Fixing Mental Health Services without Coercion

harvey2Harvey Rosenthal
Executive DirectorNew York Association of Psychiatric Rehabilitation Services (NYAPRS)

In our final post on AOT Harvey Rosenthal explores the role of evidenced-based wraparound services in providing better mental health care outcomes.

Outpatient commitment typically involves mandating individuals to accept the same treatment approaches that have already failed or deterred them in the past. We know a lot more about how to help people in severe distress, but these methods are typically not offered or are not sufficiently available. These include a number of evidence based approaches like

  • Transitional Supports: using critical opportunities to engage people when leaving inpatient and detox facilities and prisons and jails
  • Individualized Care Management: organizing care across multiple behavioral and physical health and social systems that operates from shared information and offers real time response
  • Housing First and other harm- and homelessness-reduction models: offering individuals what they most need to be safe even if they’re not currently willing to take medications or stop using alcohol and drugs
  • Person-centered Planning Tools: utilizing Wellness Recovery Action Plans and Advance Directives
  • Criminal Justice Diversion and Re-entry Services: using court-based mental health workers, Crisis Intervention Teams, and better prison discharge plans and support services
  • Peer and Family Supports: incorporating peer crisis warm lines, respite houses, outreach, bridger and wellness coaching as well as family-to-family support
  • Employment and Education
  • Evidence-based Medicine: relying upon the latest research, providing more individualized care, and utilizing less drugs over a shorter period of time
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Reforming Mental Health Care Begins with Rethinking Provider Engagement

harvey2Harvey Rosenthal
Executive DirectorNew York Association of Psychiatric Rehabilitation Services (NYAPRS)

Last week, Harvey Rosenthal shared why he believes the answers to improving mental health care for individuals with more serious conditions lie in bringing state of the art engagement, services, and supports to scale, as opposed to expanding civil commitment programs. In this post, Mr. Rosenthal provides details about what these approaches and innovations should include.

Meeting individuals where they’re at
We need more accountable, aggressive action by providers. If a person does not fit into our current treatment paradigm—that is, if they don’t come into the office on time or take the medicine that is prescribed—they are typically considered noncompliant and often eligible for outpatient commitment.

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Fixing Not Forcing Services

harvey2Harvey Rosenthal
Executive Director, New York Association of Psychiatric Rehabilitation Services (NYAPRS)

In the wake of several recent mass shootings, many are calling for an overhaul of the nation’s systems of mental health care. A national debate has been renewed over whether legislation is needed to force local officials and mental health providers to be more responsive to those with more profound mental health needs, and whether those groups should, in turn, force such individuals to accept some form of treatment. In this post, Harvey Rosenthal argues we should reframe the debate and focus on reforms that significantly increase the range and raise the bar for community outreach and supportive services.

Fixing Not Forcing Services

Over the past year, we’ve seen an intensified focus on our nation’s and state mental health systems that has drawn a broad array of advocacy groups to weigh in on the merits of two legislative proposals put forward by House members Rep. Tim Murphy (R-Pennsylvania) and Ron Barber (D-Arizona).

Central to Congressman Murphy’s bill is a provision that would require states to adopt or expand court-mandated outpatient commitment programs like New York’s Kendra’s Law in order to access federal block grant dollars. These and several other provisions have generated much controversy. While it now appears that contentious provisions like these will not be moved by the House GOP leadership this year, it is imperative that we address a number of challenges that the bills present.

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Now that the Fireworks are Over, Let’s Really Celebrate the 4th of July Holiday

BRAIN2025-imageWhat’s more American than hot dogs, and fireworks on the 4th July? How about celebrating that we live in a country that allows us to have a voice in public policy and encourages us to exercise our freedom to stand up and be heard? Where should you begin? Who needs to hear your voice? Consider lending your support to fund the BRAIN.

Now that the Fireworks are Over, Let’s Really Celebrate the 4th of July Holiday
The National Institute of Health (NIH) is seeking $4.5 billion to implement the “Brain Research through Advancing Innovative Neurotechnologies” (BRAIN) initiative. That makes this one of the more aggressive initiatives since the space race.

During a White House briefing in April 2013, President Obama stated the goal of the project is to “accelerate the development and application of new technologies that will enable researchers to produce dynamic pictures of the brain that show how individual brain cells and complex neural circuits interact at the speed of thought.”

While the executive branch has committed $1 million to jump-start the project, Congress needs to appropriate the majority of the funding. And we’re all going to need to do our part to educate them that funding the BRAIN is the right thing to do.

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Readers Reveal Thoughts about HIPAA Reform in Online Survey

oncomputerDuring the month of June, Care For Your Mind explored with our readers the nuances of HIPAA regulations. Each weekly post included a short poll to assist in better understanding the views of the CFYM readership around this topic. The polls asked questions about individual privacy protection, as well as a family member’s right to be involved in a loved one’s mental health care.

