Families in Mental Health Crisis Act allows payment for two services received in a single day.
Bans Medicaid Programs from Discriminating Against Medications Used to Treat Serious Mental Illness
Background: Many treating authorities are trying to move people off expensive treatments and on to less expensive ones without regard to their efficacy.
The Helping Families in Mental Health Crisis Act protects the most seriously ill. For “major depression, bipolar (manic-depressive) disorder, panic disorder, obsessive-compulsive disorder, schizophrenia, and schizoaffective disorder, a State shall not exclude from coverage or otherwise restrict access to such drugs other than pursuant to a prior authorization program” The bill also requires managed care organizations to cover all mental illness medications.
Strengthens Hospital Discharge Procedures
Background: For many seriously mentally ill, the crack is the system. Hospital responsibility ends at discharge, and community programs have no responsibility for patients who don’t show up.
The Helping Families in Mental Health Crisis Act attempts to make the crack smaller, by requiring (medicare reimbursed?) hospitals to prepare discharge plans and facilitate connection with outpatient treatment for patients they are discharging.
National Institute Of Mental Health
Background: Extensive research shows that most mentally ill seriously mental illn are not violent, but that seriously mentally ill who are not in treatment are as a group more violent than others. Historically, the mental health industry has refused to admit this for fear of causing stigma.
The Helping Families in Mental Health Crisis Act provides $40 million annually for four years specifically for NIMH to start studying violence to self and others plus the Brain Initiative.
Increases Minority Mental Health Workforce
Authorizes fellowships to increase the number of culturally competent behavioral health professionals
Creates Suicide Prevention Technical Assistance Center to Focus on those at High Risk for Suicide.
Background: Most investments in suicide prevention are made based on politics rather science. For example, programs aimed at preventing suicide in children are expanded, even though children are the least likely age group to commit suicide.
The Helping Families in Mental Health Crisis Act will provide grants for “prevention of suicide among all ages, particularly among groups that are at high risk for suicide.”
Establishes Interagency Serious Mental illness Coordinating Agency
Background: The federal government has dramatically expanded its mental health efforts by decalring things such as bad grades, bad marriages, lack of jobs, bullying and cyberbullying as mental illnesses and diverting funds to them. Government should help those who need help the most, not least.
The Helping Families in Mental Health Crisis Act establishes this committee to refocus efforts on the most seriously ill. In addition to those responsible for mental health policy, the Attorney General is on it. Other mandatory members include a judge, a law enforcement officer, and a corrections officials.
Other Provisions
Reports on Best Practices to Train and Certify Peer Support Specialists
Background: “Peer Support” is a program that pays people with mental illness or substance abuse to guide others with it. Peer support has been shown to be a useful program to address substance abuse. For mental illness, there is solid evidence that those paid like it. According to those paid to provide it, those who receive it feel more hopeful. No independent studies show meaningful improvements in important outcomes like homelessness, arrest, incarceration and suicide. No independent studies compare peer support with non-peer support. And no independent studies of peer support report on the effect on those serious mental illness. There is clear evidence the money SAMHSA historically distributed for peer support goes to organizations that lobby against treatments that help the most seriously ill like the availability of hospitals, AOT and the 2013 version of the Helping Families in Mental Health Crisis Act (HR 3717). I.e, Peer support for mental illness has generally had a negative systemic impact even if those who receive it do receive some benefit.
The Helping Families in Mental Health Crisis Act requires the Assistant Secretary to prepare a biennial report on best practices for “training and certifying peer support and establishing and operating programs using peer-support”. It defines a peer support specialist as someone who has “been an active participant in mental health or substance use treatment for at least the preceding 2 years” and “uses his or her recovery from mental illness or substance abuse plus skills learned in formal training, …to work …with individuals with a serious mental illness or a substance use disorder, in consultation with and under the supervision of a licensed mental health or substance use treatment professional.”
Following is a summary of what Mental Illness Policy Org. considers the most important provisions of HFMHCA and a discussion of others. We did not analyze provisions related to children or technology.
SAMHSA Replaced by an Assistant Secretary of Mental Health and Substance Use Disorders
Background: It is well known that the Substance Abuse and Mental Health Services Administration (SAMHSA) has failed to focus it’s efforts on serious mental illness as mandated in the enabling legislation, use science to develop policy, hire anyone with medical expertise, or focus on reducing important metrics like rates of homelessness, arrest, incarceration, suicide, violence or hospitalization in people with mental illness.
