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Want to Insure Federal Agencies Prioritize Mental Illness Reforms? Call A Private Citizen To Testify

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(12-18-17) Dr. Elinore McCance-Katz, the Assistant Secretary for Mental Health and Substance Abuse, did an excellent job testifying last week about a new law designed to improve our federal mental health care system.

But in the future, the Senate Health, Education, Labor and Pensions Committee  should also consider questioning one of the 14 non-federal members of the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) when monitoring the effectiveness of federal programs.

Under the 21st Century Cures Act, Dr. McCance-Katz was put in charge of riding herd on the eight federal agencies that oversee more than an hundred mental health programs. To help her, Congress appointed a blue ribbon committee of federal and non-federal appointees. That means the 14 non-federal members, and I am one of them, on the ISMICC committee also need to be held accountable.

One of our tasks is praising agencies that are doing great work and taking others to task when it appears they are dragging their feet. For instance, the Department of Education didn’t bother to show up last week at the second ISMICC meeting.

That’s inexcusable given how important early intervention is in recovering from a mental disorder.

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NAMI Leader Keeps Focus On Serious Mental Illnesses and So Does Assistant Secretary

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12-14-17) Mary Giliberti was on fire!

The Executive Director of the National Alliance on Mental Illness and I spoke at a press conference earlier today held in Washington to unveil a national plan to reform our federal mental health care system. (I’ll write more about the plan later.)

For those of you who don’t want to watch the entire news conference posted above, Mary’s remarks begin at the 30 minute mark and end at about minute 38, when I start my remarks. (I was asked, as always, to share my son’s story so it might be familiar territory to most of you.)

It was what happened afterwards that really had me cheering. Off camera, a discussion was taking place about how wide of a net the newly created Interdepartmental Serious Mental Illness Coordinating Committee should cast. There was talk about providing services for groups other than the seriously mentally ill. And it was Giliberti who immediately said, “No!”  The focus of the committee had to be on SMIs and serious emotional disturbances.

Lately, NAMI has been accused of not paying enough attention to SMIs.  Her firm reaction reminded me of a story that she told me months ago.

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Press Conference Tomorrow To Unveil Reforms To Federal Mental Health System: You Can Tune In

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(12-13-17) I will be participating tomorrow (Thursday)  in a press conference being held at SAMHSA to unveil the Interdepartmental Serious Mental Illness Coordinating Committee’s  first report to Congress.

Who will speak:

·         Eric D. Hargan, Department of Health and Human Services (HHS) Acting Secretary

·         Dr. Elinore F. McCance-Katz, Assistant Secretary for Mental Health and Substance Use

·         Dr. Anita Everett, SAMHSA Chief Medical Officer

·         Mary Giliberti, ISMICC non-federal member

·         Pete Earley, ISMICC non-federal member

WHEN: Thursday, December 14, 2017 from 9 a.m. to 10 a.m. EST

WHERE:  Online via webcast. Visit www.samhsa.gov/ismicc on the day of the event for more information.

The ISMICC committee was created by the Helping Families in Mental Health Crisis Act that became law during the final days of the Obama administration after that legislation (pushed by former Rep. Tim Murphy R-Pa.) was incorporated into the 21st Century Cures Act. The new law also created the Assistant Secretary of Mental Health and Substance Abuse – a position held by Dr. Elinore F. McCance-Katz.

Congress created this new Assistant Secretary position and the ISMICC committee because it wanted to prioritize federal mental health reform. Because of time restraints related to federal clearance reviews, this report was written exclusively by the committee’s non-federal members. I am proud that these recommendations come from advocates who have worked tirelessly in the trenches and faced the real problems that I faced.

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How’s Your State Compare? Spending on Mental Health

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(12-12-17) I’m in Richmond today participating in a meeting about mental health priorities for incoming Virginia Governor Ralph Northam. Meanwhile, I want to share a study being released today. 

New Study Reveals Shameful Eight-Fold Difference in Percentage of State Funds Allocated to Helping Mentally Ill. 

  • Maine, Pennsylvania and Arizona are the most generous states. 
  • Arkansas, West Virginia, Idaho, Kentucky, Oklahoma, Louisiana and Delaware are the stingiest states.  

Mental Illness Policy Org just released the first study to rank all fifty states based on the percentage of state-controlled funds that each state spends on mental illness. States that spend a higher percentage of their overall budget on mental illness are ranked as generous and those that spend a lower percentage of their overall budget on mental illness are ranked as stingy. Put another way, this report describes which states have been “naughty or nice” to the mentally ill.

Funds for Mental Illness found the most generous states in mental health spending are Maine, Pennsylvania and Arizona. The stingiest states are Arkansas, West Virginia, Idaho, Kentucky, Oklahoma, Louisiana and Delaware. The most generous states, Maine and Pennsylvania (5.6%), allocate eight times more as a percentage of total state spending than the stingiest state, Arkansas (.7%).

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The Doctor Is Out: Even If You Have Insurance, Finding A Psychiatrist Is Difficult

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(12-8-17) Every time we take a step forward, it seems we get knocked two steps back.