Readers Reveal Thoughts about HIPAA Reform in Online Survey

CFYM readership while not self-disclosing, is positioned towards individuals living with a mood disorder, their families, and policy makers. It would be reasonable to believe that readers responding to the polls fall into one of those three categories. However, because respondents are not asked to self-disclose, one cannot not make any calculations about trends within those categories.

What can be determined from the poll results, is that further dialogue about individual privacy protection and the rights of family members to be included when a loved one’s mental health is at stake needs to continue.

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Coordinating Patient Care in the HIPAA Era

drsecrestLeslie Secrest, MD
Chairman of the Department of Psychiatry at Texas Health Presbyterian Hospital Dallas

In our final post discussing the effect HIPAA policy and regulations have on both individuals living with a mood disorder and their families, we look at the implications of sharing elements of mental health treatment as part of the electronic health record (EHR).

Coordinating Patient Care in the HIPAA Era

Protecting patient privacy has long been a vital, but complicated priority for mental health care providers. In guarding our patients’ privacy, we aim to defend against prejudicial or discriminatory care. We balance those concerns with the realization that a patient’s health could be jeopardized if other providers do not have access to the full health picture. Sharing elements of a mental health record is, at times, in a patient’s best interest.

With the advent of electronic health records (EHR), it has become easier to control who has access to a person’s mental health information, and who does not. For instance, the EHR system that my hospital uses allows me to restrict mental health information to only the providers that I name. Certain keywords in the notes also trigger automatic privacy settings.

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How Are States Addressing Patient Mental Health Privacy?

JenniferPhotoJennifer Bernstein, JD, MPH
Senior Attorney, The Network for Public Health Law—Mid-States Region
University of Michigan School of Public Health

We continue our series on the interplay between patient privacy and families’ interest in their loved one’s care. Here, Attorney Jennifer Bernstein covers what two states are doing to allow for increased family involvement.

How Are States Addressing Patient Mental Health Privacy?
Though HIPAA is not necessarily a bar to family members obtaining information about their loved ones with mental illness, the wishes of patients are usually paramount. Some states have adopted more innovative legal provisions to help assist families and patients in both protecting privacy while improving care.


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Balancing Family Rights to Know with Patient Rights to Privacy

CounselingFamily members are an inescapable fact of life for most of us—good and bad. So how do peers navigate personal decisions about their own treatment options and living a life of recovery with their family members? Today we continue our series on HIPAA with peers sharing their thoughts on the role of family members vs the right to direct their own treatment and recovery.

Balancing Family Rights to Know with Patient Rights to Privacy
It can be difficult for family members, who often have the best interest of their loved ones at heart, to provide enough space for their loved one to accept their disorder, seek treatment and build a life of recovery based on personal choice. But when speaking with individuals living with a mood disorder, many state that this is exactly what needs to happen. While it can be tempting to place oneself in a position of “knowing what’s best,” loved ones may need to recognize that they are on their own separate journey with an unknown destination.

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Change HIPAA for Better Care

Nancy Sharby profileNancy Sharby

This is the second week of our series discussing HIPAA regulations with regards to mental health care. In this post, we provide a family perspective.

Good and Bad Experience with HIPAA
As a mother, I have had positive and negative experiences with HIPAA, with an example for each.

The negative event happened when my adult son was hospitalized while I was out of town. I knew he was in that particular hospital because that is where the ER told me they were sending him. His doctor, who had permission to talk with me, was the one to tell me which ER he was in. I called the hospital where I knew he was and tried to tell hospital staff about his medications. The staff person kept insisting that they could not confirm or deny that my son was at the hospital, and they refused to hear what I was telling them about his meds. I knew he was there and didn’t need them to confirm it. What I really needed them to do was to take the information about his medications. They would have it to use if he was there, and they could throw it out if he wasn’t.

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HIPAA in Mental Health Care

JenniferPhotoJennifer Bernstein, JD, MPH
Senior Attorney, The Network for Public Health Law – Mid-States Region
University of Michigan School of Public Health

This is the second of three posts discussing privacy rights for mental health care provided by Attorney Jennifer Bernstein. Read the first installment from earlier this week. Additionally learn more by reading FAQs from the U.S. Department of Health & Human Services.

When and How Can A Family Member Become Involved in Care?
Now that we have discussed some of the basics of the HIPAA Privacy Rule, let’s consider some specific concerns that family members often have regarding treatment and care of their adult family members with a mental health disorder. Generally, HIPAA gives ultimate deference to a patient’s wishes as to the sharing of their health information. There are some exceptions that are important for the family members of individuals with mental illness.

When does mental illness constitute incapacity under the Privacy Rule?
The HIPAA Privacy Rule does make allowance for when a patient is unable to authorize disclosure due to incapacity. A major determining factor on whether to disclose a patient’s information to the their family, friends or other persons involved in their care is whether or not the disclosure is in the best interests of the patient.  Incapacity criteria may include when a patient is incoherent or suffering from psychosis.

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