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6/11/2015 12:00 AM

Although some in the mental health community applaud provisions in Rep. Tim Murphy’s (R-Pa.) long-awaited revamped mental health reform bill, such as promoting early intervention and prevention programs, research advancement and telepsychiatry use in hard-to-reach populations, and bolstering the federal parity law, others fear that reform of the Substance Abuse and Mental Health Services Administration could mean its “dismantling.”

Although some in the mental health community applaud provisions in Rep. Tim Murphy’s (R-Pa.) long-awaited revamped mental health reform bill, such as promoting early intervention and prevention programs, research advancement and telepsychiatry use in hard-to-reach populations, and bolstering the federal parity law, others fear that reform of the Substance Abuse and Mental Health Services Administration (SAMHSA) could mean its “dismantling.”

“The Helping Families in Mental Health Crisis Act of 2015” was introduced by Murphy in a different form in December 2013 following a yearlong investigation, including public forums and hearings, to investigate the country’s mental health system. At that time, groups were divided on the merits of Murphy’s proposal (see MHW, Dec. 23, 2013).

Among its provisions, the bill, H.R. 2646 (formerly H.R. 3717), introduced June 4, would reauthorize the National Child Traumatic Stress Network and launch a new early childhood grant program to provide intensive services for children with serious emotional disturbances in an educational setting.

Lawmakers from the Energy & Commerce Subcommittee on Health are scheduled to examine the bipartisan legislation on June 16. The bill is co-authored by Rep. Eddie Bernice Johnson (D-Texas).

Provisions of the new bill would include requiring psychiatric hospitals to establish clear and effective discharge planning to ensure a timely and smooth transition from the hospital to posthospital care and services. It would also advance telepsychiatry to link pediatricians and primary care doctors with psychologists and psychiatrists in areas where patients do not have access to needed care.

New legislation

Murphy’s legislation is clearly a different bill from what he presented in 2013, said Paul Gionfriddo, president and CEO of Mental Health America. “He didn’t reintroduce last year’s bill,” Gionfriddo told MHW. “We’re treating it as a brand-new bill. The other one no longer exists.”

Gionfriddo said he noted some important changes from the last bill. The earlier legislation tied the receipt of block grants to states adopting assistant outpatient treatment (AOT), he said. Now, states will be incentivized by 2 percent if officials expand community treatment programs, Gionfriddo noted. States will not be penalized, he said, adding that it will remain a state option. “It’s a better approach,” he said.

A provision regarding the interagency coordinating council will enable it to invest more heavily in research, he said. Also, the inclusion of early identification and intervention provisions is “very heartening to see,” Gionfriddo said.

“The legislation [provides] oversight at the federal level with an eye toward elevating and strengthening SAMHSA,” Gionfriddo said.

Murphy spoke about the legislation at the MHA’s annual conference on June 4 in Alexandria, Va., the day the bill was introduced, said Gionfriddo. “We’re still in the early stages of reviewing the bill,” said Gionfriddo. “Clearly, it’s a different bill. It needs to be looked at on its own merit. [The field] should treat it as a brand-new bill and decide how they feel about the provisions of this bill.”

The legislation designates an assistant secretary for mental health and substance use disorders in the U.S. Department of Health and Human Services. The assistant secretary would promote, evaluate, organize, integrate and coordinate research, treatment and services across departments, agencies, organizations and individuals with respect to the problems of individuals suffering from substance use disorders or mental illness.

“This is a great overreach of congressional authority,” Daniel Fisher, M.D., Ph.D., a psychiatrist and founder of the National Coalition for Mental Health Recovery, told MHW. “The first forty-seven pages of the document are designed to dismantle SAMHSA completely.”

The legislation would replace SAMHSA with the new office headed by a government official overseen by Congress, noted Fisher. “It will mean that mental health policy will be driven primarily by Congressman Murphy’s office,” he said. Grant notification, for example, which typically occurs within 48 hours, may now include nearly 60 days of review under the new bill, said Fisher.

Fisher added that such a move would have “dire consequences” for SAMHSA, which focuses on recovery and community integration for people with mental illnesses.

