Thursday, October 27, 2016

White House Parity Task Force Report Leaves Out Seriously Mentally Ill

Federal Parity Task Force Report Fails to End Federal Discrimination Against the Seriously Mentally Ill that is part of Medicaid.

The Mental Health and Substance Use Disorder Task Force report issued by the White House today shamefully fails to end the federal government's own massive discrimination against people with serious mental illness that is embedded in Medicaid. The Medicaid Institutes for Mental Disease (IMD) provision prevents states from receiving federal reimbursement for seriously mentally ill individuals between 18 and 64 who need long-term psychiatric hospital care. This limitation applies only applies to the mentally ill and parity can not be achieved without eliminating it. If you have a disease in any organ and are Medicaid-eligible, Medicaid pays with a single exception: individuals who have a mental illness in their brain.  

The IMD Exclusion causes states to lock the front door of psychiatric hospitals and kick the mentally ill out the back. The failure to eliminate the IMD Exclusion will cause more individuals with disorders like schizophrenia and bipolar disorder to be offloaded to jails, shelters, prisons and morgues. The Task Force should have called for ending this injustice. 

We do appreciate the recommendation of the Task Force to end the 190-day limit on inpatient care for the seriously ill that is part of Medicare Part A and urge the President to act on it immediately.

Background Info: Op-ed by DJ Jaffe in Washington Post
http://mentalillnesspolicy.org/media/bestmedia/imd-exclusion-washington-post.html

Tuesday, October 25, 2016

NYC Health & Hospitals Corp Kicked Mental Health Advocate (Me) Out of Meeting.

Last night (October 24) I was prevented from attending the 2016 Annual PUBLIC meeting of the Harlem Community Advisory board to NYC Health and Hospitals Corp. It was in the second floor auditorium of Harlem Hospital.

The annual meeting was entitled, “Understanding the Roadmap to Mental Health.” The word “roadmap” refers to ThriveNYC, the $800 million NYC mental health plan. Since I think it is failing because it funds pop-psychology and useless programs and generally ignores serious mental illness, I thought attendees would be a good audience to share my point of view with.
So I made up a package of three handouts: a one-pager on why I believe ThriveNYC is failing, a copy of the critical article on ThriveNYC that Seth Baron wrote for City Journal and a fact sheet containing the research on Kendra’s Law, a useful program that Dr. Gary Belkin, the director of mental health services in NYC refuses to make available to most who could benefit from it.
As I usually do, I showed up early (I knew several people who are members of Harlem NAMI, as am I) and started handing out my fact sheet to those few who were already seated. This all took place before the event started.
A man came over and told me I couldn’t hand out literature. I explained that it was directly related to the purpose of this PUBLIC meeting. He said I couldn’t and asked me to leave. I was pretty sure I was within my rights, and I said that at a public meeting all sides should be allowed to present their point of view. He said, “We are trying to build support for the Roadmap and you want to say it doesn’t work so you have to leave” 
While I was gathering my belongings a woman who identified herself as Detective Fleming came over, and said Mr. Cook said I had to leave. I asked who that was and she said he was (I think) a hospital (Community Affairs?) Director. I said that I was surprised as a police officer that she takes orders from him, versus someone at NYPD, but she said she is a detective, but did not work for NYPD, she works for the hospital and escorted me out. Note that I was very calm and so were they. We had a disagreement, that is all, and they said they had the right to force me to leave, and I didn’t know enough to know if they are right or not.
Guards posted outside Harlem Hospital to make sure no literature questioning efficacy of ThriveNYC was given to participants at public hearing on Thrive NYC (10.24.27)

So I left and started handing out my literature on the street to people who were going into Harlem Hospital. I would ask, “Are you going to the mental health meeting” and if they answered in the affirmative, I handed them literature. At that point Detective Fleming and a big guy who I took to be a boss (Cook?) and a little guard came out and told me I couldn’t hand out literature in front of the hospital. I said, respectfully, that I am ex-hippie who has participated in many protests and I am pretty sure I am allowed to hand out literature on the sidewalk. The big guy tried to mildly intimidate me and said, “Do you want me to ratchet this up.” And at that point I took a big breath and said, “yes, I think I do.” (In my mind, I was thinking, if he wants to escalate this, he will likely call police and if they tell me I can't hand out literature, I would have to take their word for it.) He went inside-I thought to call police-and the other security guards stayed behind to watch me and tell me repeatedly I had to leave. I didn’t. I continued. And they continued to tell me I had to leave. I must have been right, because even though they stayed around watching me, continually saying I could not hand out literature, they did nothing when I did.
I was frankly very surprised. It did get the adrenaline going a little a bit. I had thoughts about a night in jail, something that hasn't happened to me since the Vietnam War Protests in DC. 

