Choose life… Insure Tennessee

by hopeworkscommunity

Choose life. When in doubt, when you are not sure... When there is a question choose life.

The question of Insure Tennessee is a question of whether or not we will choose life. It is not a question of a better way to choose life. It is not a question of not this but that. As more and more stories pour in it is obvious. For thousands of Tennessean it is increasingly each day a question of life or death... a question of life or needless and preventable suffering... a future of hope or one bound by despair. It is not about finding an answer. It is about the common sense and political will to grab the one (the only one) in front of us and stop the unnecessary misery that defines the lives of so many vulnerable Tennesseans.

Chattanooga voted last night to choose life. Their city council voted overwhelmingly in favor of a resolution supporting Insure Tennessee. They joined a growing movement of cities and towns saying they support their neighbors, their friends, their families. No one should have to unnecessarily suffer or suffer as a direct result of governmental policy. Insure Tennessee.

The movement is growing. Thanks to the leadership of people like Pam Weston in East Tennessee and Meryl and Randall Rice in West Tennessee and the stories and words of more and more Tennesseans the movement is growing. It is the growing crescendo of more and more ordinary Tennesseans saying "CHOOSE LIFE!!!!!"

Imagine a flood, a hurricane in Tennessee. The waters are rising.. People are dying.... Many are on top of their houses waiting for a miracle.. a boat... a something... someone who cares.... hope. The government has boats. But they decide to wait. "Let's make sure this is a good idea..."

The waters still rise. For some it is too late. For others it will soon be too late. Action matters. The hurricane is here for thousands of Tennesseans. And they are on top of their houses waiting.

Join the movement to choose life. Talk to your local government. Ask them to join Chattanooga and the other towns and counties that have acted.

Today. Today please choose life.

Insure Tennessee

Larry Drain ~

Allen Reflects on Thriving in 2014

As DBSA’s 2014: The Year of Thriving comes to a close, it seems appropriate to reflect on what we’ve accomplished this past year, and to think about what’s yet to come.

At the beginning of 2014, we outlined our vision of a future where every adult and child living with a mood disorder has the opportunity not just to survive, but to thrive. To some, this was a message of hope; to others, it seemed a goal almost impossible to imagine. I completely understand how some of my peers might find total wellness to be an unattainable goal. Indeed, I too have experienced times in my life when the only reality I could imagine was the intense pain of depression. In fact, I experienced times this very year when thriving seemed so very far away for me personally. But amidst messages about the danger and drain of people with mental health conditions, and my own concurrent thoughts of self-loathing and self-stigma, to know that there was a community that would hope for the return of my best self was a blessing. To hold hope when we cannot carry it ourselves: this has always seemed, to me, the fundamental purpose of peer support. DBSA was founded on a model of peer support, and DBSA will always be about creating opportunities for peer support, and through peer support—the thousands of people meeting in communities across the country—we are creating a world in which all of us may be reminded of our potential, our strength, and our best selves.

For me to return to a place of thriving took a lot of time and work and collaboration. It also took some luck. For I have been very lucky: to have found clinicians that do not put limitations on what my life can be; to have the support of loved ones and colleagues who remind me of who I am, not what condition I live with; to have insurance that gives me access to quality health care that covers both my physical and mental health; and to find inspiration in my work and the amazing people I have the privilege of working with, and for, in my role at DBSA.

Such good fortune—in clinical collaboration, in supportive community, in access to resources, in meaningful work—are what I, and the DBSA Board and staff, want for everyone, not just the very lucky.

So in 2014, we asked our peers, families, clinicians, researchers, politicians, and the public to expect more. We asked our community to promote and seek full wellness—because better is not well, and everyone deserves the opportunity to thrive. 

I am proud of the work DBSA accomplished in 2014, and I encourage you to review our 2014: Year of Thriving programs. I believe that we did open minds—and even a few doors—to the possibility of thriving. A few highlights include:

• In January, DBSA welcomed the Balanced Mind Parent Network into our family of programs to enable us to provide critical support for parents and to create a thriving future for children living with mood disorders.
• In April, Target Zero to Thrive asked clinicians and peers to set zero, not just reduced, symptoms as a new standard for successful treatment. 
• In May, DBSA kicked off our six-month Positive Six: Thrive campaign, challenging us to make a small change each month to support our health.
• In June, DBSA completed a third contract with the VA to train their Veteran peer specialist workforce.
• In August, DBSA joined forces with DBSA New Jersey to host the From Surviving to Thriving weekend of public and chapter educational events featuring a special interview with Demi Lovato.
• In September, DBSA hosted Better Is Not Well—a peer and professional panel that explored ways to elevate mental health treatment to complete wellness.
• This fall, DBSA hosted a series of webinars on Treatment Choices, Health Care Reform, and Restoring Intimacy.
  
• In November, DBSA issued the WHO-Five Challenge to mental health professionals to integrate wellness measurements, like the WHO-Five, into their practice.

But so much more must be done. So we ask,

“What needs to happen for us to have wellness change from being a possibility for some to a probability for most?”

It will require:

• Better Treatments: DBSA will continue to work with our esteemed Scientific Advisory Board to integrate peers into the development of new and better treatments— medical and non-medical. And, to connect our peers and parents to studies that hold the promise of a brighter future for ourselves, our children, and our peers.
• New Measurements: DSBSA will continue to promote widening the definition of treatment success to include not just elimination of symptoms, but presence of wellness.
• Access to Quality Mental Health Care: DBSA will continue to advocate for the rights of all adults and children living with mood disorders to receive access to quality mental and physical health care.
• Increased Expectations: DBSA will continue to spread the message that better is not good enough. That wellness IS possible. That everyone deserves the opportunity to not just survive, but thrive.
• Peer Support: DBSA is committed to continuing, and increasing both the availability and quality of, life-saving in-person and online peer support for people who have diagnoses, parents, family, and friends.
• Inspired, Imperfect Action: DBSA will continue to ask ourselves, our peers, our parents, our clinicians, our legislators, and our communities to take action. It may be small. It most certainly will not be perfect. But it will be progress—action inspires action, which in turn inspires more action.