The National Disability Leadership Alliance intends to send a letter to lawmakers expressing their concerns similar to the letter they sent April 23, 2014, to members of the Energy and Commerce Committee and the Health Subcommittee, said Fisher, also a member of the alliance. At the time, they wrote that Murphy’s bill “would weaken current federal efforts to address the unmet needs of people with psychiatric disabilities.…” What remains a concern, however, is the proposed SAMHSA restructuring. “Has there ever been restructuring of another branch of the administration?” he said. “It’s unbelievable.”

At press time, SAMHSA Administrator Pam Hyde was unavailable for an interview. SAMHSA released the following statement to MHW: “SAMHSA appreciates Reps. Murphy and Johnson’s interest in and commitment to addressing issues re services for individuals with mental illness or addiction, and continuing to bring attention to this critically important public health issue. SAMHSA looks forward to working with the representatives to offer technical assistance about the implications of the legislation for current federal programs and for the needs of persons with or at risk of serious mental illness or addiction, and their families.”

MH pilot program expansion

The Excellence in Mental Health Act establishes a two-year demonstration program for eight states to offer a broad range of mental health and substance abuse services that would expand under the reform legislation. The legislation, which certifies behavioral health clinics, passed in 2014.

Under Murphy’s bill, the demonstration program would expand by an additional two years and increase the number of participating states from eight to 10, said Chuck Ingoglia, senior vice president of public policy and practice improvement for the National Council for Behavioral Health. “We’re very happy about that,” Ingoglia told MHW.

“A lot of the provisions are laudable,” said Ingoglia. The legislation includes provisions from the Health Information Technology for Economic and Clinical Health Act, he said. “It would extend meaningful use payments to a variety of mental health and addiction treatment organizations as well as to clinical psychologists,” he said.

Additionally, the legislation clarifies that Medicaid can pay for physical health services and mental health services that are provided at the same time, Ingoglia said. “Right now, in some states the Medicaid program does not allow recipients to receive both a mental health and a substance use service on the same day,” he said. “There is no federal prohibition against this; it’s a state issue. The bill clarifies that would be the expectation.”

Stakeholders have been waiting back as early as January for Murphy to introduce the bill, Ingoglia said. “There’s a lot of excitement about the bill being introduced,” he said. The National Council intends to meet with stakeholders, said Ingoglia. “Obviously we’re looking forward to the hearing and talking with stakeholders as well as staff to understand the next steps,” he said.

Bottom Line…

Some in the field intend to meet with congressional staff and stakeholders to support the bill and determine the next steps, while others intend to write letters opposing its provisions.

5/28/2015 12:00 AM

The news is all too familiar. Last week a California mother called for change, support and awareness following the death by suicide of her 14-year-old transgender son. Kyler Prescott, born a boy, embraced life as a girl, ABC News reported. Prescott, who had been diagnosed two years ago with depression, was harassed on social media and had been cutting himself.

The news is all too familiar. Last week a California mother called for change, support and awareness following the death by suicide of her 14-year-old transgender son. Kyler Prescott, born a boy, embraced life as a girl, ABC News reported. Prescott, who had been diagnosed two years ago with depression, was harassed on social media and had been cutting himself.

Helping young people talk about depression, emotional distress or thoughts of suicide is at the crux of two new suicide prevention initiatives by national organizations. MHW spoke to organizers and officials affiliated with the programs that offer slightly different approaches but go beyond increasing awareness to taking corrective action.

The American Foundation for Suicide Prevention (AFSP) announced on May 27 that the organization joined forces with Legal One, a provider of school law training for educators, and Rutgers University Behavioral Health Care to launch an online training program for educators on how to prevent suicide in the nation’s schools.

AFSP officials say there are currently 24 states in the United States that have laws dictating mandatory suicide prevention school personnel training. This program will fulfill many state requirements for educators to have two hours of instruction on suicide prevention, officials said.

“Signs Matter: Early Detection” is an online suicide prevention training program that will show K–12 educators how and when to express concern and refer students to counseling staff or administration.

“We wanted the entire K–12 [community] because we know that, even in elementary school you can recognize the signs with early detection and reduce risk of later problems,” Doreen Marshall, Ph.D., senior director of education and prevention at AFSP, told MHW. Teachers can play an important role in noticing the signs of mental distress in students and identifying the signs of suicide risk, she said.