I think they were wrong to try to shut down free-speech, especially, as I wasn’t even saying anything, just handing out literature. I don’t think it was part of any cabal, although frankly I don’t understand it, as handing out literature at a public meeting is fairly mom and apple pie. 

I do think it explains one important reason why ThriveNYC is failing to serve the seriously mentally ill. First Lady Chirlane McCray, Deputy Mayor Richard Buery and others are only hearing from mental "health" officials, mental "health" industry reps, and mental "health" advocates. 
In fact, they usually won't even use the term "mental illness" as if it were a pejorative. 
 I don't think McCray or Buery had anything to do with me being kept out. T
he most likely reason officials kept me out was because they wanted to  avoid upsetting them by having it get back to them that someone questioned their program publicly. McCray and Buery are not hearing from those of us who care about the seriously mentally "ill". The mental health industry loves to receive money from the city without any obligation to serve the seriously ill. And McCray and Buery's ThriveNYC largely gives it to them.

Read thoughtful articles about ThriveNYC failing the most seriously ill here or here and here

NYC Health & Hospitals Corp Kicked Mental Health Advocate (Me) Out of Meeting.

Last night (October 24) I got kicked out of the 2016 Annual PUBLIC meeting of the Harlem Community Advisory board to NYC Health and Hospitals Corp. It was in the second floor auditorium of Harlem Hospital.

The annual meeting was entitled, “Understanding the Roadmap to Mental Health.” The word “roadmap” refers to ThriveNYC, the $800 million NYC mental health plan. Since I think it is failing because it funds pop-psychology and useless programs and generally ignores serious mental illness, I thought attendees would be a good audience to share my point of view with.
So I made up a package of three handouts: a one-pager on why I believe ThriveNYC is failing, a copy of the critical article on ThriveNYC that Seth Baron wrote for City Journal and a fact sheet containing the research on Kendra’s Law.  
As I usually do, I showed up early (I knew several people who are members of Harlem NAMI, as am I) and started handing out my fact sheet to those few who were already seated. This all took place before the event started.
A man came over and told me I couldn’t hand out literature. I explained that it was directly related to the purpose of this PUBLIC meeting. He said I couldn’t and asked me to leave. I was pretty sure I was within my rights, and I said that at a public meeting all sides should be allowed to present their point of view. He said, “We are trying to build support for the Roadmap and you want to say it doesn’t work so you have to leave” 
While I was gathering my belongings a woman who identified herself as Detective Fleming came over, and said Mr. Cook said I had to leave. I asked who that was and she said he was (I think) a hospital (Community Affairs?) Director. I said that I was surprised as a police officer that she takes orders from him, versus someone at NYPD, but she said she is a detective, but did not work for NYPD, she works for the hospital and escorted me out. Note that I was very calm and so were they. We had a disagreement, that is all, and they said they had the right to force me to leave, and I didn’t know enough to know if they are right or not.
Guards posted outside Harlem Hospital to make sure no literature questioning efficacy of ThriveNYC was given to participants at public hearing on Thrive NYC (10.24.27)

So I left and started handing out my literature on the street to people who were going into Harlem Hospital. I would ask, “Are you going to the mental health meeting” and if they answered in the affirmative, I handed them literature. At that point Detective Fleming and a big guy who I took to be a boss (Cook?) and a little guard came out and told me I couldn’t hand out literature in front of the hospital. I said, respectfully, that I am ex-hippie who has participated in many protests and I am pretty sure I am allowed to hand out literature on the sidewalk. The big guy tried to mildly intimidate me and said, “Do you want me to ratchet this up.” And at that point I took a big breath and said, “yes, I think I do.” (In my mind, I was thinking, if he wants to escalate this, he will likely call police and if they tell me I can't hand out literature, I would have to take their word for it.) He went inside-I thought to call police-and the other security guards stayed behind to watch me and tell me repeatedly I had to leave. I didn’t. I continued. And they continued to tell me I had to leave. I must have been right, because even though they stayed around watching me, continually saying I could not hand out literature, they did nothing when I did.
I was frankly very surprised. It did get the adrenaline going a little a bit. I had thoughts about a night in jail, something that hasn't happened to me since the Vietnam War Protests in DC. 