We made some significant strides this past year, but we do not fool ourselves by believing that these first steps have produced monumental change. That will take persistence. That will take courage. That will take time. That will take hope. That will take ALL of us.

It is through thousands, indeed millions, of inspired, imperfect actions that we will slowly transform these small steps into big changes and create a future where wellness is no longer a possibility for only some lucky few, but a probability for all.

Thank you for joining us on this journey,

– Allen

I have many cherished friends living with major, "invisible" health challenges. Everyday they work very hard to prevent others from knowing of their struggles. They work to "pass" as being just another face in the crowd.

The death of the Murphy Bill: On being the national spokesman
Larry Drain


The Murphy Bill as we know is dead.  The Republican leadership in the House announced a change in strategy.  They basically decided to toss in the towel on the more controversial parts of the plan and try to see if they can move forward on elements that seem to have a greater consensus behind them. There may be CPR efforts yet but it appears done.

It was a bill in trouble from the start despite the massive pr campaign that tried so hard to say it wasnt so.  It managed to unify groups that might not agree on what kind of reforms they wanted, but were absolutely sure what they didnt want and that was the Murphy Bill.

Part of the problem was Murphy himself.  He assumed that as "the only psychologist in Congress" he was the obvious and deserved national spokesman for mental health reform.  He wasnt.  Being a psychologist certainly didnt qualify for the role.  Neither did being a member of the House of Representatives.  It seemed that Dr. Torrey annointed him and for some reason they both thought that mattered.  In the end it was hard to know where he started and Dr. Torrey ended and that was perhaps a fatal flaw.

He didnt understand that leadership was built or that it was a two way street.  He alienated people who had lived mental health reform their entire adult lives.  He thought it was about them joining him and never seemed to know it was the other way around.  And he never realized that trust was everything and that when he snuck AOT into the medicare bill he destroyed his chances of trust with people whose support he needed.

He was naive.  The only people who believe federal laws change everything are federal lawmakers and most of them know better.  To say that his law was going to prevent the next shooting was simply ego.  He believed his own press clippings and his posturing before the dead were even buried just seemed like rank opportunism.

Mental health reform is an ongoing effort by many, many people with different values and priorities.  Sometimes it is its own worst enemy.  People who cant stand each other have a hard time standing together for anything.  Murphy I hope has to some degree taught people they can find unity despite their differences.  And maybe the fragile unity borne of him will be the biggest take-away from the entire thing.

He may indeed try again.  He probably will.  Dr.  Torrey most surely will.  He has won many, many short term victories and will doubtless win more, but the big prize has eluded him again. He is not the national spokesman he has annointed himself to be either.

May 2014: Kathy Flaherty

Kathy Flaherty works as a senior staff attorney at Statewide Legal Services of CT, Inc.  She has dedicated her professional life to advocating for the rights of the underserved.  A graduate of Kingswood-Oxford School, Wellesley College and Harvard Law School, Kathy has 17 years of experience in poverty law, specifically focusing on housing, benefits, and consumer law. 

Kathy lives with bipolar disorder.  She makes full use of her work place’s very generous sick leave benefits and a flexible schedule.  Kathy was diagnosed her first year of law school after being civilly committed.  She was not permitted to return to Harvard until the next fall, at which point the school put conditions on her return. 

During her third year of law school, she used the Harvard Law School newspaper as the forum to come out about her illness.  Against the advice of the Office of Public Interest Advising, when applying for jobs after law school, she included her position on the council of former patients of McLean Hospital, making her disability fairly obvious.  “If someone didn’t want to hire me because of my disability, I didn’t want that job.” Kathy says that she has gotten jobs because she has disclosed.

Kathy shares that her biggest barrier to the legal profession was getting admitted to the Connecticut Bar.  Despite the fact that she had already been admitted to the Massachusetts and New York Bars, she had to wait for a year and a half and then was conditionally admitted. For the next nine years, she had to report that she was taking her medication, as well as provide a doctor’s note twice a year confirming that she was in fact taking her medication. 

Since 1999, Kathy has served as a volunteer trainer, presenter, and facilitator for Connecticut’s chapter of the National Alliance on Mental Illness (NAMI-CT).  Combining her personal experience as a recipient of mental health services and her legal background, she is able to speak to issues affecting those living with mental illness from a multi-faceted perspective.  Her advocacy work has earned her numerous honors including the Dr. Karen Kangas Advocacy Award from Advocacy Unlimited in 2010.   “Winning an award named for someone who is a role model for advocacy and a very dear friend is humbling.”

Kathy currently serves as a member of the Board of Directors of Advocacy Unlimited, Lawyers Concerned for Lawyers-CT, and the Connecticut Alliance to Benefit Law Enforcement (CABLE). She also serves on Governor Malloy’s Sandy Hook Advisory Commission.  Her goal for the future?  “To continue to do work I enjoy.”

Larry Drain, Legislative Liaison for DBSA Tennessee, offers this blog with its many references that provides points for and against the Murphy bill. Please take time to self educate. Larry gives us a good start.

[Children's Mental Health Network

The Morning Zen]

Congressman Tim Murphy introduces controversial Helping Families in Mental Health Crisis Act of 2013

2 Comments | Posted December 15, 2013

On Friday, one day before the anniversary of the Newtown school shooting tragedy and on the same day of yet another tragic shooting at a school in Colorado, Congressman Tim Murphy introduced the Helping Families in Mental Health Crisis Act of 2013, a bill that would effectively rewrite how the Substance Abuse and Mental Health Services Administration (SAMHSA) operates and significantly narrow the focus of the types of mental health services and supports it helps promote through its grant programs. While the bill is at this point just a proposal, it is an important read for Network faithful as it sheds a light on the thinking of many individuals across the country about how to improve mental health services in America. Unfortunately, with the continued tragedies occurring at schools across the nation the tendency to equate guns and violence with mental illness leads to recommended solutions in this bill that are narrow in focus and could potentially set back the advances in the field of mental health 20 to 30 years.