Student scenarios

The program contain three vignettes (elementary, middle school, high school) featuring detailed scenarios of situations in which students might find themselves (e.g., bullying) and that may be cause for concerns related to mental health.

Among its components, the online, school-based training program includes:

  • A close look at the most common mental health problems and how they typically present in a school setting.
  • An online assessment tool to ensure that all participants have gained an understanding of the material covered.
  • Resources for understanding a school’s role in suicide prevention.
  • Review of legal requirements for schools to keep in mind.

Virtual training

In Virginia’s Fairfax County, considered one of the largest counties in the country, more than 9,400 teachers and staff have so far participated in a series of online simulation programs in suicide prevention and mental health. The online programs, At-Risk for High School Educators and At-Risk for Middle School Educators, are developed by Kognito, a New York–based company specializing in immersive learning experiences.

A number of suicide deaths by students prompted the Fairfax-Falls Church Community Services Board to offer its teachers and staff the online training in suicide prevention and mental health, said Laura Yager, director of partnership and resource development for the board. Yager said she selected At-Risk because it is listed in the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices.

Yager said she looks for programs that are effective and produce good outcomes. “We’re always looking for evidence-based practices that are related to health and wellness,” she said. “This program fits the bill. It’s proven to be convenient and it demonstrates skill building.”

She added, “We want to make a good investment when contracting for services or purchasing programs and helping teachers learn how to intervene effectively.”

The virtual role-play helps participants recognize common signs of psychological distress and learn how to approach and effectively talk to students. In the high school version, for example, At-Risk users assume the role of a teacher who has concerns about three students. The user reviews the students’ academic performance, behavior and physical appearance and then engages each virtual student in a simulated conversation to determine what further action should be taken.

The entire simulation takes an hour to complete. At the end of the simulation, users receive personalized feedback on their performance, gain access to a list of available support services in their school and area, and are able to print a certificate of completion.

The online professional development program helps teachers learn about the common signs of psychological distress and how to approach an at-risk student for referral to the school counselor. “It’s an immersive experience,” explained Mary Ann Panarelli, Ed.D., director of the Fairfax County Public Schools Office of Intervention and Prevention. The role-play scenario enables teachers to practice talking with a student and provides prompts to the kinds of things they can do, she said. “It builds coaching tips along the way, and builds a better relationship with the kids,” Panarelli said.

Panarelli added, “We don’t expect educators to be mental health experts, but it is important that they understand and recognize the signs that a student is at risk for suicide.”

Simulation technology

The simulation technology allows the user to role-play with virtual humans, said Ron Goldman, co-founder and CEO for Kognito. “We want to help you move into action to actually talk to the students, reach out to the community and support them,” he said. “It’s good to see that the Fairfax County school district recognizes the value of mental health and how it plays [into] the quality of life for students and their academic performance.”

The program is akin to learning how to ride a bike, he said. “You can’t learn how to ride a bike by watching someone else,” Goldman said. “You have to get on the seat and practice yourself. We’re doing the same thing.”

Kognito’s online programs are used by health and mental health agencies, nonprofits and education agencies in more than 10 states, including Alaska, California, New York, Illinois, Maryland and Ohio.

Yager explained that the program is entering its second year. Next year the Community Services Board will introduce an elementary school curriculum for educators along with another program, “Step In, Speak Up!” for peers. “Young people will take the training and learn how to intervene with peers,” Yager said. The peer program will begin after July 1, she said.

The program is easily accessible and cost-effective, added Yager. There’s no need to spend money on staff for traveling costs or for materials, she said. “You enter a virtual world and get instant feedback,” she said. “It’s a positive approach.”

For more information about AFSP’s Signs Matter: Early Detection, visit www.afsp.org/signsmatter and www.legalonenj.org/signsmatter. For information about Kognito’s At-Risk for High School Educators, visit www.kognito.com/products/pk12/.

5/19/2015 12:00 AM

New legislation representing the first federal ban of gay conversion therapy introduced May 19 would prohibit the practice of providing “conversion therapy” to any person in exchange for monetary compensation or advertising such services. The practice, which advocates consider an “unfair” or “deceptive” act, would give the Federal Trade Commission the duty to enforce this provision in accordance with existing law.