I think they were wrong to try to shut down free-speech, especially, as I wasn’t even saying anything, just handing out literature. I don’t think it was part of any cabal, although frankly I don’t understand it, as handing out literature at a public meeting is fairly mom and apple pie. 

I do think it explains one important reason why ThriveNYC is failing to serve the seriously mentally ill. First Lady Chirlane McCray, Deputy Mayor Richard Buery and others are only hearing from mental "health" officials, mental "health" industry reps, and mental "health" advocates. 
In fact, they usually won't even use the term "mental illness" as if it were a pejorative. 
 I don't think McCray or Buery had anything to do with me being kept out. T
he most likely reason officials kept me out was because they wanted to  avoid upsetting them by having it get back to them that someone questioned their program publicly. McCray and Buery are not hearing from those of us who care about the seriously mentally "ill". The mental health industry loves to receive money from the city without any obligation to serve the seriously ill. And McCray and Buery's ThriveNYC largely gives it to them.

Read thoughtful articles about ThriveNYC failing the most seriously ill here or here and here

Monday, October 24, 2016

NYC's New Helpline Not What Seriously Mentally Ill Really Need

On Oct. 24, with great fanfare, NYC First Lady Chirlane McCray announced a new HelpLine for Mentally Ill (Call 1-888-NYC-WELL or text, "WELL" to 65173). When pressed by a reporter, Ms. McCray admitted that it was little more than 1 800 LIFENET with the addition of text capability.

Ms. McCray is widely hailed by the mental health industry for introducing THRIVE/NYC an $800 million mental health plan. But it largely ignores the seriously mentally ill.



WHY THRIVE/NYC IS FAILING

IT THROWS MONEY HERE[1]
THAT SHOULD BE USED HERE

Evidence
Mental Health First Aid (MHFA)
Peer Support
Assisted Outpatient Treatment[2]
Hospitals
Housing
Cuts Homelessness
No

No
Yes
Yes
Yes
Cuts Arrest
No
No
Yes
Yes
Yes
Cuts Incarceration
No
No
Yes
Yes
Yes
Cuts Suicide
No
No
Yes
Yes
Yes
Cuts hospitalization
No
No
Yes
Yes
Yes

THRIVE/NYC shuns the seriously ill and focuses on “improving mental wellness” in all others.
  • ·      Thrive/NYC funds “prevention” but serious mental illness can’t be prevented because we don’t know what causes it.
  • ·      Thrive/NYC funds “early intervention” but we can’t predict who will become seriously ill until after the symptoms first appear.
  • ·      Thrive/NYC funds “trauma,” but trauma is not a mental illness. Everyone loses a loved one, loses a job, experiences accidents, etc. PTSD is mental illness and even that runs from mild to severe.
  • ·      Thrive/NYC diverts mental health funds to programs that do not help seriously mentally ill.


NYC needs an “all hands on deck” approach to reducing homelessness, arrest, incarceration, suicide, and hospitalization of seriously mentally ill. Mental Illness Policy Org promotes ideas to accomplish that. Join us on Facebook and Twitter and subscribe to our email list at http://bit.ly/2eKarUd

Here is an article that appeared in City Journal that got it right. Also read this one in Daily News


De Blasio’s Mental-Health Blindspot

By Seth Barron (City Journal Online 10/20/16)