What makes writing this Morning Zen piece difficult for me is that I have the utmost respect for Congressman Murphy. A child psychologist by training, co-author of two books ("The Angry Child: Regaining Control When Your Child Is Out of Control" and "Overcoming Passive-Aggression), it is obvious that Congressman Murphy cares deeply about improving mental health services. For that he is to be applauded. But what is in this proposed bill for the most part is either mystifying or antithetical to what the research tells us works best for young people with emotional challenges and their families. In fairness, at the end of this post I have included links to position statements on the proposed bill from national organizations and thought leaders both for and against the bill. As always, we pride ourselves on providing as many perspectives as possible so that our educated readers can make up their own minds and respond to their elected officials accordingly.

The response from mental health advocates and provider groups both for and against the bill was swift. As is the general approach of the Children's Mental Health Network we took the weekend to read and digest the 135-page bill before making our comments. The list is long so grab a cup of coffee for this one.

The proposed bill is complex in that mixed in with proposals that are administratively bureaucratic, relying on reference resources that in some cases are twenty years old and frankly dismissive of anything outside of the realm of narrowly defined evidence based practice, are some excellent proposals such as continuing funding for the Garrett Lee Smith and National Child Traumatic Stress initiatives.

However, overwhelmingly the recommended changes in the bill set the advances made in knowledge about what works for youth with mental health challenges and their families back a good twenty to thirty years.

Clouding the picture of how to interpret this proposed bill was the timing of its release – on the eve of the anniversary of the Newtown tragedy and on the day of yet another shooting at a school in Colorado, where emotions were already running high and the popular press was flooded with news stories about guns, violence and mental illness. Even though research shows that those with a mental illness are significantly more likely to be a victim of violence than a perpetrator of violence, discussions in Congress about what to do tend to fall too easily into the guns + violence = mental illness equation.

Note: Be sure to read Lisa Lambert's Morning Zen post for a parent’s reflection on the anniversary of the Newtown tragedy.

Okay, with all of this in mind as a backdrop for what is in the proposed bill, let’s take a walk through some of the highlights. The 135 page document is one I encourage you to read to get your own sense of its merits and drawbacks. In this post I will focus on some of the key areas that are important to highlight. Page numbers of the bill are cited so that you can read the full text in the copy of the proposed bill that you can download here.

Additional layers of bureaucracy added while diminishing the decision-making role of key SAMHSA personnel (Page 4)
The position of Assistant Secretary for Mental Health and Substance Use Disorders would be created. This individual would directly supervise the Administrator of the Substance Abuse and Mental Health Services Administration. Reading through the responsibilities that this individual would have left me perplexed, as the duties described appear to already be in place under the responsibility of the Administrator.

National Mental Health Policy Laboratory (page 7)
The proposed bill calls for the creation of a National Mental Health Policy Laboratory (NMHPL) headed by a Director. The purpose of this Director position would be to:

• (A) Identify and implement policy changes and other trends likely to have the most significant impact on mental health services and monitor their impact in accordance with the principles outlined in National Advisory Mental Health Council’s 2006 report entitled ‘The Road Ahead: Research Partnerships To Transform Services’;
• (B) Collect information from grantees under programs established or amended by the Helping Families in Mental Health Crisis Act of 2013 and under other mental health programs under this Act, including grantees that are federally qualified community behavioral health clinics certified under section 201 of the Helping Families in Mental Health Crisis Act of 2013 and States receiving funds under a block grant under part B of title XIX of this Act; and
• (C) Evaluate and disseminate to such grantees evidence-based practices and services delivery models using the best available science shown to reduce program expenditures while enhancing the quality of care furnished to individuals by other such grantees."

The description of the NMHPL goes on to say that "In selecting evidence-based practices and services delivery models for evaluation and dissemination under paragraph (2)(C), the Director of the NMHPL 

• (A) Shall give preference to models that improve the coordination, quality, and efficiency of health care services furnished to individuals with serious mental illness; and
• (B) May include clinical protocols and practices used in the Recovery After Initial Schizophrenia Episode (RAISE) project and the North American Prodrome Longitudinal Study (NAPLS) of the National Institute of Mental Health.

On page 10 the language continues with "In carrying out the duties under this section, the Director of the NMHPL shall consult with representatives of the National Institute of Mental Health on organization, hiring decisions, and operations, initially and on an ongoing basis; (B) other appropriate Federal agencies; and (C) clinical and analytical experts with expertise in medicine, psychiatric and clinical psychological care, and health care management.

The Children’s Mental Health Network is troubled that there is no mention of youth and family involvement in such a consulting pool, especially with the impressive track record achieved by SAMHSA in cultivating a family-driven, youth guided approach through its system of care grants and cooperative agreements over the past 20+ years.

Interagency Serious Mental Illness Coordinating Committee (page 14)
Yet another bureaucratic layer is added to the decision-making process with the recommendation to establish an Interagency Serious Mental Illness Coordinating Committee to "assist the Assistant Secretary in carrying out the Assistant Secretary's duties.

The responsibilities of this Committee include:

• (1) Develop and annually update a summary of advances in serious mental illness research related to causes, prevention, treatment, early screening, diagnosis or rule out, intervention, and access to services and supports for individuals with serious mental illness;
• (2) Monitor Federal activities with respect to serious mental illness;
• (3) Make recommendations to the Assistant Secretary regarding any appropriate changes to such activities, including recommendations to the Director of NIH with respect to the strategic plan developed under paragraph (5);
• (4) Make recommendations to the Assistant Secretary regarding public participation in decisions relating to serious mental illness;
• (5) Develop and annually update a strategic plan for the conduct of, and support for, serious mental illness research, including proposed budgetary requirements; and
• (6) Submit to the Congress such strategic plan and any updates to such plan.

There is a long list of required members for this committee (page 15), including the Director of NIH, the Attorney General of the United States; the Director of the Centers for Disease Control and Prevention and more. Members of the Committee serve 4-year terms and would be required to meet a minimum of two times per year. In addition, the Committee “may establish subcommittees and convene workshops and conferences "to enable the subcommittees to carry out their duties."