New legislation representing the first federal ban of gay conversion therapy introduced May 19 would prohibit the practice of providing “conversion therapy” to any person in exchange for monetary compensation or advertising such services. The practice, which advocates consider an “unfair” or “deceptive” act, would give the Federal Trade Commission the duty to enforce this provision in accordance with existing law.

The Therapeutic Fraud Prevention Act was introduced by Rep. Ted W. Lieu (D-Calif.) during a press conference last week. The bill provides congressional recognition that being LGBT (lesbian, gay, bisexual and transgender) cannot be and does not need to be “cured,” according to a fact sheet about the legislation, which has not been assigned a number yet.

California banned conversion therapy in 2012, New Jersey banned the practice in 2013 and Washington, D.C., followed suit in 2014. Oregon Governor Kate Brown is expected to sign a recently passed ban, the fact sheet stated.

The national community of professionals in mental health, education, social work, health and counseling has determined that there is no scientifically valid evidence for attempting to prevent a person from being lesbian, gay, bisexual, transgender or gender nonconforming, according to a discussion draft of the bill. Such professionals have determined that there is no evidence that conversion therapy is effective or that an individual’s sexual orientation or gender identity can be changed through conversion therapy, according to the draft.

Conversion therapy

“Conversion therapy” is defined as seeking to change an individual’s sexual orientation or gender identity. Practitioners of conversion therapy charge large sums of money for services that are completely ineffective and have caused serious side effects, such as depression, self-harm and family rejection, according to a press release.

“This vitally important legislation has the potential to save countless lives across this country by helping to end a practice that uses fear and shame to tell LGBT people the only way to find love or acceptance is to change the nature of who they are,” David Stacy, director of government affairs for the Human Rights Campaign (HRC), the nation’s largest LGBT civil rights organization, said in a press release.

Stacy added, “We’re proud to work alongside Congressman Lieu and our partners to send a different message — a message of hope, acceptance, and love where such a demeaning and destructive practice isn’t promoted as useful therapy.”

HRC and the Southern Poverty Law Center (SPLC) are urging congressional support for the federal ban on conversion therapy. Conversion therapy has been discredited or highly criticized by virtually all major American medical, psychiatric, psychological and professional counseling organizations. People who have undergone conversion therapy have reported increased anxiety, depression and, in some cases, suicidal ideation, according to SPLC officials.

Lawsuit ties

The bill’s creation has strong ties to a case in SPLC’s pending lawsuit against gay conversion therapy provider JONAH (Jews Offering New Alternatives for Healing), noted David Dinielli, deputy legal director of SPLC. The SPLC case is the first of its kind against gay conversion therapy providers tied to fraud under New Jersey’s consumer fraud act, according to Dinielli. The proposed federal legislation takes this approach to a national level under the Federal Trade Commission Act, he said.

The lawsuit alleges that JONAH; its founder, Arthur Goldberg; and counselor Alan Downing violated New Jersey’s Consumer Fraud Act by claiming that their counseling services could cure clients of being gay.

In prepared comments for the May 19 press conference, Dinielli wrote, “The entire conversion therapy industry is built upon a single, central lie — that being gay or transgender is an illness or disorder that can and should be cured. This is a lie, and it is a lie that conversion therapists regurgitate over and over again in their attempt to sell their snake-oil treatments to vulnerable families across this country.”

The lawsuit is represented by co-counsel Cleary, Gottlieb, Steen & Hamilton LLP, an international law firm; and Lite DePalma Greenberg LLC. A New Jersey Superior Court judge ruled on February 10 that misrepresenting that homosexuality is a disorder in marketing conversion therapy services violates the state’s consumer protection laws — a devastating ruling for the conversion therapy industry, which claims to “convert” people from gay to straight, Cleary, Gottlieb, Steen & Hamilton stated in a press release.

The ruling marks the first time a court in the United States has found that homosexuality is not a disease or a disorder and that it is fraudulent for conversion therapists to make such a claim, they said. The case heads to trial June 2.

Bottom Line …

Groundbreaking lawsuit against a conversion therapy provider heads to trial on June 2.

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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