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1/7/2016 12:00 AM

While the mental health community is applauding President Obama’s call for a half-billion-dollar increase in mental health funding as part of his executive order on reducing gun violence, some in the field have expressed concerns about the Social Security Administration’s intention to make its records available for gun background checks, although full details have yet to be released.

While the mental health community is applauding President Obama’s call for a half-billion-dollar increase in mental health funding as part of his executive order on reducing gun violence, some in the field have expressed concerns about the Social Security Administration’s (SSA’s) intention to make its records available for gun background checks, although full details have yet to be released.

President Obama announced a series of executive actions January 5 that would continue to fill in the gaps in the background check system and make it harder for people to obtain access to guns. The field is pleased that the president has acknowledged that people with mental illness are more likely to be victims of violence than perpetrators. He also noted that nearly two in three gun deaths are from suicide. “A lot of our work is preventing people from hurting themselves,” Obama said.

Obama noted that he wants to ensure federal records are submitted to the background check system to remove barriers that prevent states from reporting relevant information.

The U.S. Department of Health and Human Services on January 5 modified the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule to expressly permit certain covered entities to disclose to the National Instant Criminal Background Check System (NICS) the identities of those who, for specific mental health reasons, are prohibited by federal law from having a firearm, officials said.

HHS clarified a few areas but made it clear that patient privacy is still protected, said Judith M. Glassgold, Psy.D., associate executive director at the government relations office at the American Psychological Association (APA). “HHS in the regulation made it very clear that individual providers do not have to report on a patient’s mental health condition and have to protect the patient’s privacy,” Glassgold told MHW.

Glassgold added that it’s important to improve the universal background check and reduce the loophole. “APA supports the public health approach to reduce gun violence,” Glassgold said. “We particularly support efforts around suicide prevention. We support universal background checks.”

“APA wants to ensure that there be evidence of dangerousness; that is a key risk factor,” said Glassgold. “Evidence of dangerousness is central to why someone should not buy guns. The focus should be the history of violence, including domestic violence.”

Continuing field efforts

A call for more stringent background screening also occurred in the days following the Newtown tragedy, and members of the mental health community back then noted that searching the population for people with mental illness will not prevent violence, and will only stigmatize people with mental illness, the vast majority of whom are not dangerous (see MHW, Dec. 24, 2012).

“We have been on this issue ever since Newtown,” Ron Manderscheid, Ph.D., executive director of the National Association of County Behavioral Health & Developmental Disability Directors (NACBHDD), told MHW. Manderscheid pointed to efforts he and Eric Goplerud, Ph.D., director of substance abuse, mental health and criminal justice studies at the University of Chicago’s National Opinion Research Center, embarked on following the Newtown tragedy (see MHW, Dec. 24, 2012).

Their call-to-action letter back then to President Obama and Congress, among its recommendations, called on the president and members of Congress to provide federal support to immediately implement school,- family- and community-based programs to promote mental health, to prevent mental illness and substance abuse and to provide early interventions for those exhibiting these conditions.

The NACBHDD is pleased about the president’s new plan to improve the process of background checks for guns, Manderscheid said. “The important part is to be able to identify people who are violent, and we need [assessment] tools,” Manderscheid said. “We want to make a very strong case that people who are violent are not mentally ill.”

SSA

The Social Security Administration has indicated that it will begin the rulemaking process to ensure that appropriate information in its records is reported to NICS, according to the fact sheet on the president’s new executive actions to reduce gun violence.

The reporting that the SSA, in consultation with the Department of Justice, is expected to require will cover appropriate records of the approximately 75,000 people each year who have a documented mental health issue, receive disability benefits, and are unable to manage those benefits because of their mental impairment, or who have been found by a state or federal court to be legally incompetent, according to the fact sheet.

The SSA’s intent has caused a number of concerns from the field. The National Council on Disability said in a statement that “linking the need for a representative payee with a presumption of incapacity to exercise any right sets a dangerous precedent that undermines the goals of the ADA [Americans with Disabilities Act]: equality of opportunity, full participation, independent living, and economic self-sufficiency.”