And finally, with regard to administrative duties, on page 70 it is noted that the administration of block grants would be removed from the Director of the Center for Mental Health Services and shifted to the Assistant Secretary for Mental Health and Substance Use Disorders. Gonna be one busy Assistant Secretary if this proposal goes through!

I can't help but think that if this plan were to come to fruition there would be bureaucratic gridlock. Two new significant leadership positions assuming key duties of currently existing high ranking officials within SAMHSA and a large Committee with sub-committees to "assist the Assistant Secretary in carrying out the Assistant Secretary's duties" (Page 14). In my mind, this is a huge duplication of duties already ascribed to the SAMHSA Administrator, the Director of the Center for Mental Health Services and others within SAMHSA.

Let's move away from administrative duties to some of the new grant programs proposed, specifically the Assisted Outpatient Treatment Program. The proposed bill calls for up to 50 grants each year for a 4-year pilot program to focus on assisted outpatient treatment programs (Page 19). Each grant would be eligible for one million dollars per year for four years - $15,000,000 per year would be authorized totaling $60,000,000 over the four-year period.

Assisted outpatient treatment is a controversial topic, with some saying it is the best option for an adult with a mental illness who "lacks capacity to fully understand or lacks judgment to make informed decisions regarding his or her need for treatment, care, or supervision." Others, including the Children's Mental Health Network, see this as a potentially dangerous road to travel in that it could have wide-ranging impact on those who might be swept up unnecessarily. You can review both sides of the argument regarding Assisted Outpatient Treatment at the end of this post.

Number of seriously mentally ill who are imprisoned (page 63)
Section 405 focuses on reports of the number of seriously mentally ill who are imprisoned. An important topic for sure, the intent is to "calculate the number and type of crimes committed by persons with serious mental illness each year, and detail strategies or ideas for preventing crimes by those individuals with serious mental illness from occurring… For purposes of this section, the Attorney General, in consultation with the Assistant Secretary of Mental Health and Substance Use Disorders shall determine an appropriate definition of ‘‘serious mental illness’’ based on theHealth Care Reform for Americans with Severe Mental Illnesses: Report’’ of the National Advisory Mental Health Council, American Journal of Psychiatry 1993; 150:1447–1465. The link is provided though you will need to pay the journal for the download. We can only hope that this document, written 20 years ago, reflects the evolution of thinking about mental health challenges since then. Of greater concern is the proposed process for decision-making about defining "serious mental illness." Should this just be left to the Assistant Secretary and the Attorney General? This is much too vague for our liking.

Reducing the stigma of serious mental illness (page 79)
It is hard to even comment on this section when the entire document is stigma-laden, focusing primarily on a narrow subset of those individuals with a diagnosis of serious mental illness when describing what needs to happen within a federal agency charged with looking at the full spectrum of behavioral health issues. However, Network faithful should read it and decide for themselves.

Title XI-SAMHSA Reauthorization and Reforms (page 99)
Mentioned earlier is the fact that the Assistant Secretary for Mental Health and Substance Use Disorders would be in charge of SAMHSA. One of the more fascinating recommendations is that "At least 30 days before awarding a grant, cooperative agreement, or contract, the Administrator shall give written notice of the award to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate.’’ This suggests adding yet another layer of review, more opportunity for delay and added bureaucracy. Though not specified, one could assume that a member of either Committee could block a grant award.

In addition, it would be required that "Before awarding a grant, cooperative agreement, or contract, the Secretary shall provide a list of the members of the peer review group responsible for reviewing the award to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate." This is yet another opportunity for delay and bureaucratic red tape.

Transfer of all functions and responsibilities of the Center for Behavioral Health Statistics and Quality to the National Mental Health Policy Laboratory (page 102)
This section discusses the transfer of "all functions and responsibilities of the Center for Behavioral Health Statistics and Quality to the National Mental Health Policy Laboratory. Why would one do this? In addition, in this section responsibilities currently assigned to the Administrator are reassigned to the Assistant Secretary. I am beginning to wonder what is left for the Administrator to do?

Establish a clearinghouse of evidence-based practices  (page 106)
In this section there is mention of the establishment of "a clearinghouse of evidence-based practices, which has first been reviewed and approved by a panel of psychiatrists and clinical psychologists, for mental health information to assure the widespread dissemination of such information to States, political subdivisions, educational agencies and institutions, treatment and prevention service providers, and the general public, including information concerning the practical application of research supported by the National Institute of Mental Health that is applicable to improving the delivery of services..."

Unfortunately there is no mention of consumers, families or youth involved in this review.

Limitations on Authority (page 133)
The section on Limitations on Authority includes some questionable items. For example, in this section it is stated that in order for SAMHSA to host or sponsor a conference they "must give at least 90 days of prior notification to the Committee on Energy and Commerce and Committee on Appropriations of the House of Representatives and the Committee on Health, Education, Labor, and Pensions and Committee on Appropriations of the Senate." Again, this seems like yet another unnecessary layer of bureaucracy.

No financial assistance to any program without evidence-based practices (page 133)
Continuing on page 133 is the directive that the Administrator of SAMHSA "shall not provide any financial assistance for any program relating to mental health or substance use diagnosis or treatment, unless such diagnosis and treatment relies on evidence-based practices."

If you have made it this far in this lengthy post you know that this leads back to the question "What is an evidence-based practice and who is involved in deciding that?" From reading the full text of the proposed bill the decision makers are definitely skewed toward the medical community with a strong focus on a narrow slice of the overall population of individuals needing mental health services.

Elimination of unauthorized SAMHSA programs without explicit statutory authorization (page 134)
Saving one of the more controversial items for last (at least as based on the tenor of emails sent to the Network over the weekend) is the section on the elimination of unauthorized SAMHSA programs without explicit statutory authorization. The language is clear that no new programs are to be created that are not explicitly authorized or required by statute and that "by the end of fiscal year 2014, any program or project of the Substance Abuse and Mental Health Services Administration that is not explicitly authorized or required by statute shall be terminated."

