Showing posts with label HIPPA. Show all posts
Showing posts with label HIPPA. Show all posts

Thursday, September 19, 2013

Rep. Tim Murphy Announces Important Mental Health Legislation

This is big news.

Rep Tim Murphy (R. PA) is a former child psychologist, and head of the Mental "Health" Caucus. In spite of that,  he totally gets serious mental "illness" in adults and what the important versus tangential issues are.  He is as good as a Wellstone or a Domenici, and better than a Kennedy (who tended to focus on mental 'health' versus mental 'illness')

Rep. Tim Murphy has held extensive hearings where he listened to others focused on the most seriously ill including Dr. E. Fuller Torrey, Sally Satel, Joe Bruce , Ed Kelly. He also received extensive input from consumers around the country who contacted him. He  announced the results of his hearings today and the legislation he intends proposing.  It includes preserving hospitals, AOT (a/k/a Kendra's Law), revising HIPPA Handcuffs ( so families can get the info they need to help mentally ill loved ones), reigning in SAMHSA's anti-treatment activities , increasing police training, increasing NIMH budget for serious mental illness, and other key issues. I am very excited. 

 I am no Washington Insider, so I have no knowledge if it will fly or not. But at least someone is focused on right issues, not just PC tangential ones. Please support these efforts. He is totally on the right track. His press release and link to the floor speech follows: (Read more)

Wednesday, July 18, 2012

Federal Mental Health Funds Fail To Reach Mentally Ill


Role of Federal Government’s Attempts to Improve Services
for Individuals with Serious Mental Illness
E. Fuller Torrey, MD

(Note: The following shows how various federal funding streams for mental "health" fail to reach people with mental "illness")

1963, Community Mental Health Centers (CMHC) Act:  The passage of this legislation effectively shifted responsibility for funding public mental illness services from the states to the federal government, thus reversing a policy that had existed for more than a century. NIMH paid the new federal funds directly to local Community Mental Health Centers, thus bypassing state governments. Prior to 1963 states were held responsible for the quality of those services; since 1963 nobody claims responsibility. The CMHC Act shifted the main focus of treatment from the state mental hospitals to the new CMHCs, but almost no planning took place regarding follow-up care for the seriously mentally ill patients being discharged from the state hospitals. The 1963 CMHC Act was the beginning of the increase of mentally ill persons becoming homeless, incarcerated in jails and prisons, etc.

1965, Institutions for Mental Diseases Medicaid exclusion: When Medicaid was enacted in 1965 the federal government was afraid that states would use it to cover the costs of mentally ill individuals in state mental hospitals so these hospitals were excluded from Medicaid coverage. This was the Institutions for Mental Diseases (IMD) exclusion. However, since Medicaid did cover these same patients if they were hospitalized on the psychiatric ward of a general hospital or living in nursing homes or group homes, the IMD exclusion created a major incentive for states to empty the state hospitals, thus shifting most state costs to federal Medicaid. States had, and still have little incentive to place patients in appropriate community settings or to follow-up and insure that they receive continuing care; the fiscal reward comes simply from emptying the state hospitals. The IMD exclusion has been the single largest reason why deinstitutionalization has failed so abysmally.
Reference: Geller, J.L. Excluding institutions for mental disease from federal reimbursement for services: strategy or tragedy? Psychiatric Services 2000; 51: 1397-1403.

1986, Protection and Advocacy for Individuals with Mental Illness Act: Under Senator Lowell Weicker’s sponsorship, this legislation set up a federal program to fund independent state agencies to investigate allegations of abuse or neglect of mentally ill or disabled persons residing in mental institutions. Widely referred to as the Protection and Advocacy (P&A) program, it has been administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) under the Department of Health and Human Services. As soon as the P&A program was enacted it was taken over by civil rights ideologues who believed that no mentally ill person, no matter how disabled or psychotic, should even be involuntarily hospitalized or medicated. Thus P&A programs in many states have assumed a function of protecting patients from treatment, rather than insuring that they receive appropriate treatment. The federal government has made no efforts to correct this well-intentioned-program-gone-astray, and in fact SAMHSA has encouraged it. The tragic consequences of the P&A program were highlighted by the Wall Street Journal on August 16, 2008, describing how P&A workers in Maine insisted on the discharge of a psychotic young man from the state hospital despite the objections of the treating physicians and his family; he went home and killed his mother with an axe. Others have described how P&A programs, in clear violation of the law, “have engaged in federally prohibited lobby efforts and how they have tried to defeat proposed legislation, some of which would actually benefit their clients.”
Reference: Peters, AJ. Lawyers who break the law: What Congress can do to prevent mental health patient advocates from violating federal legislation. Oregon Law Review 2010; 89: 133-173.

1990, American with Disabilities Act: Another well-meaning federal program, the American with Disabilities Act (ADA) was an attempt to prohibit discrimination based on disability, which was officially defined as “a physical or mental impairment that substantially limits a major life activity.” Thus under the ADA disabled people could not be discriminated against, for example, in hiring, promotion or termination, and employers were expected to make “reasonable accommodation” for disabled employees. The consequences of the ADA have been exactly the opposite of what was intended. Employers, fearful of endless litigation, simply stopped hiring disabled workers. In recent years the ADA has also been used by the Department of Justice to demand that state psychiatric hospitals discharge patients to live in “the least restrictive alternative” in the community. For example, in April 2011, the Department of Justice sued New Hampshire. In many cases moving patients from a state hospital to a nursing home or a group home in a crime-ridden neighborhood is just as or more restrictive as a state hospital, but the former is regarded as more acceptable to the federal government because the patients are “in the community.”
Reference: Olson, W. Under the ADA, we may all be disabled. Wall Street Journal, May 17, 1999.