“We have grave concerns about [including] people with SSDI [Social Security Disability Insurance] and DI [Disability Insurance] as part of this process,” added Manderscheid. “They are the very last [population] to run out and buy guns.”

In general, while there may be an easy way of getting on the gun control checklist, there is no definitive way of getting off that list, Manderscheid said. “Say you’re 20 years old with a mental health condition, and then you’re 40 or 50 years old and have not suffered from your condition in about 30 years,” he noted. “Why should someone have to still be on the checklist?”

Ron Honberg, J.D., director of policy and legal affairs for the National Alliance on Mental Illness (NAMI), told MHW, “We’re going to wait to carefully assess what the plans are [regarding] Supplemental Disability Insurance and Supplemental Security Income recipients,” he said. “We don’t want to inadvertently adopt policies and reinforce stereotypes about a correlation between mental illness and violence.”

DJ Jaffe from Mental Illness Policy Org., in an analysis of the mental health provisions of the president’s executive actions, said that the organization “supports this proposal, which essentially requires SSA to report to NICS recipients of benefits who are so mentally incapacitated the court has assigned them a representative payee to manage their money. We believe this represents a group of seriously mentally ill individuals who should not own firearms.”

Funding increase

Among the actions outlined, the president called for an increase of $500 million for mental health services.

Honberg said more resources for mental health care is critical. “That’s a pretty significant amount of money,” he said. “The devil is always in the details. There have been so many mental health cuts, particularly during the recession, and we haven’t made up for lost ground.”

The $500 million proposal will be subject to the appropriations process, he said. “We’ll get more details when the president’s budget is submitted,” Honberg said. “It’s going to be a long road ahead to have this money become available.” NAMI applauds the investment and hopes that an agreement can be reached on both sides of the aisle, he said.

“We’re absolutely delighted about the $500 million; we wish it were $5 billion,” Manderscheid told MHW.

Between 2008 and 2014, states cut $4.35 billion in public mental health spending from their budgets, said Manderscheid. “I don’t mean to be critical, but we need much more,” he said.

Regarding HHS’s modification of the privacy law, Manderscheid said the HIPAA law as written is already pretty good. “It’s not practiced in the field the way it is written because providers are scared of the ‘HIPAA police,’” he said. In the 13 years since HIPAA became effective, it has only prosecuted 25 cases, said Manderscheid.

Manderscheid pointed to a document published by the Office for Civil Rights (OCR) in March 2014, “OCR’s Guidance on the HIPAA Privacy Rule and Sharing Information Related to Mental Health.” The rule is balanced to protect privacy and allow users and disclosures of information for treatment and other appropriate purposes, according to OCR.

What’s key is people with mental illness should not be blamed for the mass shootings, said Manderscheid. “It leads to greater stigma and difficulty in access care, and to get housing,” he said.

Manderscheid added, “We are completely committed to working with the administration, and with Valerie Jarrett, [senior advisor] to Obama, to help move the agenda forward.”

Bottom Line…

The field is applauding the $500 million investment in mental health services and intends to work with the president and with Congress to ensure services are provided to those in need.

12/29/2015 12:00 AM

Looking ahead to 2016, mental health field leaders and advocates are buoyed by the prospect of achieving comprehensive mental health reform, which they say is long overdue. The push for comprehensive reform legislation by bipartisan lawmakers has held center stage for some time now. Both House and Senate bills are gradually drawing more support from both Democrats and Republicans.

Looking ahead to 2016, mental health field leaders and advocates are buoyed by the prospect of achieving comprehensive mental health reform, which they say is long overdue. The push for comprehensive reform legislation by bipartisan lawmakers has held center stage for some time now. Both House and Senate bills are gradually drawing more support from both Democrats and Republicans.