The proposed bill goes on to say "The Assistant Secretary for Mental Health and Substance Use Disorders shall seek to enter into an arrangement with the Institute of Medicine under which the Institute (or, if the Institute declines to enter into such arrangement, another appropriate entity) agrees to submit a report to the Congress not later than July 31, 2014, identifying each program, project, or activity to be terminated under subsection (a).

So, there you have it. Quite a bit to chew on and I cut this post down significantly. Please take the time to read the proposed bill. Whether it gains traction in the House or not it is important to remember that this proposed bill reflects the thinking of many. If you are concerned about this, as we are, then you might want to consider an education campaign.

Next week we will share our collaborative efforts with Maryland-based mental health providers, adult and youth representatives with experience receiving mental health services, and family advocates and other agency representatives to put together a site visit for Senate and House Appropriations Committee staff to not only show them what a coordinated system of care approach looks like in the effective provision of services and supports for young adults with mental health challenges, but also to provide them the opportunity for one on one dialogue with youth and adults who utilize mental health  services, families and the amazingly dedicated professionals who work side by side with them. We began organizing this effort for Senate Appropriations staff as a result of our inquiry into the Healthy Transitions Initiative in August of this year. Senate Appropriations Committee staff have agreed to come and we will be extending an invitation to House Appropriations Committee staff this week. I will give you full details in the Morning Zen post this coming Friday.

What is so important about our education campaign is that it is not focused on one grant or particular service. We are not bringing staffers to a visit to ask for money. We are bringing staffers to a visit to let them experience firsthand the importance of a comprehensive approach to meeting (in this case) the needs of young adults with mental health challenges. Sounds like a systems of care approach to me!

And finally, here is a sampling of different individual and organizational analyses and reactions to the proposed bill, both pro and con. Remember, an educated voice is a powerful voice.

For the proposed bill

• How Should We Help the Seriously Mentally Ill?
• NAMI NY State Position Statement  
• NAPHS Applauds Rep. Tim Murphy for Introduction of Comprehensive Mental Health Reform Legislation

Against the proposed bill

• National Coalition for Mental Health Recovery press release jointly issued with the National Disability Rights Network and the Bazelon Center for Mental Health Law
• Involuntary Outpatient Commitment (IOC)1 Myths and Facts
• Mental Health America statement

Time to do your homework folks!

Scott Bryant-Comstock
President & CEO
Children’s Mental Health Network

Submitted by Jennifer Dochod, Legislative Liasion for DBSA Tennessee. The brief summary by Mr. Murphy's office highlights the points in the proposed Bill he drafted.

                     Tim Murphy

                U.S. Congressman

    for the 18th District of Pennsylvania

Short Summary of The Helping Families In Mental Health Crisis Act (H.R. 3717)

Ensuring Psychiatric Care for Those in Need of Help the Most Rep. Tim Murphy, PhD

Mental illness does not discriminate based on age, class or ethnicity. It affects all segments of society. More than 11 million Americans have severe schizophrenia, bipolar disorder, and major depression yet millions are going without treatment as families struggle to find care for loved ones.

To understand why so many go without treatment, the Energy and Commerce Subcommittee on Oversight and Investigations launched a top-to-bottom review of the country’s mental health system beginning in January 2013. The investigation revealed that the approach by the federal government to mental health is a chaotic patchwork of antiquated programs and ineffective policies across numerous agencies.

Not only is this frustrating for families in need of medical care, but when left untreated, those with mental illness often end up in the criminal justice system or on the streets. The mentally ill are no more violent than anyone else, and in fact are more likely to be the victims of violence than the perpetrators, but individuals with untreated serious mental illness are at an increased risk of violent behavior. Tragically, undertreated mental illness has been linked to homicides, assaults, and suicides.

The Helping Families In Mental Health Crisis Act (H.R. 3717) fixes the nation’s broken mental health system by focusing programs and resources on psychiatric care for patients and families most in need of services. The legislation:

EMPOWERS PARENTS AND CAREGIVERS

What the investigation found:

Physicians are often unwilling to share or receive information with loved ones about an individual who has a serious mental illness and is experiencing a psychotic break because of complicated federal rules on communicating with immediate family members and caregivers. This scenario is especially problematic for parents of young adults with mental illness because psychosis begins to manifest between ages 14 and 25.

Clarifies Health Information Portability and Accountability Act (HIPAA) privacy rule and the Family Educational Rights and Privacy Act so physicians and mental health professionals can provide crucial information to parents and caregivers about a loved one who is in an acute mental health crisis to protect their health, safety, and well-being.

2332 Rayburn House Office Building | Washington, DC 20515
Murphy.House.Gov | (202) 225-2301 | (202) 225-1844 | @RepTimMurphy | Facebook.com/RepTimMurphy

The Helping Families in Mental Health Crisis Act (H.R. 3717), Rep. Tim Murphy 2

FIXES THE SHORTAGE OF INPATIENT PSYCHIATRIC BEDS

What the investigation found:

There is a severe lack of inpatient and outpatient treatment options. Seventy years ago, the country had 600,000 inpatient psychiatric beds for a country half the size. Today, there are only 40,000 beds.

What the legislation does:

Increases access to acute care psychiatric beds for the most critical patients by making two narrowly tailored exceptions to the Institutions for Mental Disease (IMD) exclusion under Medicaid. The IMD exclusion is what originally caused the shortage of psychiatric beds.

ALTERNATIVES TO INSTITUTIONALIZATION

What the investigation found:

Approximately forty percent of individuals with schizophrenia do not recognize they have a mental illness, making it exceedingly difficult for them to follow through on a treatment regimen.
What the legislation does:
Promotes alternatives to long-term inpatient care such as court-ordered ‘Assisted Outpatient Treatment,’ which has been proven to save money for state and local governments by reducing the rates of imprisonment, homelessness, substance abuse, and costly emergency room visits by the chronically mentally ill.

REACHING UNDESERVED AND RURAL POPULATIONS

What the investigation found:

The delay between a first episode of psychosis and the onset of treatment averages 110 weeks. Early diagnosis and medical intervention improves outcomes dramatically, but there is only one child psychiatrist for every 7,000 children with a mental illness or behavioral disorder.