The Helping Families in Mental Health Crisis Act replaces SAMHSA and it’s administrator with Assistant Secretary for Mental Health and Substance Use Treatment who must be a licensed Psychiatrist or Clinical Psychologist. This raises the profile of mental health in the government org chart and ensures that the lead policy official for mental health policy knows something about mental illness. The Assistant Secretary will administer responsibilities formerly administered by SAMHSA.
The Helping Families in Mental Health Crisis Act requires the Asst. Sec to focus on important metrics like rates of suicide and attempts, emergency psychiatric hospitalizations, emergency room boarding; arrests, incarcerations, victimization, and homelessness. The bill dramatically tightens the definition of evidence to be used in determining the efficacy of programs. It establishes a coordinating committee to advise the secretary that includes significant representation from criminal justice.
Mental Health Block Grant Applicants Required to Address Serious Mental Illness
Background: Mental Health Block Grants (MHBGs) are roughly $500 million in federal funds allocated to SAMHSA to distribute as “block grants’ to the states. Both SAMHSA and the Block Grants are supposed to serve people with Serious Mental Illness, but SAMHSA gives guidance to the states to divert the money from people with serious mental illness.
The Helping Families in Mental Health Crisis Act requires states applying for block grants to “include a separate description of case management services and provide for activities leading to reduction of rates of suicides, suicide attempts, substance abuse, emergency hospitalizations, incarceration, crimes, arrest, victimization, homelessness, joblessness, medication” and other important outcomes.
Assisted Outpatient Treatment Programs Receive Modest Funding
Background: Assisted Outpatient Treatment (AOT) allows judges to order a small group of seriously mentally ill who already accumulated multiple episodes of arrest, violence and hospitalization as a result of failing to comply with treatment to stay in mandated and monitored treatment while in the community. This has reduced their incarceration, arrest, homelessness and hospitalization by 70% each and saved money for taxpayers by reducing the use of expensive jails and hospitals. In 2013 Rep Murphy inserted a provision in the 2014 Protecting Access to Medicare Act (a/k/a “SGR” or “DocFix”) that provided $15 million annually for AOT.
The Helping Families in Mental Health Crisis Act of 2015 ups the amount provided to states for AOT by $5 million to $20 million annually and extends the grants through 2018. (20% to existing programs and 80% to new programs.) Further, states with an AOT law on their books will receive a 2 percent increase in their block grant funding. (Roughly $10 million annually split between them)
The Helping Families in Mental Health Crisis Act requires the Asst. Sec to measure outcomes in states with AOT which will help strengthen the evidence for it. Relatedly, states with a need for treatment standard will also receive a 2 percent increase in their block grant funding (about $10 million nationally).
HIPAA/FERPA Regulations Slightly Modified to Allow Helpful Disclosures to Caregivers
Background: Parents who provide case management, housing, income support and other services out of love to their children, are prohibited by HIPAA and FERPA from getting information about diagnosis, medications and next appointments of loved ones. Therefore they can’t make sure prescriptions are filled, transportation to appointments arranged and help facilitate compliance. Doctors and mental health programs also falsely claim that HIPAA prevents them from receiving information from family members.
The Helping Families in Mental Health Crisis Act allows an entity normally required to maintain patient confidentiality to share some limited information with “caregivers”. HIPPA disclosure is limited to information about the diagnoses, treatment plans, appointment scheduling, medications, and medication related instructions, but does not include any personal psychotherapy notes. The Helping Families in Mental Health Crisis Act does not put a limit on which FERPA-protected information may be disclosed.
The Helping Families in Mental Health Crisis Act defines “caregivers” as “an immediate family member; someone who assumes primary responsibility for providing a basic need of such individual; a personal representative; someone who can establish a longstanding involvement and is responsible with the individual.”
The Helping Families in Mental Health Crisis Act provides that HIPAA protected information may be disclosed only if the patient is over 18 and has “serious mental Illness” diagnosed by a doctor that results in functional impairment of the individual that “substantially interferes with or limits one or more major life activities of the individual.” HIPAA protected information for people without serious mental illness may not be disclosed. FERPA protected information can be disclosed without those limitations.
Disclosure of information can only be made if all the following conditions are met for HIPAA protected information or the first condition only is met for FERPA protected information.
• Such disclosure is necessary to protect the health, safety, or welfare of the individual or general public.
• The information to be disclosed will be beneficial to the treatment of the individual if that individual has a co-occurring acute or chronic medical illness.
• The information to be disclosed is necessary for the continuity of treatment of the medical condition or mental illness of the individual.
• The absence of such information or treatment will contribute to a worsening prognosis or an acute medical condition.
• The individual by nature of the severe mental illness has or has had a diminished capacity to fully understand or follow a treatment plan for their medical condition or may become gravely disabled in absence of treatment.
