Alabama Health Officials Told Hospitals Not To Waste Ventilators On Americans With Cognitive Issues. Disability Rights Made Them Stop: The Importance Of Watchdogs

image of a DIY ventilator, by Johnny Lee Chung

Photo by Johnny Chung Lee published in The Register

(4-17-20) Should patients with intellectual disabilities, profound mental retardation, dementia, and other cognitive problems (including serious mental illnesses) be denied life-saving ventilators if a hospital falls short of them during the Covid-19 pandemic?

Are the lives of individuals with mental issues worth less than other Americans?

The Alabama Department of Public Health thought so.

It adopted a protocol in 2010 entitled “Criteria for Mechanical Ventilator Triage Following Proclamation of Mass-Casualty Respiratory Emergency,” that instructed hospitals to “not offer mechanical ventilator support for patients, who were being treated for heart attacks, metastatic cancer, “severe or profound mental retardation,”  “moderate to severe dementia,” “severe traumatic brain injury” and other cognitive problems.

When that protocol surfaced recently,  The Alabama Disabilities Advocacy Program filed a complaint with the U.S. Health and Human Services Office for Civil Rights, accusing the health department of violating the Americans with Disabilities Act, which prohibits discrimination based on disabilities. The Bazelon Center for Mental Health Law joined in that complaint.

HHS forced the Alabama health department to rescind those recommendations to hospitals.

Alabama is not the only state coming under fire for targeting persons with mental and physical issues. Similar concerns have been raised about triage protocols in Arizona and Washington.

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New PBS Series Shows How Miami Dade Went From Hellhole To National Model For Helping Persons With Mental Illnesses

(4-13-20) PBS will premier two separate and important documentaries tonight and tomorrow at 10 p.m. EST about mental illness in America.

BEDLAM will trace the history of mental health treatment (or lack thereof) in America. At 2 p.m. EST today, the documentary’s director will host a Facebook discussion about mental health care that will feature  Daniel H. Gillison, Jr. the CEO of the National Alliance on Mental Illness. You can participate by signing up here.

Tuesday night,  4-14-20,  PBS will show The Definition of Insanity, an eight part series that reveals how Miami Dade County, Florida, has transformed itself from a hellhole of misery into a national model when it comes to jail diversion, Crisis Intervention Team Training, and other mental health services.

I’m especially interested in The Definition of Insanity because two advocates, whom I greatly admire, are responsible for the series and because my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, exposed the barbaric conditions that were in the Miami Dade jail back in 2006.

Judge Steven Leifman, who was responsible for getting me into that jail, has become a nationally recognized expert on how communities can better deal with individuals when they become entangled in the criminal justice system. Norman “Norm” J. Ornstein, who you might have seen on television offering expert commentary as an American political scientist and resident scholar at the American Enterprise Institute, a Washington D.C. conservative think tank, collaborated with Judge Leifman and is a major financial backer of the series.

Ornstein created the Matthew Harris Ornstein Memorial Foundation Inc., after his 34 year-old son who died from carbon monoxide poisoning in 2015. Matthew fell asleep in a tent with a propane lantern emitting toxic fumes – an accident — but his death was shaped by a lack of judgment driven by his 10-year struggle with mental illness, his father said.

More than 360,000 individuals with diagnosed mental illnesses are currently in our jails and prisons, and 2.2 million are booked into jails each year. What Judge Leifman has demonstrated and the Ornstein PBS series poignantly documents, is how our communities could dramatically reduce that number and help people recover while saving tax dollars!

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Govt. Waives Restrictions Allowing Psychiatric Wards In Hospitals To Admit Covid-19 Patients

Virginia Western State Hospital, state photo

(4-10-20) Notes about mental health and the Covid-19.

At the urging of lobbyists for hospital associations, the Trump Administration has announced that beds reserved for psychiatric patients in general hospitals and state mental hospitals can now be converted into beds for treating Covid-19 patients.

The authority to begin housing Covid-19 patients in beds previously reserved for psychiatric patients was authorized on March 30 and announced in a release by the Centers for Medicare & Medicaid Services which authorizes federal payments through the Medicare, Medicaid, and CHIP programs. CHIP is the Children’s Health Insurance Program (CHIP) that provides health coverage to eligible children.

Why would hospitals want to treat Covid-19 patients rather than psychiatric patients, especially since  advocates have been complaining for years about a lack of crisis care and longer care psychiatric beds?

One could argue that hospitals want to help flatten the curve by using every bed possible to combat the corona virus. That’s admirable. A less noble view is that psychiatric departments in hospitals are among the least profitable.  Time magazine recently reported that one uninsured Covid-19 patient was charged $34,927.43 for treatment in her hospital.

If general hospitals, eager to earn bucks off the pandemic, begin turning away individuals in the midst of a psychiatric crisis or sending them to state hospitals, there will be even more overcrowding and long waits for beds.

So where will psychiatric patients go if all of their beds are being filled with Covid-19 patients?