What the legislation does:

Modeled on a successful state project in Massachusetts, the bill advances tele-psychiatry to link pediatricians and primary care physicians with psychiatrists and psychologists in areas where patients do not have access to mental health professionals.

DRIVING EVIDENCE-BASED CARE

What the investigation found:

The federal government spends $125 billion annually on mental health, but there is little interagency coordination on programs, nor does the federal government collect data on how mental health dollars are spent or whether those dollars are resulting in positive health outcomes.

What the legislation does:

Creates Assistant Secretary for Mental Health and Substance Use Disorders within the Department of Health and Human Services to coordinate federal government programs and ensure that recipients of the community mental health services block grant apply evidence-based models of care developed by the National Institute of Mental Health. The Assistant Secretary will ensure federal programs are optimized for patient care rather than bureaucracy.

The Helping Families in Mental Health Crisis Act (H.R. 3717), Rep. Tim Murphy 3

What the investigation found:

STABILIZING PATIENTS BEYOND THE ER

Access to physician-prescribed medication is vital for vulnerable individuals in avoid acute mental health crisis. Current policies that permit only “one drug” per therapeutic class policy ignore the clinical needs of individuals with mental illness who rely on vital, non-interchangeable prescription drug therapies.

What the legislation does:

Protects certain classes of drugs commonly used to treat mental illness so physicians have prescribe the right medication for those on Medicare and Medicaid similar to the protected classes for persons with epilepsy and cancer.

ADVANCES CRITICAL MEDICAL RESEARCH

What the investigation found:

The National Institute of Mental Health measures public health outcomes to develop medical models of care. For example, the Recovery After Initial Schizophrenia Episode (RAISE) project shows earlier intervention with treatment for a person at risk of developing full-blown schizophrenia allows patients to lead functional lives. The NIMH also excels at basic medical research, but lacks the financial resources.

What the legislation does:

Authorizes the BRAIN research initiative at the National Institute of Mental Health and encourages the agency to undertake additional research projects on serious mental illness and self- or other-directed violence.

HIGH QUALITY COMMUNITY BEHAVIORAL HEALTH SERVICES

What the investigation found:

Community Mental Health Centers receiving funds from the federal government receive lower reimbursements federal insurance programs than comparable care facilities.

What the legislation does:

Applies rigorous quality standards for a new class of Federally Qualified Community Behavioral Health Clinics (FQCBHC), requiring them to provide a range of mental health and primary care services.

DEPARTMENT OF JUSTICE REFORMS

What the investigation found:

Between twenty and fifty percent of the incarnated system inmates have a mental illness. Mental health courts have provided a cost-effective and responsible alternative to incarcerating the mentally ill.

What the legislation does:

So patients are treated in healthcare system and not warehoused in the criminal justice system, the bill reauthorizes mental health courts and requires the Department of Justice to collect more data on interactions between the police and the mentally ill. The bill also authorizes Byrne Justice Assistance Grants (JAG) to be used for mental health training of law enforcement and corrections officers.

The Helping Families in Mental Health Crisis Act (H.R. 3717), Rep. Tim Murphy 4

BEHAVIORAL HEALTH AWARENESS FOR CHILDREN AND TEENS

What the investigation found:

Despite increased medical and scientific research into the nature and source of serious mental illness, a mental illness stigma persists.

What the legislation does:

The Department of Education, working with mental health stakeholders, will undertake a national campaign aimed at reducing the stigma of severe mental illness in schools. The bill also reauthorizes the Garrett Lee Smith suicide prevention program.

INTEGRATES PRIMARY AND BEHAVIORAL CARE

What the investigation found:

Low-income individuals with serious mental illness and addiction disorders have high incidences of cancer, heart disease, diabetes and asthma. Untreated depression increases the risk of chronic diseases, and can double the cost of healthcare for health disease and diabetes. Integrating mental healthcare providers into electronic medical records systems will result in better coordinated care for patients as well as cost savings.

What the legislation does:

Extends the health information technology incentive program to mental health providers so they can communicate and work with primary care clinicians.

INCREASES PHYSICIAN VOLUNTEERISM

What the investigation found:

Health centers and mental health clinics are experiencing a staff shortage. Clinicians and healthcare professionals can volunteer at federal free clinics, but federal legal barriers and the high cost of medical malpractice insurance prevent them from doing so at community health centers and mental health clinics.

What the legislation does:

Eliminates federal legal barriers under the Federal Tort Claims Act preventing physician volunteerism at community mental health clinics and federally-qualified health centers.

REFORMS THE SUBSTANCE ABUSE & MENTAL HEALTH SERVICES ADMINISTRATION

What the investigation found:

Unauthorized in the last decade, the Substance Abuse and Mental Health Services Administration has lacked mission focus. Grant programs are not evidence-based or guided by the best available medical science.

What the legislation does:

Emphasizes evidence-based treatments, sunsets unauthorized programs, and strengthens congressional oversight of all federal behavioral health grants.

It is unacceptable that people who are suffering from and struggling with mental health issues in their life be at risk of injury, trauma, assault or even death in their interactions with police officers whose only training as "being a good police officer"  leads them to a course of action that produces tragedy.  There is ample evidence that CIT training (Crisis Intervention Training) makes a difference. The "Memphis Model" has made an impact in many communities both large and small. Tragedies may continue to happen, but to expect and accept them as the cost of doing business as normal is simply and deeply wrong.

A few days ago I talked with a man whose 39-year-old "mentally ill" son had been attacked, beaten up and tasered by police in this community who "were doing their job."  Over the last few days I have spent a lot of time thinking about other incidents I either have direct knowledge of  or I have heard about.  And it has left me deeply troubled.

There are lots of people to blame and many people seem intent on solving the problem by trying to figure out who to blame.  I hear people talk about needing more psychiatric hospitals, more coercive treatment options etc.  I dont think there are really going to be an appreciable increase in psychiatric beds regardless of where you stand on the argument, rather you think it is a good idea or not.  Financially it simply not an option.  Arguments that vastly increasing AOT (assisted outpatient treatment) can solve the problem are not honest or realistic.