The Helping Families in Mental Health Crisis Act makes it clear that healthcare providers may “listen to information or review medical history provided by family members or other caregivers who may have concerns about the health and well-being of the patient, so the health care provider can factor that information into the patient’s care.”
IMD Exclusion Slightly Ameliorated to End Discrimination Against Seriously Mentally Ill who Need Hospital Care
Background: IMD’s are “Institutes for Mental Disease” colloquially known as state psychiatric hospitals. Likewise any facility, like an adult homes with more than 50% mentally ill are also IMDs. The IMD provision of Medicaid prevents states from getting reimbursed for people 18-64 who need long-term care in these IMDs. That is why states lock the front door of hospitals, open the back, and kick patients out of the hospitals and into the community where Medicaid will pick up 50% of the cost of care. Many of these individuals cannot live in the community and end up in jail or homeless. Rep. Eddie Bernice Johnson (D. TX), and a former head of psychiatric nursing at a VA hospital has been a stellar proponent of eliminating the IMD Exclusion and helping people with the most serious mental illnesses.
The Helping Families in Mental Health Crisis Act allows states to get Medicaid reimbursement for care of adults in IMDs where the facility-wide average length of stay is less than 30 days. It also provides language preventing residential facilities from being declared IMDs. (CK) I believe this only allows amelioration of IMD is GAO scores it cost neutral. (CK)
PROTECTION AND ADVOCAY (P&A, PAIMI, Disability Rights) Returned to Original Mission of Protecting Mentally Ill from Abuse and Neglect
Background: The Protection and Advocacy for Individuals with Mental Illness (PAIMI/P&A) program was set up by Congress with the noble purpose to establish 50 state organizations to protect institutionalized individuals from neglect and abuse. (These frequently go by name of “Disability Rights [Name of State]). The programs moved beyond that purpose and used other language in the legislation to take on the mission of stopping treatment for the seriously ill, lobbying for laws to close hospitals, kicking people out of adult homes and opposing AOT. Many a state mental health director who has tried to improve care, and families of the seriously ill who have tried to facilitate it have found these federally funded lawyers opposing them.
The Helping Families in Mental Health Crisis Act returns PAIMI to it’s original mission of protecting patients against “abuse and neglect.” Outside the legislation “abuse” and “neglect” are defined.
42 USC § 10802:
(1) The term “abuse” means any act or failure to act by an employee of a facility rendering care or treatment which was performed, or which was failed to be performed, knowingly, recklessly, or intentionally, and which caused, or may have caused, injury or death to an individual with mental illness, and includes acts such as—
(A) the rape or sexual assault of an individual with mental illness;
(B) the striking of an individual with mental illness;
(C) the use of excessive force when placing an individual with mental illness in bodily restraints; and
(D) the use of bodily or chemical restraints on an individual with mental illness which is not in compliance with Federal and State laws and regulations.
(5) The term “neglect” means a negligent act or omission by any individual responsible for providing services in a facility rendering care or treatment which caused or may have caused injury or death to a [1] individual with mental illness or which placed a [1] individual with mental illness at risk of injury or death, and includes an act or omission such as the failure to establish or carry out an appropriate individual program plan or treatment plan for a [1] individual with mental illness, the failure to provide adequate nutrition, clothing, or health care to a [1] individual with mental illness, or the failure to provide a safe environment for a [1] individual with mental illness, including the failure to maintain adequate numbers of appropriately trained staff.
The Helping Families in Mental Health Crisis Act requires those who get PAIMI contracts to agree to refrain from “lobbying or retaining a lobbyist for the purpose of influencing a Federal, State, or local governmental entity or officer; and “counseling an individual with a serious mental illness who lacks insight into their condition on refusing medical treatment or acting against the wishes of such individual’s caregiver.” Importantly, it also adds a grievance process so state mental health directors, family members and consumers who feel PAIMIs are violating their mission and impeding care can be reported to a third party for investigation.
Eliminates Discrimination in Medicare Against Mentally Ill who Need Long-term Care
Background: Medicare discriminates against those with serious mental illness by imposing a 190 day lifetime cap on inpatient psychiatric hospitalizations.
The Helping Families in Mental Health Crisis Act eliminates the 190 day lifetime cap on inpatient psychiatric hospitalization in Medicare.
Requires Medicaid to Allow Two Services Within Same Day
Background: There is a proscription against Medicaid paying for two services in the same day for certain individuals. So those who go to a clinic can’t see their primary physician and psychiatrist on same day, a particularly bothersome provision in rural areas where people have to travel.
The Helping Families in Mental Health Crisis Act allows payment for two services received in a single day.
