It’s disturbing to see individuals with mental illness handcuffed and led away. Thankfully, they were taken to a crisis stabilization unit and not jail. 

(9-9-17) My good friend Miami Dade Judge Steven Leifman and his family have evacuated from Miami but not before he spoke to community leaders about the city’s seriously mentally ill, homeless population. 

 In an email, the mental health advocate told me: “These individuals were transferred to Jackson Memorial Hospital’s Crisis Stabilization Unit – they were not sent to an inappropriate shelter. We also coordinated with Jackson so they were prepared to handle the increased volume.”

Douglas Bevelacqua, a former IG for mental health in Virginia, noted in an email to me, “Hurricane Katrina raised everyone’s consciousness about the plight of companion animals during, and after, a major storm. There are many organizations and programs to help save and reunite dogs and cats with their owners. I wonder if Houston’s mentally ill street population is getting a fraction of the attention directed to its companion animals.” Bevelacqua wonders if  the National Alliance on Mental Illness, Mental Health America, or some other mental health group will sponsor or participate in a national disaster relief fundraiser. Good question.

During emergencies, everyone realizes many homeless individuals are so impaired by their brain disorders they cannot make rational decisions to protect themselves. But when the sky is clear, society is fine leaving them to fend for themselves on the streets.)

Miami shelters homeless against their will as Irma closes in

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(9-4-17) Health and Human Services Secretary Thomas Price called serious mental illness a “silent epidemic” that touches nearly all Americans. Housing and Urban Development Secretary Ben Carson agreed. But where were their peers when the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC), created by Congress, held its first meeting last week?

The 21st Century Cures Act stated that these top federal officials would be members of the committee.

Attorney General Jeff Sessions.

Secretary of Veterans Affairs David J. Shulkin.

Secretary of Defense James Mattis.

Secretary of Education Betsy DeVos.

Secretary of Labor R. Alexander Acosta.

Commissioner of Social Security Nancy A. Berryhill.

I know I am nitpicking. All of these leaders work grueling hours and simply can’t be everywhere the public would like them to be. Plus, they sent senior officials from their agencies to represent them, many of them mental health experts.

But the Trump Administration missed a opportunity by not having its elite leadership team appear at the inaugural meeting, even if it were only long enough for a photo. (See photo at end of this blog showing those who did attend.) Each agency also should have issued a press release on the day of the meeting issued by its top executive addressing how their agency is working on improving mental health services and is reducing stigma within its own ranks.

Consider the powerful, positive message their appearances would have sent to the public and to the federal employees who work in their agencies.

Last week, I posted Secretary Price’s impressive opening statement and in this blog, I will share Dr. Elinore McCance-Katz’s important remarks to the committee.

But first a personal observation. When Secretary Price arrived at the meeting, he spoke to everyone in the room, asked their names, and shook their hands. Unfortunately, Secretary Ben Carson arrived at the last minute and left immediately after he spoke so he was unable to greet everyone.

When I worked at The Washington Post, I spent several weeks traveling with Archbishop Desmond Tutu. He made a point of introducing himself to every doorman, every food server, and the housekeeping staff when we traveled, at times, he did this before greeting dignitaries. I never forgot the visual statement it made: you are important regardless of whether you are the head of a great university or a janitor. You matter.

You might not agree with Secretary Price’s politics, but he showed tremendous class when he arrived at the meeting and took time to introduce himself and shake hands.

As for the others, they missed an important moment when they could have done tremendous good simply by showing up for a picture.

Remarks by Assistant Secretary Dr. Eleanor McCance-Katz

Thank you Secretary Price.

• In my role as Assistant Secretary for Mental Health and Substance Use, I am pleased to pledge the support of SAMHSA to the Secretary’s priority issue related to Serious Mental Illness. As many of you know, SAMHSA is the agency within HHS that is charged with leading the efforts to address behavioral health issues, such as SMI and SED in our country and I look forward to the work of this committee in helping SAMHSA to address this mission.

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(8-30-17) The debate about patient consent that I’ve highlighted this week has spurred additional interest in the first meeting of the congressional mental health advisory committee scheduled for August 31, Thursday, here in Washington D.C.

I’ve received emails from readers who have asked if involuntary commitment laws will be discussed. That’s highly unlikely because involuntary commitment standards are set by each state – not the federal government – based on a “dangerous” criteria established by a U.S. Supreme Court ruling.

This first meeting will be about introductions of commission members and potential topics to be discussed in the future.

In preparation, I’ve been asking for suggestions about steps that can be taken to improve the federal system. Here are some of the ideas that have been shared with me.

Medication pre-authorization: a suggestion from Dr. Dinah Miller, c0-author of Committed: The Battle over Involuntary Psychiatric Care.

 As you probably know, when a patient is prescribed a medication, they may go to the drug store to fill it, only to be told that it requires “pre-authorization.”  The pharmacy may then contact the prescriber by sending a form that needs to be filled out, or the prescriber may need to call the insurance company’s pharmacy benefits manager (PBM) to negotiate for the patient to be approved for the medication, a process that often takes 20-30 minutes of uncompensated doctor time.  Sometimes it’s just a hoop to jump through, often the PBM wants to know that the patient has failed other, cheaper, medications or that there is a specific diagnosis that requires this specific medications without any leeway to use medications “Off label” as we sometimes resort to.  Usually the process is instituted for expensive medications, but not always: one psychiatrist recently mentioned that she spent 30 minutes getting authorization for a sleeping pill — she was not aware that a 90 day supply of the medication could be obtained at WalMart for $10, much less than the cost of her time. 

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