On Tuesday, an NYPD sergeant shot and killed 66-year-old Deborah Danner, an emotionally disturbed woman who attacked officers, first with a pair of scissors and then with a baseball bat. Mayor Bill de Blasio and police commissioner James O’Neill wasted no time blaming the sergeant for not following correct police protocol for responding to mentally distressed individuals. It may well be the case that the responding officers made serious errors. It may be that the sergeant’s actions were criminal. But the real mistake was the city’s Department of Health and Mental Hygiene’s neglect of Danner’s serious mental illness.
Danner’s case was known to the city. Her sister, with whom she lived, was Danner’s legal guardian, and the NYPD had been called to their house many times. Like many seriously mentally ill individuals, Danner had cycled through the city’s police-medical complex, and was apparently non-compliant with her medical regimen—that is, she didn’t take her anti-psychotic medicine as prescribed. “It’s the classic situation: someone is supposed to take meds and they go off their meds,” de Blasio said at a press conference. “Because of their illness they choose not to take their meds. Once they don’t take their meds it is very hard to get them to engage another kind of treatment.”   
Listening to the mayor, one would think that the paradox he outlined has never been addressed before. But New York, like almost every state, has a robust set of laws known generally as assisted outpatient therapy (AOT). Locally, the statute is known as “Kendra’s Law.” It has proven effective at keeping the mentally ill out of hospitals and shelters and promoting compliance with doctor’s orders. Kendra’s Law covers cases where a non-compliant and seriously mentally ill individual has previously been hospitalized, and is judicially and medically judged to pose a danger to himself or others. The law provides for a six-month period of supervision, during which the subject must comply with treatment or face possible commitment to a hospital. This rarely happens. 
Kendra’s Law is remarkably successful at helping the seriously mentally ill live relatively stable lives. The statistics are stunning: violent or harmful behaviors decrease by 44 percent; hospitalizations decrease by 77 percent; drug and alcohol abuse decrease by half. Patients report high levels of satisfaction with their participation in AOT, and the costs of care decline substantially, because outpatient treatment is so much cheaper—in financial and human terms—than incarceration or hospitalization.
Despite AOT’s track record of success, New York State rarely chooses to apply Kendra’s Law, even in seemingly obvious cases like Deborah Danner’s. Liberal critics of involuntary psychiatric commitment, still shuddering from the 1972 Willowbrook exposé, argue that any hint of coercive intervention is a violation of the civil liberties of the mentally ill. Meanwhile, the mental-health industry prefers to focus on mental illness as a public-health problem, like venereal disease or typhus. Publicity campaigns advise people on how to identify the signs of depression in themselves or their associates, or warn about the problem of stigmatizing mental illness. This epidemiological approach to mental illness fails because untreated schizophrenia is not contagious, nor is it hard to identify.
Thousands of homeless or incarcerated mentally ill New Yorkers aren’t living on the streets or in Rikers Island jail because they fear the stigma of mental illness. Rather, the city’s mental-health establishment has chosen not to deal seriously with their care.  
De Blasio speaks magnanimously about his grand approach to treating mental illness through his ThriveNYC plan, but that plan includes virtually nothing for the seriously mentally ill. Instead, the mayor is spending millions of dollars on feel-good advertising campaigns promoting peer counseling and awareness. His wife, Chirlane McCray, announced a collaboration this week between ThriveNYC and Tumblr, where people will be encouraged to submit quilt patches representing “a creative expression around changing the conversation around mental health and an individual’s relationship with mental illness.” 
Awareness isn’t the most pressing issue regarding the mentally ill in New York City. New Yorkers are already aware of the many suffering people in their midst. By making the police take up the slack for the city’s failed mental-health policy, de Blasio is being cynical and careless. Kendra’s Law is a working solution to the problems of people like Deborah Danner, but the mayor refuses to use it.





[1] MHFA Research at http://mentalillnesspolicy.org/samhsa/mental-health-first-aid-fails.html. Peer support studies showing no benefit beyond ordinary care: Cochrane Collaborative, “Consumer-Providers of Care for Adult Clients of Statutory Mental Health Services." American Psychiatric Association “Guideline Watch: Practice Guideline for the Treatment of Patients with Schizophrenia.” "BMC Psychiatry, A Systematic Review and Meta-Analysis of Randomised Controlled Trials of Peer Support for People with Severe Mental Illness.”  
[2] Assisted Outpatient Research at http://mentalillnesspolicy.org/national-studies/aotworks.pdf