Bans Medicaid Programs from Discriminating Against Medications Used to Treat Serious Mental Illness
Background: Many treating authorities are trying to move people off expensive treatments and on to less expensive ones without regard to their efficacy.
The Helping Families in Mental Health Crisis Act protects the most seriously ill. For “major depression, bipolar (manic-depressive) disorder, panic disorder, obsessive-compulsive disorder, schizophrenia, and schizoaffective disorder, a State shall not exclude from coverage or otherwise restrict access to such drugs other than pursuant to a prior authorization program” The bill also requires managed care organizations to cover all mental illness medications.
Strengthens Hospital Discharge Procedures
Background: For many seriously mentally ill, the crack is the system. Hospital responsibility ends at discharge, and community programs have no responsibility for patients who don’t show up.
The Helping Families in Mental Health Crisis Act attempts to make the crack smaller, by requiring (medicare reimbursed?) hospitals to prepare discharge plans and facilitate connection with outpatient treatment for patients they are discharging.
National Institute Of Mental Health
Background: Extensive research shows that most mentally ill seriously mental illn are not violent, but that seriously mentally ill who are not in treatment are as a group more violent than others. Historically, the mental health industry has refused to admit this for fear of causing stigma.
The Helping Families in Mental Health Crisis Act provides $40 million annually for four years specifically for NIMH to start studying violence to self and others plus the Brain Initiative.
Increases Minority Mental Health Workforce
Authorizes fellowships to increase the number of culturally competent behavioral health professionals
Creates Suicide Prevention Technical Assistance Center to Focus on those at High Risk for Suicide.
Background: Most investments in suicide prevention are made based on politics rather science. For example, programs aimed at preventing suicide in children are expanded, even though children are the least likely age group to commit suicide.
The Helping Families in Mental Health Crisis Act will provide grants for “prevention of suicide among all ages, particularly among groups that are at high risk for suicide.”
Establishes Interagency Serious Mental illness Coordinating Agency
Background: The federal government has dramatically expanded its mental health efforts by decalring things such as bad grades, bad marriages, lack of jobs, bullying and cyberbullying as mental illnesses and diverting funds to them. Government should help those who need help the most, not least.
The Helping Families in Mental Health Crisis Act establishes this committee to refocus efforts on the most seriously ill. In addition to those responsible for mental health policy, the Attorney General is on it. Other mandatory members include a judge, a law enforcement officer, and a corrections officials.
Other Provisions
Reports on Best Practices to Train and Certify Peer Support Specialists
Background: “Peer Support” is a program that pays people with mental illness or substance abuse to guide others with it. Peer support has been shown to be a useful program to address substance abuse. For mental illness, there is solid evidence that those paid like it. According to those paid to provide it, those who receive it feel more hopeful. No independent studies show meaningful improvements in important outcomes like homelessness, arrest, incarceration and suicide. No independent studies compare peer support with non-peer support. And no independent studies of peer support report on the effect on those serious mental illness. There is clear evidence the money SAMHSA historically distributed for peer support goes to organizations that lobby against treatments that help the most seriously ill like the availability of hospitals, AOT and the 2013 version of the Helping Families in Mental Health Crisis Act (HR 3717). I.e, Peer support for mental illness has generally had a negative systemic impact even if those who receive it do receive some benefit.
The Helping Families in Mental Health Crisis Act requires the Assistant Secretary to prepare a biennial report on best practices for “training and certifying peer support and establishing and operating programs using peer-support”. It defines a peer support specialist as someone who has “been an active participant in mental health or substance use treatment for at least the preceding 2 years” and “uses his or her recovery from mental illness or substance abuse plus skills learned in formal training, …to work …with individuals with a serious mental illness or a substance use disorder, in consultation with and under the supervision of a licensed mental health or substance use treatment professional.”
Thursday, May 21, 2015
Ask your state mental health director to apply for these federal funds to expand Assisted Outpatient Treatment (AOT)
(June/July 2015)
Thanks to Rep. Tim Murphy, there is new federal funding available that can be used to expand access to assisted outpatient treatment. Following is the draft of a letter you should
send your state mental health director, local mental health director and share
with anyone who is operating an AOT program in your state encouraging them to apply for the funds.