1996, Health Insurance Portability and Accountability Act (HIPPA): This was an attempt to protect the privacy of an individuals’ health information and medical records; people who disclose such information without the consent of the individual involved can be fined up to $25,000 per year. HIPPA is widely regarded as having markedly reduced the information available to families as they attempt to get treatment for seriously mentally ill family members. This was recently illustrated by the New York Times Magazine cover story about a man with bipolar disorder. Blatantly psychotic, the family finally got him hospitalized but then was unable to get any information, even that he was in the hospital to which they had had him admitted:
“It took a week just to get the social worker assigned to his case on the phone. Although I had been sitting right next to my father at PESS when he was told where he would be transferred, privacy laws prohibited the nurses at the new facility from even confirming, without his written consent, that he had been admitted. I asked if someone could tell him we called and have him sign a consent form so that we could speak with his doctor or social worker.
Yes, I was told, he would be given a consent form — if he was there, which again they would not confirm or deny.
Eventually one nurse took pity and told us that he had indeed filled out the form but had granted access only to Barack Obama and Duke Ellington.”
Such examples are the rule under HIPPA, not the exception.
Reference: Interlandi, J. Love and commitment: What it takes to put your father away in a mental hospital. New York Times Magazine, June 24, 2012, pp. 26-47.

Thus, almost everything the federal government has attempted to do legislatively has made the problems associated with serious mental illness worse rather than better. And if anyone has any lingering doubts about the ability of the federal government to improve matters, look closely at the federal agency whose official mission is to reduce the “impact of substance abuse and mental illness on America’s communities.” This is the Substance Abuse and Mental Health Services Administration (SAMHSA), a $3.6 billion component of the Department of Health and Human Services. It has 537 federal employees whose average salary is $107,760. Its current three-year plan, a 41,804 word document entitled “Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014,” does not even mention schizophrenia or bipolar disorder because, in fact, SAMHSA has no interest in serious mental illnesses. What does interest SAMHSA are producing free coloring books and sticker sets for children, such as their “Mental Well-Being Sticker Sets,” and producing a musical for SAMHSA staff to celebrate World AIDS Day (cost of musical: $83,625). SAMHSA also gives away lots of money. It gives $70,000 a year to organizations in California and Pennsylvania that have lobbied against legislation making it easier to treat seriously mentally ill individuals. And it gives $330,000 a year to an organization in Massachusetts whose director claims that “the covert mission of the mental health system…is social control.” Indeed, SAMHSA has been described as “a federal health agency distinguished by the fact that the health of its clients would improve if it went out of business.”
Reference: Torrey, EF. Bureaucratic insanity: The federal agency that wastes money while undermining public health. National Review, June 20, 2011, pp. 25-26.

Conclusion: The track record of the federal government in its attempts to improve services for individuals with serious mental illnesses is a record of well-intentioned programs which have made the problem worse, not better. Rarely in the history of American government have programs conceived with such good intentions produced such bad results.

Friday, March 30, 2012

Connecticut tries to help treatment providers hear from parents of people with mental illness

A big problem that people with serious mental illness have in getting the best possible care, is the treatment providers rarely have complete information, and many treatment providers specifically reject sharing information with, or receiving information from families of the ill person. This is absurd.

Families tend to have the most comprehensive information about the treatment of their loved ones. Only by receiving this information can doctors give the best possible care. For example, a doctor needs to know if a medication they are suggesting has been used in the past and whether it worked or not and what the side-effects, if any, were. Sometimes the individual with mental illness can't or won't communicate that and the records are incomplete.

In addition, people with mental illness are often released from facilities to go back to live with their parents, yet information on diagnosis and treatment is withheld from the parents. As Rael Jean Isaac famously said in "Madness in the Streets": the family has become the institution, but they are an institution without training, without financing, and without the ability to enforce compliance" (although I did the quote from memory so check me on it.)

Some doctors and treatment providers say they can't share information because of federal Health Insurance Portability and Accountability Act, commonly referred to as HIPAA (pronounced Hip-a). It is arguable as to whether HIPPA prevents providing information to parents of people with serious mental illness, but it is inarguable that it does not prevent doctors from receiving information.

Connecticut Senate Bill 452 attempts to clarify this. It revises certain laws pertaining to the treatment of people with mental illness. Connecticut law already says
Every patient treated in any facility for treatment of persons with psychiatric disabilities shall receive humane and dignified treatment at all times, with full respect for his personal dignity and right to privacy. Each patient shall be treated in accordance with a specialized treatment plan suited to his disorder. Such treatment plan shall include a discharge plan which shall include, but not be limited to, (1) reasonable notice to the patient of his impending discharge, (2) active participation by the patient in planning for his discharge, and (3) planning for appropriate aftercare to the patient upon his discharge.
But this bill adds a section stating:
Subject to the privacy protections afforded a patient under federal law, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191) (HIPAA), as amended from time to time, the head of a facility may direct that any person involved in the formulation of the patient's treatment plan or discharge plan communicate with, and obtain medical records from inpatient and outpatient health care providers who have previously treated the patient. In addition, when formulating such treatment plan or discharge plan, persons involved in the formulation of such plans may also communicate with any person with whom the patient has resided in the twelve-month period prior to being admitted to the facility and with the patient's spouse, parents, siblings or children in order to better understand the patient's medical needs.

It's a smart idea.