Rep. Tim Murphy’s (R-Pa.) “Helping Families in Mental Health Crisis Act” and Sens. Chris Murphy (D-Conn.) and Bill Cassidy’s (R-La.) “Mental Health Reform Act of 2015” are pending. Murphy’s bill cleared a subcommittee hearing last November.

Other priorities for the field this new year include parity enforcement, workforce development and the decriminalization of people with mental illness in the nation’s jails and prisons.

“For 2016, I’m optimistic that more states will move forward to meeting their Olmstead obligations,” Robert Bernstein, Ph.D., executive director at the Bazelon Center for Mental Health Law, told MHW. “In this regard, I see great opportunities as the Affordable Care Act (ACA) gains wider acceptance. Not only will more individuals have access to mental health care through their insurance, but more states will see how the ACA helps them with funding for the community-based services they should be providing in order to comply with Olmstead.”

Bernstein added, “Also, Congress has the opportunity to come back and work on real reform of the mental health care system. I hope to see proposals that focus on making sure that supports and services are available to people in their communities.”

The quest for comprehensive reform has received the most attention from the mental health community and lawmakers by far in 2015. Both bills represent historic legislation for the first time in decades, said Renée Binder, M.D., president of the American Psychiatric Association. “A comprehensive mental health reform bill is one of the huge things we’re looking forward to,” Binder told MHW. The legislation, Binder noted, would bring systemwide reform and improvements to care for patients and access to psychiatric treatment.

“As to be expected, there are minor policy differences between the two,” Binder said. “Although the bills are remarkably similar, there is considerable overlap.” The quest for reform has become a bipartisan issue in Congress as people are recognizing the need to do something to improve access to mental health care, she said.

“Our top priority continues to be getting comprehensive mental health legislation passed and hopefully signed by the president,” Mark Covall, president and CEO of the National Association of Psychiatric Health Systems, told MHW. “We see comprehensive mental health reform as way overdue. The time is now to move forward and hopefully work with the mental health community as we continue to look at the details and work with Congress to make reform a reality.”

Parity enforcement

Although more than five years have passed since the passing of the Mental Health Parity and Addiction Equity Act, there has been only minimal enforcement on both the state and federal levels.

“We continue to support further clarity in the mental health law so that there’s more transparency,” Covall said. An important step in complying with the mental health parity law is for health insurers to fully disclose how they’re complying with the law, he said.

The American Psychiatric Association has made some efforts to educate consumers about what they can do about health care plans that are not in compliance with the parity law, said Binder. The APA has created the “Fair Insurance Coverage: It’s the Law” document that can be posted in such places as physicians’ offices and break rooms at workplaces. It’s also available on the APA website. “We’ve been doing that in 2015 and are continuing to do it in 2016,” she said.

Additionally, the APA has embarked on other efforts when health plans are not complying with “the spirit of the parity law,” said Binder, including support of Rep. Joe Kennedy’s (D-Mass.) bill, “The Behavioral Health Coverage Transparency Act of 2015.” The legislation will hold health insurers accountable for providing adequate mental health benefits and increase transparency for consumers seeking coverage for mental illness and substance use disorders.

The APA is encouraging consumers to let them know about insurers who are not complying with the parity law, and encouraging psychiatrists and other mental health providers to do the same, said Binder. “We hope to make great strides in 2016 in the enforcement of mental health parity,” she said.

Criminal justice

Binder noted that the APA will co-host, with the National Association of Counties and the Council of State Governments Justice Center, the Stepping Up National Summit in Washington, D.C., on April 17–19. The goal will be to train communities on how to decrease the number of people who are in jails and prisons, she said.

During the event, the APA will present the APEX (American Psychiatric Excellence) Awards to individuals who are advancing the cause of mental health and using public platforms to raise attention to the issue.

Ron Honberg, J.D., national director of policy and legal affairs at the National Alliance on Mental Illness, told MHW that NAMI is also looking forward to the summit. “It’s going to be a very intensive three-to-four-day summit,” he said. “The best solutions get forged at the local level,” Honberg said.