Name of Mental Health Director
Title
Name of Dept
Street
City, State, Zip
Re: Apply for Federal Certified Community
Behavioral Health Clinic Funding and use it expand availability of Assisted
Outpatient Treatment
Dear name of state mental health
director:
The “Protecting Access to Medicare Act of 2014”
(H.R. 4302, 2013-2014) established funding for eight states to create two-year Demonstration
Projects allowing Certified Community Behavioral Health Clinics (CCBHCs) to be reimbursed
prospectively to help people with serious mental illness. As the result of
action by Rep. Tim Murphy, Section 223(d)(4(iii) of the
law (P.L. 113-93) states that
“preference should be given to those (Demonstration Project applicants) that “will improve availability of, access to, and participation in Assisted Outpatient
mental health treatment in the State.” The bill is at
On June 8, SAMHSA is hosting a pre-application webinar
to inform you how to apply for funding for the Demonstration Programs. See http://www.samhsa.gov/sites/default/files/sm-16-001-webinar-notification_0.pdf. Your application must be submitted by August 5,
2015. Comprehensive information on all of this is at http://www.samhsa.gov/grants/grant-announcements/sm-16-001.
We strongly urge you to apply for these funds
and to specifically use them to increase the availability of Assisted
Outpatient Treatment (AOT) in (name of state).
Thank you very much.
Name
Cc: Local Mental Health Director
Local Programs with AOT program
Tuesday, April 14, 2015
Bills to Help People with Mental Illness in California Pass Mental Health Committee
(April 14, 2015) Several California bills proposed by Assemblymembers Eggman, Waldron and Brown passed the mental health committee today and go to other committees. The first two improve Laura's Law, California's Assisted Outpatient Treatment (AOT) program. It allows courts to order noncompliant persons with mental illness who have already become violent or needlessly hospitalized as a result of going off treatment, to stay in six months of mandated and monitored treatment while they live in the community. It's been very successful in counties and states that use it. The following summaries are based on bills before they were amended by the committees, so this may not be entirely accurate. Check the actual bills.
- AB1193 (Eggman) eliminates the requirement that counties vote to implement Laura's Law and eliminates the requirement that counties certify that voluntary programs are not being cut. Counties that don’t want Laura’s Law have to vote not to have it, rather than to have it as before. It also allows superior court judges to request a Laura’s Law petition be filed for individuals who come before the court. It extends Laura's Law until 2022.
- AB 59 (Waldron) supposedly complements AB 1193. I believe it removes the sunset (whereas AB 1193 moved it until 2022, but maybe that was one of the provisions removed during the meeting.) It also removes the requirement that counties certify that no voluntary programs are cut before implementing Laura's Law. That certification requirement basically required counties to maintain failed programs before they could implement Laura's Law. The bill originally would have authorized the court to order a person to obtain assisted outpatient treatment for up to 12 months, rather than 6 months as is now the case. But that provision was removed at last minute. It allows hospitals to petition for AOT for people who are involuntarily committed to inpatient care (5150) and who are being released. That is a good idea as there are people who are involuntarily committed who could leave the hospital if Laura's Law was available to them.
Two other bills, not related to Laura's Law, but that help the seriously ill also passed the mental health committee and move to other committees.
- AB1194 (Eggman) allows courts to consider past history when deciding when to 5150 (involuntarily commit) someone. Past history is best predictor of future behavior (l,e someone who went off meds in past, and became violent is more likely to become violent again if they again go off meds). AB1194 now goes to appropriations.
- AB 1237 (Brown) passed mental health committee and goes to next committee. It requires state hospital system to create pool of psychiatrists to evaluate people who are found mentally incompetent to stand trial or who has been found to be insane at the time he or she committed the crime.
Thursday, March 12, 2015
Darrell Steinberg Report on California Mental Health Services Act (MHSA) Wrong
Darrell Steinberg and the California Mental Health Directors who distribute Mental Health Services Act funds just released their own MHSA report saying MHSA is working fine and they are doing a good job. It got press in SacBee and LA Times and others.
MHSA does help some people with serious mental illness. But following was what was left out of the report
- 100% of the funds go to the mentally ill who are well enough to recognize they are ill. The homeless psychotic screaming at voices and eating out of dumpsters are not.
- There was no info about the diagnosis of those being served in the report. MHSA is legislatively limited to helping those with “serious mental illness”. The funds are going to others who are easier to serve, hence the good numbers.
- There was also no mention of the MHSA waste and how Mental Health Services Oversight and Accountability regulations divert Prevention and Early Intervention funds to those without serious mental illness.
- There was no mention of oversight regulators diverting MHSA funds to their own programs.
- There was no mention of funds being given to groups that want to sue to stop counties from using Laura's Law to help people with serious mental illness.
Learn about Laura's Law at http://mentalillnesspolicy.org/states/lauraslawindex.html
Learn about waste and fraud in Mental Health Services Act at http://mentalillnesspolicy.org/states/california/mhsa/mental_health_services_act_mhsa.html
Learn about serious mental illness at http://mentalillnesspolicy.org
Subscribe to:
Posts (Atom)