Getting mental health treatment remains difficult in our country despite passage of The Paul Wellstone and Pete Domenici Mental Health Parity and Addictions Equity Act of 2008 (MHPAEA) that requires parity in health insurance coverage of mental health and physical health benefits.

That’s the findings of a survey the National Alliance on Mental Illness has released based on an online survey conducted in 2016 to examine what happened when individuals with insurance sought mental health care. The study, which drew responses from 3,177 individuals, is called The Doctor Is Out.

When trying to find a provider, respondents reported the most severe problems as follows: 1. Providers were not accepting new patients (55% psychiatrist, 45% therapist); or 2. Providers were not accepting their health plan (56% psychiatrist, 11% therapist).

An earlier study had found that only a little over half of all psychiatrists will accept insurance – compared to close to 90% of physicians in other medical specialties. It’s even worse if you depend on Medicare and Medicaid because psychiatrists accept patients at “significantly lower rates than other physicians do.”

That’s especially troubling when you consider that Medicaid is the biggest payer for mental health services.

Why is finding a psychiatrist who will accept insurance so difficult?

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Lynn Nanos: A Street Social Worker Tells What It’s Really Like

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(12-04-17) I’ve always hoped someone who actually provides direct services to persons with serious mental illnesses would write a book so I was excited when I received an email from Lynn Nanos. She is putting the finishing touches on a nonfiction book about her personal experiences as a inpatient social worker. I got more excited after I read a short excerpt of BREAKDOWN: A Clinician’s Experience in a Broken System of Emergency Psychiatry due to be published in next year. Here’s a slightly edited excerpt.

Dangerously Unaware   By Lynn Nanos, LICSW

When I started working on an inpatient psychiatric unit as a social work intern for the New York state’s Office of Mental Health in 1996, my supervisor told me, “No one here is mentally ill.” She was never part of the anti-psychiatry group who believe that mental illness doesn’t exist. By stating this, she meant that many of these patients didn’t believe that they were ill.

  The Woman Who Wouldn’t Eat

I go to a psychotic woman’s apartment with an outpatient worker because she stopped eating. She stopped eating because of her belief that people are poisoning her food. Because she believes that poisonous gas is coming out of her heating vents, she covers these. Because she believes that poisonous gas is coming out of her faucets, she keeps the water running continuously. She believes that running the water blocks the gas.
As we are standing in water inches deep, she tells me that she is not mentally ill. Therefore, from her perspective there’s no need to take any medication.
The police are called and an ambulance transports her to the hospital emergency department. The emergency medical doctor calls and tells me that because she is well groomed, speaking clearly, not suicidal, and not homicidal, she is being discharged back to her home.
Everything I report to them is disregarded. I’m just a social worker.
Would she be moved on to inpatient if I am a psychiatrist or medical director of an agency? Would she be moved on to inpatient if she has a family member to advocate for her?

Weeks later, she is evicted from her apartment with nowhere to sleep except for the streets.

The Devil Told Him
A psychotic man got discharged from Bridgewater state “hospital,” really managed by the Department of Corrections, earlier that week. He was there because he was eating his feces and cutting himself to remove what he believed was the devil from his body while incarcerated. He yells out his fears of the devil when I evaluate him at the state-funded respite unit.
He tells me that he got sentenced to prison because he pointed a loaded gun toward a stranger. I inquire about what made him do this. He says that the devil told him to do it. He doesn’t believe that he is mentally ill.
Emergency medical doctors are more likely to discharge to the streets a dangerous patient who is not wanting any treatment, than a dangerous patient who is wanting treatment.
They are more likely to move on to inpatient the malingerer who doesn’t need treatment, than a psychotic patient who can “pull it together,” and cover up symptoms.
Our Current Train Wreck
 Psychiatric emergency services work can be akin to watching a train wreck without any ability to prevent the wreck from happening. When will the next tragedy involving serious injury or loss of life due to untreated serious mental illness occur? Governments are reactive.

The severe shortage of inpatient psychiatric beds along with overly restrictive inpatient commitment criteria often results in only the sickest of the sick getting admitted to inpatient units. For people with psychosis who lack awareness of being psychotic, brain deterioration often occurs long before sufficient psychiatric treatment is obtained. Early psychosis programs are completely voluntary, thus marginalize those who refuse to engage in treatment because they don’t believe that they are ill.

I know there are success stories out there. But as an inpatient social worker, I was alarmed at the extremely high rate of readmission to our units. This is what motivated me to begin writing about what I see daily.
We, or at least, I can’t close my eyes at night knowing that we could, no, we must do better.
I think of a patient on my caseload who was paranoid delusional and was refusing to accept treatment because he did not believe that he was mentally ill. He refused to sign a release of confidentiality for me to communicate with his mother, even though they resided together. She knew he was there, so I just supportively listened to her concerns. I passed these on to the rest of the team, including his psychiatrist.
Shortly after his discharge, he used a knife to stab his mother to death.
When something such as this happens, you have choices. You can pretend these events don’t happen or turn away from them. Or you can roll up your sleeves and begin advocating to improve the lives of the seriously mentally ill population who are the sickest.
I’m in my tenth year as a mobile psychiatric emergency clinician. I’ve rolled up my sleeves.