Regarding criminal justice, NAMI is also supportive of Sen. John Cornyn’s (R-Texas) bill, “The Mental Health and Safe Communities Act of 2015” (S. 2002).

“The bill tries to establish resources for people with mental illness and co-occurring substance use disorders,” said Honberg. Additionally, the legislation offers jail diversion programs, law enforcement training, discharge planning and re-entry services, he said. The Cornyn bill “is a good bill,” noted Honberg, although there is some controversy around a provision that seeks to clarify mental health reporting requirements, he said.

“The whole gun issue is very divisive,” Honberg said. “I believe Sen. Cornyn is trying to clarify what is already in the law.” Cornyn is faced with criticism by gun control groups, he noted. “Getting the bill passed is one of our priorities,” Honberg said.

2016 election

“We really need to figure out how to make mental health an issue in the 2016 election,” said Honberg. The over-incarceration of people with mental illnesses in jails and parity enforcement are just some of the examples of issues NAMI would like to see candidates address, Honberg said.

NAMI and a host of other organizations are partnering with the Kennedy Forum to engage presidential candidates to address mental health– and addiction-related issues.

The Kennedy Forum’s NOW Campaign is a nationwide movement to find solutions to educate the candidates on issues important to the mental health and addictions fields. “It’s really critical that we’ve got NAMI as a partner to launch this campaign with us,” Lauren Alfred, policy director at the Kennedy Forum, told MHW.

“Having any 2016 candidate hear from NAMI through this coordinated effort is a big priority,” said Alfred. This is a coalition that is speaking with one voice, she said. “We want to hear from candidates about specific solutions [regarding] access, innovation, research efforts and what they plan to do for veterans,” said Alfred.

Current partners of the NOW Campaign also include the National Council for Behavioral Health, Faces and Voices of Recovery, Mental Health America, the American Foundation for Suicide Prevention and the Legal Action Center. For more information, visit www.nowcampaign.org.

Engagement

Another priority for NAMI is engagement, said Honberg. Over the last few months, NAMI has looked at what the best practices are in getting people engaged in services, he noted. “Why are people reluctant to receive services?” Honberg said. “The question is what can be done?  We convened a group of stakeholders of very diverse people” to address these issues, he said. A report is expected in early spring on what can be done to improve engagement.

Some tension already exists in the field between those who support involuntary treatment and those who oppose it, said Honberg. He also noted that he’s heard some stories about the mistreatment of people in hospitals and how the experience has added to their trauma. Their opinions about their own health have not been valued, he noted.

Young people in particular are reluctant to access treatment, said Honberg. Some feel ostracism from their peers, loss of friends, and missed opportunities for employment and the fear of negative impact on relationships, he said. “We have to figure out a way to make the system more user-friendly and humanistic, and try to [involve] people in their own care the way we see in other disciplines,” Honberg said.

Other issues

Another key point for NAPHS in 2016 is reform of the Substance Abuse and Mental Health Services Administration, said Covall. “We want to see changes and enhancement and build upon it,” he said. NAPHS would like to see a medical treatment component within the federal agency, Covall said.

Additionally, NAPHS wants to support change in the Health Insurance Portability and Accountability Act privacy rule so that patients and families can get the kind of information needed to help individuals get access to the services they need, he said.

“We support changes in the IMD [Institution for Mental Diseases] exclusion, except regarding short-term hospitalization,” he said. Much is needed, noted Covall, particularly because of the limits in accessing inpatient care, and the limited number of beds.

Workforce development is also a priority. “We need more clinicians,” he said. “We have to find ways to encourage physicians and other professionals to come into the field.”

Changing marketplace

The health care marketplace, including behavioral health, will continue to change, said Linda Rosenberg, president and CEO of the National Council for Behavioral Health. “We see insurance companies consolidated to actually become providers in some cases,” she said. Behavioral health organizations will be partnering with insurance organizations, hospitals, businesses and managed care companies to forge new relationships, she said. “You need strong partners,” Rosenberg said. “Health care as a commodity is really intensifying. Private investors are entering the marketplace.”

