Senate agrees to pass lame duck mental health reform bill


A description of the bill is here. A copy of the bill is here.

Alrighty, Toadie, you asked me what my thoughts are on this bill. I know you asked me over on FB, but there was no short answer to your question and I really hate giving a wall of text answers over there. If I’m going to write a blog post, I’m going to post it on my blog 😉

Well, it’s hard to say what will happen with this bill from here. No way to say how it will be modified and if it will become law. There just isn’t any way for me to guess that. I don’t think our president is someone that I can predict.

But as this bill stands? There is a lot of structure changes that I am not convinced will effectively change things on the patient level. I like that it would require health care professionals with experience in the relevant fields to be on the advisory boards. Yes, we need businessmen in there too, but it never made sense to me for it to be all businessmen making healthcare decisions. No wonder it isn’t working out. Social workers are amazing at figuring out social problems, get them in there!

The bill creates a coordinating committee to evaluate federal programs related to the seriously mentally ill and provide recommendations to better coordinate mental health services for them, but I’m not sure that will go anywhere. They will be giving this advice to congress but they will have no political power. They’ll just be a group of people that give suggestions. It’s only as useful as the people giving the suggestions and as the people listening to it. So, if you have dolts giving advice and people not interested in listening… well, yeah. But it is an interesting idea. Having patients on the committee takes me aback. What comes to mind when I think of “the seriously mentally ill” doesn’t line up with someone that would able at a functional level for giving advice to congress. But there is also a serious potential for change with this. If you get people who are insightful and people who are willing to listen, you could get real change; good change.

I like the push for more evidence based practice in substance abuse treatment. AA is bullshit and the court system loves to push people into it even though the evidence shows that it is no better then trying to quit on your own. Some people can. And that’s awesome.

“Grants for Treatment and Recovery for Homeless Individuals”, interesting. But what’s the plan to keep them from becoming homeless again once we get them in an apartment? Getting them there is meaningless if there is no plan and system in place for keeping them there. Will there be services to keep them fed? Where will their rent come from? The list of questions to this one is long. If the services to keeping the person in housing was available, they would most likely be in housing. The problem is keeping people there. Keeping their illness and resources stable. One big push means shit.

“Reauthorizes and makes technical updates to develop and implement programs to divert individuals with a mental illness from the criminal justice system to community-based services.” But there are no community programs to divert them to. It’s a great idea to keep the mentally ill out of jail and to get them into community programs. It’s an awesome idea to make a program to ensure that happens, but this is putting the cart before the horse. We need to have the community programs to put these people into. There aren’t enough programs for the people that need them. The waiting lists are long. The people are over flowing and some are flooding over into the legal system.

I think it is an excellent idea to have a web site and phone number that people can go to or a number to call to find a service that they need. Knowing what places exist is the first part of the battle in getting help. I am all for requiring this.

Grant to help states generate a “database of beds”… Really? I’m pretty sure that the states are already painfully aware of where all their beds are. Those of us working in the system know where those few fucking beds are. We don’t need a grant to make a fucking database.

I don’t like that the bill leaves the issue of HIPAA wide open. It just states “clarification is needed regarding existing permitted uses and disclosures of health information under the Health Information Portability and Accountability Act”. It then says “Requires the Secretary to, within a year of finalizing updated rules related to the confidentiality of health records related to alcohol and drug abuse, convene relevant stakeholders to determine the effect of the regulation on patient care, health outcomes, and patient privacy.” so, I’m not sure who is going to be deciding this very important issue of HIPAA. Feels a little too slight of hand to me.

It will make money available to police, firemen and EMT’s for training in crisis management for mental illness. I think this is essential. In context of their jobs, they will most likely be coming in contact with people in crisis. It is essential that they have crisis training. They need to know how to help someone who is suicidal and has a gun. They also need to know how to help some one who is in a medical crisis which is now causing them to move into a psychiatric crisis.

The part that I am most unsure about is the portion of the bill that would put into place a pilot program for a federal involuntary commitment program. I really don’t know how I feel about that. I have no idea how that would effect the system. It makes my heart hurt. It makes my brain bleed. I am not of the opinion that making more people involuntary is the answer to the problems we are facing in mental heath or criminal systems.

Yeah, I think that’s about it 😉

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Posted on November 29, 2016, in mental health and tagged . Bookmark the permalink. 16 Comments.

  1. Okay so involuntary treatment was wrapped up on all that. I don’t think the return of asylums are the answer. Once they do come back it’s only a matter of how you define “seriously mentally ill” to send someone in there just like it was back then. And just like back then it will only be a matter of time before it becomes policy that once you go in, you never come out. There is a reason that exclusion from the community was considered inhumane and that ultimately asylums were shut down. The moment this comes into effect as official policy is the moment that stigma is going to sky rocket and people that need help and treatment are going to go dark and not seek it.

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    • the federal involuntary piece to this would work just like the state involuntary process does and as written would not be a life commitment. The idea of having federal level invol is that currently people cannot be invol for a federal crime, they have to go to jail. At state level if someone commits a crime, the court can say that they are mentally ill and choose to send them to get treatment instead of sending them to jail. The invol process and criteria would be the same, it would just be allowed to happen at a federal court as well as a state court. My concern isn’t that people will be locked up for life because the invol system is step up against that. My concern is that it will create an influx into the mental health hospitals that are already over crowded and will increase demand on beds. These are patients that don’t want care. I wrote a post about this so I won’t go into it more making it federal doesn’t change my issues with invol status, it just increases the number of people that will be invol.

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  2. I think the bill you are thinking of is H.R.2646 – Helping Families in Mental Health Crisis Act of 2016.
    The major coverage (the piece that really stirred things up) on all of that was this:
    http://www.usatoday.com/story/news/2016/02/26/privacy-law-harms-care-mentally-ill-families-say/80880880/
    The bill was passed in July. It doesn’t change guardianship law, never tried to. But I did hear that rumor. In reality it didn’t change HIPAA law. In 2014, there was a document put out that tried to give “guidance” to health care providers about how HIPAA did and did not apply. The problem was that this guidance didn’t carry the force of law so if it was followed it didn’t offer providers any protection. This becoming law made things more clear and protects providers when they make their decisions to talk to families.
    You can read that document here: http://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/mhguidancepdf.pdf
    This is a pretty good article talking about the bill after it was passed:
    http://www.self.com/story/the-house-just-passed-the-most-important-mental-health-bill-in-decades
    Let’s keep in mind that the law has long established that the family is the go to for when a person is in crisis and cannot make their own decisions, even for an adult. If someone is in a car accident and has severe trauma, health care providers ask their families for information, talk to them about the case and get guidance about what the patient would want. This is assumed as how people would want it done. Having advanced directives are the exceptions. Why should mental health cases be different? Yes, those cases are complex, but so is dementia and end of life.
    You can also read about HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT here:
    https://murphy.house.gov/helpingfamiliesinmentalhealthcrisisact

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