Someone will be the next Kelly Thomas.  Someone will be the next person a police officer faces on the street corner or in their home or in the jail.  It is happening right now.  It will be happening in a few minutes.  It will be happening tomorrow.  And what stops it from being someone you know, someone you care about, or even you.

It is pointless to bemoan the fact that police are being asked to do things they are not trained to do and then do absolutely nothing about providing them that training.  It is as unfair to the officer who is trying to do the best he can as it is to the person he is trying to deal with.

As far as I know the decision to implement CIT training is a local decision and depends very much on the financial resources of that community as well as the commitment to training that local officials may have.  Many communities, like the one I live in, have gotten officers involved in a piecemeal fashion but they are largely at the mercy of who offers the training and when.

Again, no one should be the victim of where they live.  I have been following in recent days the effort of New York state to deal with the same issue.  The proposal that is currently being fought over is whether or not to include in the state budget funds for what they are calling a "center of excellence for CIT training."  The idea, as I understand it, is for the state to establish a resource that could help communities access CIT training in a way they can afford and in a way that is most effective to them.  It shifts the burden of the argument from "is it practical?  Can we afford to do it?" to "Can we afford to not do it?"

It is too late for anything like that to happen in Tennessee this year, but is not to late to start the conversation.  Several other states already have chosen to establish something like "a center of excellence for CIT."  Some have found access to federal funding.  Others have found grants from other sources.

In the end, it not only saves lives but also saves money because of the injuries and traumas it prevents.

A couple of days I had a post which included a video of the beating of Kelly Thomas.  I made myself watch the video several days before the post and was horrified.  If you havent watched the video and still doubt the importance of what I am talking about watch the video yourself.  I have also seen videos of other beatings from virtually all over the country.  It is more than a Tennessee problem but it is a Tennessee problem.

In the days and weeks that follow I will be revisiting this conversation over and over.  I am by no means anywhere close to an expert.  If you think you know more than me on the subject there is a good chance you are correct.  My goal is to start a conversation, a widespread conversation, in Tennessee that prepares the ground to talk about this issue not as one that affects isolated localities but every person in this state.

It is a conversation I hope you will join.

Larry Drain, hope works community blog

Mental health issues topic of presentations

By Linda Braden Albert | [email protected] | Posted 14 hours ago

A series of presentations on mental health issues will begin Thursday at the Blount County Public Library. The first presentation is by Sita Diehl, past executive director of the National Alliance on Mental Illness (NAMI) Tennessee and currently national director of state advocacy for NAMI National.

Larry Drain, recently named president of NAMI Maryville, said, “When they asked me to take the job, I really wanted to figure out a way not only to help NAMI but to help the community. Every day, nowadays, when you read the paper or watch TV or whatever, in one way or another, mental health issues are there. There’s a lot of bad information, misinformation, so the idea I had was that if we could bring a series of people to Maryville to talk about mental health issues, that would be a real, real positive thing for this community.”

Diehl’s current position entails her traveling from state to state, organizing efforts to make outcomes for mental health possible in each state, Drain said. “I’ve known her for years, and she was the very first person I asked. Her topic will be about finding support, whether you’re a family member, whether you’re somebody with a mental illness. She will talk a lot about NAMI, some about the mental health system in Tennessee. There will be a question and answer period after she gets through talking. Anybody who comes will be enriched by her.”

On April 24, Doug Varney, commissioner of mental health and substance abuse services for the state of Tennessee, will speak on mental health and drug addiction. Drain said, “I think he will talk some about prescription drugs and meth, what the state is trying to do to deal with some of these things. Especially in Blount County, it is such a live issue. ... He knows the topic inside out.”

Additional speakers in upcoming months include Ben Harrington, executive director, East Tennessee Mental Health Association; Scott Ridgeway, director, Tennessee Suicide Prevention Network; Allen Doderlain, national president, Depression and Bipolar Support Alliance; Pam Binkley, recovery coordinator, Optum Health, who will talk about emotional first aid; Lisa Ragan, director, Office of Consumer Affairs, Tennessee Department of Mental Health, who will speak on peer support, recovery, etc.; and Elizabeth Power, a nationally known expert on post-traumatic stress disorder. Mental health professionals from Blount Memorial Hospital have also been invited to speak.

Drain said, “I think this will be a quality addition to the Maryville community and I hope lots of folks will come. ... For a lot of folks here, the whole area of mental health, mental health treatment, the resources involved and things like that are so confusing. My hope is that all these speakers can shed some light, bring some facts and really help people in the Blount County area.”

Larry Drain, hopeworkscommunity

The bill, Helping Families in Mental Health Crisis Act (H.R. 3717), introduced by Rep. Tim Murphy of Pennsylvania, would cut funding for the Protection & Advocacy for Individuals with Mental Illness (PAIMI grant) by 85% and restrict DLAC from engaging in systemic or public policy advocacy.

 

The bill, in part, is a reaction to testimony at a Congressional hearing in which scant anecdotal information presented in a totally one sided manner portrayed the PAIMI program as part of the problem instead of, as we know it to be, part of the solution.  The implication was that PAIMI programs were using their resources and authority to keep people with mental illness from getting necessary treatment.  We know the opposite to be true – PAIMI programs have been at the forefront of advocating for people with mental illness to receive appropriate treatment ever since President Ronald Reagan signed the PAIMI Act into law in 1986.  Unfortunately, Rep. Murphy, who ironically is a proponent of evidenced based policy making, is ignoring the well documented evidence of 27 years of successful advocacy by PAIMI advocates on behalf of people with mental illness.

 

Among the many changes contained in its 135 pages, the bill would defund mental health consumer networks, a model in which people with psychiatric disabilities have opportunities to develop independence and personal growth in supportive environments with their peers; deny mental health block grant funding to any state that has not adopted a forced treatment regime (“Assisted Outpatient Treatment,” a euphemism for Involuntary Outpatient Commitment); and amend HIPAA law to make it easier to access the records of people with a mental health diagnosis. This legislation would essentially move the clock back on decades of progress in mental health, promote discrimination and stigma, use coercion and drugs as the blunt instruments of care, silence the advocates and keep people away from seeking the treatment they need.