Meanwhile, not all of the field’s problems will be solved in one year, said Rosenberg. “There will be incremental progress,” she said. “We don’t want Congress to think their job is done.” 

 

Bottom Line…

A major summit in April to address the incarceration of individuals with mental health and a campaign to inform presidential candidates about behavioral priorities are high on the agenda for many in 2016.

12/3/2015 12:00 AM

New York State advocacy efforts paid off in a big way thanks to landmark legislation signed into law November 21 by Gov. Andrew Cuomo that creates a voluntary mental health public awareness tax checkoff to end discrimination against mental illness.

New York state advocacy efforts paid off in a big way thanks to landmark legislation signed into law November 21 by Gov. Andrew Cuomo that creates a voluntary mental health public awareness tax checkoff to end discrimination against mental illness.

The law takes effect on January 1 and will be reflected on the 2016 tax forms for 2015 income taxes. The legislation represents the first tax checkoff in the country dedicated specifically to public awareness about mental illness, noted Glenn Liebman, president and CEO of the Mental Health Association in New York State (MHANYS).

“There are a few tax checkoff bills around the country but none that is specifically related to public awareness about mental illness and anti-stigma,” Liebman told MHW. “We look at this as a landmark piece of legislation.”

The legislation has been part of the agenda for MHANYS for several years and was prominent in many of the state’s legislative sessions (see MHW, June 24, 2013). “This definitely has been a lead issue for the Mental Health Association — a major priority,” said Liebman.

Liebman added, “We think this is very important. Where else do New Yorkers get to see specific information about mental health [like this] on a tax form? They’re seeing mental health awareness is as significant as all these other issues, such as breast cancer and Alzheimer’s. That alone sends a strong message about mental health stigma.”

In fact, breast cancer research, Alzheimer’s disease and now mental illness are among the 13 causes that will be listed on New Yorkers’ tax forms. A new option this year includes educational efforts to prevent women’s cancers. Other areas, including prostate cancer and volunteer firefighter recruitment, have been listed for contributions for many years, noted Liebman.

“This was a real victory for grass roots,” said Liebman. “People coalesced around this issue. More than a thousand calls were made to the governor’s office about this issue. Over 100 agencies supported us. It felt like a real team effort. The mental health community is a smart and passionate group of people. When we all coalesce around a single issue, we can be a powerful force.”

Liebman said he recently heard from a local organization in Maine that wants MHANYS to share its strategies behind its efforts to add a mental health tax checkoff on its taxpayer forms. “It’s something that is of great interest to them,” he said.

Volunteer donations

The legislation directs the state Office of Mental Health (OMH) to provide grants to organizations dedicated to eliminating the stigma attached to mental illness and to persons with mental health needs.

New York taxpayers can specify whatever amount they want, said Liebman. It can range from $1 to $1,000 or more, he noted. OMH officials will discuss internally strategic plans to raise public awareness around mental health issues, said Liebman. They will then send out a Request for Proposal to community mental health providers to bid on, he said.

“We look at this as sort of an opening salvo in what will be a series of public awareness changes in New York state,” Liebman said.

The success of MHANYS’s efforts to push for the mental health tax checkoff has emboldened the organization’s efforts to continue pushing for more issues important to them, such as an education bill that creates a mental health curriculum throughout the state. The legislation would raise the visibility of mental health and present it as part of the health curriculum for middle school to high school students, said Liebman.

“That’s our next big effort,” he said. “We know that 20 percent of students in New York are directly impacted by mental illness. Our constant message is that mental health is an important part of health care.”

From the Field
9/26/2013 12:00 AM
FromtheField
8/7/2013 12:00 AM
In Case
7/11/2013 12:00 AM
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    Valarie Canady
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    Valerie Canady, managing editor of Mental Health Weekly, knows the mental health field inside and out. She uncovers the essential stories and gets the scoop directly from leaders and advocates in the field.
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