Notes on Senate HELP Committee Hearing on Mental Illness

Following are raw, unproofed contemporaneous notes about the Senate Hearing that took place 1/20/16. It was one hour and you can watch the tape here
http://www.help.senate.gov/hearings/improving-the-federal-response-to-challenges-in-mental-health-care-in-america Don’t rely on my notes.

On January 20, 2016, Senate Health Education, Labor and Pensions (HELP) Committee held hearing on mental illness against backdrop of several bills being proposed. Bills have been  proposed by by Senators Blount, Cornyn and Cassidy/Chris Murphy. The committee has some jurisdiction over particular parts of those bills. Chair Sen. Alexander says he has agreement with Sen. Murray (co chair) to move quickly.

Sen Murray’s opening remarks focused on inadequate access and need to integrate mental and  physical  health

Sen Mukolski talked in favor of more money for Community Mental Health Centers, but as Dr. Torrey pointed out in American Psychosis, CMHCs have largely been unwilling to serve the most seriously ill.

BRIAN HEPBURN (NASMHPD)

The first witness was Dr. Brian Hepburn, Exec Dir. of National Association of State Mental Health Program Directors (NASMHPD) He and others talked about need for relief from IMD Exclusion, a provision of Medicaid that prevents states from treating seriously mentally ill who need hospital care. He noted that there is a demo project that gives relief to certain private free standing hospitals that want to provide care to SMI, but it is  only a small demo project

He said “SAMHSA is  great partner” and complimented current leadership, which is not surprising, since SAMHSA funds them and is responsible for encouraging them to take on broad mandate rather than focused one. He complimented SAMHSA for the  First Episode Psychosis Program, but that was driven by NIMH, and Congress forced SAMHSA to allocate funds to it.
He said what we all know, but public is unaware of: Almost all admissions to state psychiatric hospitals are ordered by courts. It have become virtually impossible to get into a state hospital until after you do something that causes a court to order you into treatment.
He recommended our proposal to ameliorate effect of IMD Exclusion and for Reauthorize Medicaid follows  person” policy.

In response to a question, he said state mental health director’s role is to take care of as many people as cost effectively as possible, and only mentioned serious mentally ill as if it were some pesky afterthought.

Penny Blake (Emergency Nurses)

Next speaker was Penny Blake, a nurse speaking on behalf of Emergency Nurses Association and she was terrific. She focused on the fact that there are not enough psychiatric hospital beds so patients are boarded in emergency rooms (ERs) often for days, sometimes in a 10X10 cell that requires extensive staffing to watch them, while the staff tries to find a psych facility willing to transfer them to. She noted that nationwide Boarding Time in ER = 18  hours for psych care. 4 hours for other care. She noted that better community services, for the seriously ill who are likely to wind up in hospital is key. In response to a question from Sen. Murray she listed bed shortage as the top problem that has to be solved.

In response to a question about HIPAA, she gave a great story about HIPAA. A patient came in to ER. His parents had been calling around looking for him, but she couldn’t tell  parents he was there in the ER. That story I heard before, but she went on to make another point: Because she could not tell parents their kid was in hospital, she couldn’t get medical information from them. That information would have helped her provide better treatment. We often hear it said that nothing in HIPAA prevents facilities from receiving information (even if they can’t disclose it) but in this case HIPAA did prevent the receipt of info. In response, Sen Alexander noted that “touching HIPAA is like touching a wire. But we should look at it. “ Asked people to provide lingo for  specific HIPAA exemption.

Dr. William Eaton (Public Health)

Dr. William Eaton a Professor at John Hopkins in Baltimore was the worst, most irrelevant speaker. He basically ignored serious mental illness (SMI), and focused only on depression. He continually touted the need for “prevention” in spite of the fact that schizophrenia, bipolar, and other serious mental illness cannot be prevented.  He criticized NIMH for focusing on  biological underpinnings rather than taking a “public health” approach. (Note: the Institute of Medicine, and almost all leading authorities recognize that there is no ‘public health  approach (which can mean advertising or vaccinations, or other intereventions applied to everyone) that prevents serious mental illness. He praised SAMHSA (which he worked at two days a week), but even he admitted it was outrageous that they refuse to have a psychiatrist on staff.

His ‘solution’ is high school education programs and even supported “Teen Screen” which has been proven by research not to help. See http://mentalillnesspolicy.org/samhsa/teenscreenunproven.html )


HAKEEM RAHEEM (Consumer)

Hakeem Raheem, a person with bipolar was fairly brilliant. He was the only speaker who regularly, unabashedly used the phrase ‘mental illness’, rather than ‘mental health.’ He explained how while at Harvard he became psychotic and delusional and attributed his recovery to his parents ability to have him quickly admitted to ER and being given meds quickly. He said, “Medicines are key. I take antipsychotics every morning”. He explained the difficulty of finding right med, but said it  is difference between life and death. He suggested that meds must be protected, affordable and accessible to people with SMI. He spoke in favor of peer support provisions of S 1945 (?) bill, but did not mention the antipsychiatry peer orgs funded by SAMHSA. Instead he mentioned the peer support programs run by NAMI and Depression and Bipolar Support Alliance as being useful. Sen. Alexander asked him how to persuade people to seek help. He said, “We cant persuade people to do what they don’t want to do. When I was in psychosis, no one could tell me I was in psychosis.”

Sen Collins
Spoke in favor of Cardin bill which created IMD exemption pilot demo program allowing IMD exclusion for private psych hospital. And supported Cassidy/Murphy bill will addresses IMD exclusion

Sen Chris Murphy
Claimed that some form of bill will go to Senate floor this year
 
Sen Cassidy (LA)
was very on point about SAMHSA and lack of meds in jail, and problems at SAMHSA. Unfortunately, he also seemed to embrace peer support, but I don’t know if he is talking about the antipsychiatry ones SAMHSA supports, or the kind Hakeem Raheem talked about (or if he knows difference. I kind of think he might, since was involved in mental health legislation in House before moving to Senate.)

Sen Warren
 Focused on supportint  a reporting on insurance company parity bill introduced by Rep. Kennedy.  Apparently, it would be like a consumer watchdog for parity that could report  problems in private insurance parity to legislators.  A more important idea would be to eliminate federal IMD Exclusion, which is the biggest form of non-parity, as many speakers pointed out.

Sen Franken, like Eaton talked about prevention.  He apparently isn’t aware that SMI can’t be prevented. He also talked about kids in rural area having higher suicide rates than adolescents in urban areas, oblivious to fact that kids in any area are least likely to commit suicide. Blamed stigma.

Sen Whitehouse (RI)
Noted that the Judiciary Committee wil be considering Comprehensive Addiction Recovery Act, that has related provisions.

Again: listen to the one hour hearing for more details or to ensure my notes are correct. Thank you