 

We are convinced that the only way Rep. Murphy’s misguided bill can succeed is if the people who know the truth about the PAIMI program remain silent.  We need people who have benefitted from the PAIMI program, our allies, and members of DLAC’s Board and advisory councils which have guided our PAIMI program to speak up – to share what they know to be true - that DLAC and the PAIMI programs throughout America have been dedicated and effective advocates for people with mental illness.

 

ACTION NEEDED:

We need you to contact the members of Tennessee’s Congressional Delegation (contact information below) and communicate to them the negative impact this legislation would have and urge them not to co-sponsor this legislation.  All you have to do is leave that message with the person that answers the phone. If you want to get into more detail feel free to use the talking points and background information in this email, but the key message is to ask your legislator not to co-sponsor H.R. 3717.

 

Talking Points

 

•             Representative Murphy’s legislation (H.R. 3717) will reduce funding for the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program by about 85% leaving individuals with mental illness no independent advocates to help address the myriad of issues they face every day.

•             Representative Murphy’s legislation (H.R. 3717) will make it easier to discriminate against people with mental illness in housing, employment, and education, and lead to fewer individuals receiving the treatment they need.

•             Representative Murphy’s legislation (H.R. 3717) would remove the ability for our agency to fully serve individuals with mental illness. In its 27 year history, the PAIMI program has been highly successful assisting people with mental illness and should continue to have the broadest authority possible to ensure people with disabilities are free from abuse and neglect and receive the services and supports they need.  Contrary to the implication in Rep. Murphy’s bill our PAIMI program, Disability Law & Advocacy Center of Tennessee, has been instrumental in securing appropriate treatment for and ensuring the safety of:

o    Youth with severe mental health issues

o    People with mental illness in jails and prisons

o    People with mental illness residing in the community (board & care homes)

 

The links are to provide you background information should you want it.

 

Tennessee House Representatives

 

Rep. David Roe (TN-1)                                     

Rep. John  Duncan, Jr. (TN-2)                        

Rep. Chuck Fleischmann (TN-3) 

Rep. Scott DesJarlais (TN-4)            

Rep. Jim Cooper (TN-5)                                

Rep. Diane Black (TN-6)                              

Rep. Marsha Blackburn (TN-7)   

Rep. Stephen Fincher (TN-8)      

Rep. Steve Cohen (TN-9)           

 

Thanks for reading. If you have any questions, please let us know. Please also feel free to share this email with others in your network.
 

Francisca Guzman

Media & Development Advisor

Disability Law & Advocacy Center of Tennessee

A big step backward into the future: mental health “reform” Washington style

by hopeworkscommunity

The new mental health reform bill introduced by Rep Murphy provides for the following according to the Treatment Advocacy Center:

" Requires states to have commitment criteria broader than “dangerousness” and to authorize assisted outpatient treatment (AOT) in order to receive Community Mental Health Service Block Grant funds.

Allocates $15 million for a federal AOT block grant program to fund to 50 grants per year for new local AOT programs.

Carves out an exemption in HIPAA (Health Insurance Portability and Accountability Act) allowing a “caregiver” to receive protected health information when a mental health care provider reasonably believes disclosure to the caregiver is necessary to protect the health, safety or welfare of the patient or the safety of another. (The definition of “caregiver” includes immediate family members.)"

TRANSLATION:

What does it mean?

1.  States will be substantially limited in their control over their own mental health policy.  This, in and of itself, represents a radical change of immense implications.  It is a wall once breached that will never be rolled back.

2.  The future direction of mental health policy will basically be in the hands of the Treatment Advocacy Center.  After years and years of failing to get states to follow their policy of coercion first to the degree they want their view would effectively become federal policy.  What they could never win by choice they will win by force.

3.  Much gains in knowledge about what really works and helps people with mental health issues would be rendered unimportant and out of fashion.  The notion of recovery would be given a death blow.

4.  States by federal statute would have to agree to commit more and more people.

5.  Failure to do so would make you ineligible for federal block grants that are the backbone of so many state mental health budgets.

6. Privacy laws would not allow so much privacy.  Confidentiality would have holes big enough to drive a hole through.

And that is only the beginning.  It is a step back into an era of mental health care that was a national disgrace and one in which a diagnosis of mental illness was a life sentence.

hopeworkscommunity | December 13, 2013

A big step backward into the future: mental health “reform” Washington style

by hopeworkscommunity

The new mental health reform bill introduced by Rep Murphy provides for the following according to the Treatment Advocacy Center:

" Requires states to have commitment criteria broader than “dangerousness” and to authorize assisted outpatient treatment (AOT) in order to receive Community Mental Health Service Block Grant funds.

Allocates $15 million for a federal AOT block grant program to fund to 50 grants per year for new local AOT programs.

Carves out an exemption in HIPAA (Health Insurance Portability and Accountability Act) allowing a “caregiver” to receive protected health information when a mental health care provider reasonably believes disclosure to the caregiver is necessary to protect the health, safety or welfare of the patient or the safety of another. (The definition of “caregiver” includes immediate family members.)"

TRANSLATION:

What does it mean?

1.  States will be substantially limited in their control over their own mental health policy.  This, in and of itself, represents a radical change of immense implications.  It is a wall once breached that will never be rolled back.

2.  The future direction of mental health policy will basically be in the hands of the Treatment Advocacy Center.  After years and years of failing to get states to follow their policy of coercion first to the degree they want their view would effectively become federal policy.  What they could never win by choice they will win by force.

3.  Much gains in knowledge about what really works and helps people with mental health issues would be rendered unimportant and out of fashion.  The notion of recovery would be given a death blow.

4.  States by federal statute would have to agree to commit more and more people.

5.  Failure to do so would make you ineligible for federal block grants that are the backbone of so many state mental health budgets.

6. Privacy laws would not allow so much privacy.  Confidentiality would have holes big enough to drive a hole through.

And that is only the beginning.  It is a step back into an era of mental health care that was a national disgrace and one in which a diagnosis of mental illness was a life sentence.