The same lobbyists who pushed for the 1135 CMS wavier that allows hospitals to convert their psychic beds are urging the White House to stop the enforcement of the IMD exclusion that prohibits federal funds from going to psychiatric treatment facilities larger than 16 beds. Lifting the IMD, which many advocates have urged for years, would allow larger psychiatric facilities.

Crisis Lines: Telephone crisis lines are being swamped during the pandemic. The Veterans Administration usually fields 40,000 calls per month. In March, that number topped 150,000. Other crisis call centers also are reporting a record breaking number of calls. The VA is studying a plan to begin offering psychiatric telehealth conferencing in convenient spots, such as Walmarts, to serve veterans in crisis.

White House Conference Call Encouraging Mental Health Workers: President Donald J. Trump, Melania Trump, Vice President Mike Pence, Karen Pence, HHS Secretary Alex Azar, Veterans Administration Secretary Robert Wilkie, and Assistant Secretary of Health and Human Services for Mental Health and Substance Use Dr. Elinore McCance Katz, spent a half hour on a conference call Thursday with 177 by-invitation-only listeners with varying ties to mental health.

Author D. J. Jaffe, Treatment Advocacy Center Executive Director John Snook, and Miami Dade Judge Steven Leifman were on the call, as was I.

The purpose of the call was to thank mental health workers who are risking their lives to serve individuals in need and to tout what the administration is doing to help Americans with opioid addictions and mental illnesses. The call was mostly a much needed pep talk and I am extremely grateful that the President took time to recognize the importance of mental health workers and mental health care.

As always is the case in Washington, conference calls with the White House are carefully scripted. Four individuals were allowed to ask questions that had been cleared beforehand. Those listening were not allowed to ask questions, which admittedly would have turned into a much longer and chaotic session.

Before the call, I asked a number of mental health experts to share recommendations they would make to the White House.  (These were personal requests by me and should not be seen as statements by any of the organizations that the experts represent.) I will forward these recommendations to the White House. Click to continue…

Mental Health Workers Are Not Getting Masks: I Know Because It’s Happening In My Family

(4-6-20) Why are mental health workers going without protective equipment?

Two of my adult children work in the mental health profession. Although they are utilizing tele-medicine, clients still need help getting groceries and their prescriptions. They need to be taken to doctor appointments. Those in crisis still need to be seen.

My wife, Patti, has hired a neighbor to make masks for both of them that should be ready tomorrow. She’s also managed to secure a few paper ones.

The reporter in me is wondering how this is possible? How can we expect our mental health workers to do their jobs without personal protective equipment?

The father in me is outraged that my adult children are potentially putting their lives at risk.

I suspect that what my adult children are experiencing is not unique. If you work in a jail, prison, with the homeless or with the mentally ill, please tell me on my Facebook page if you are getting the protective gear that you need to do your jobs.

Meanwhile, thank you for your continued service to those who need your help.

God bless you. Stay safe.

Supreme Court Majority Effectively Eliminates 700 Years Of Legal Thinking About Insanity Defense

(4-2-20) With all of our attention on the pandemic, a U.S. Supreme Court decision about the insanity defense last week didn’t attract much attention. As long-time mental health advocate and attorney Ron Honberg reports it should have!

Kahler V. Kansas Ruling Says States Can Separately Define Insanity In Criminal Cases.

By Ron Honberg, J.D.

A divided U.S. Supreme Court issued a ruling last week that essentially said states can eliminate the option of insanity as a defense regardless of how sick someone might be.

There is an old adage that “hard cases make bad laws.”   What this essentially means is that cases with unusual facts sometimes lead to decisions that create bad legal precedents for a large number of people.

Kahler v. Kansas may prove that point.

No one disputes that James Kraig Kahler committed a horrific crime. He shot to death his estranged wife, their two daughters, and his wife’s mother, sparing only their nine-year-old son who witnessed the shootings .

Kahler did not have a previously documented history of mental illness.

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Mother Flees U.S. In Search For Affordable Mental Health Care: Outrageous In Richest Nation

(3-30-20) Dianne Hiltman is flying to Costa Rica with her adult son who needs mental health treatment. The reason why she has to leave the United States will not surprise you, but it should anger you.

On Our Way Desperately Seeking Help: A Mother’s Journal

By Dianne Hiltman

Mar 28, 2020

The plane descends in the dark evening, far away lights scatter the horizon and reveal the distant city. It could be any city, a metal tube filled with travelers, folks simply getting home, some people fulfilling business obligations, others just doing life.

But this airplane is landing in San Jose, Costa Rica and I am accompanying my 33 year-old son with mental illness there.

I manage a rueful smile. I’m certain I’d win betting that we are the only people on this flight because of mental illness. Then I remember all the times we have hoped in the past. The numerous medications. The yet one more fine and highly recommended psychiatrist. The clinical trial of IVKetamine therapy. So many hopes. Twenty two years of failed hopes.

I can’t quite “read” Matt this night.

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