Category Access to Treatment

Keeping Our Loved Ones Safe and Getting Them Well

Families for Depression Awareness

FDA_logo_greenAs family caregivers and caring friends of people living with mood disorders or other mental health conditions, we want to help our loved ones by

  • keeping them safe
  • getting them care to get well; and
  • preventing suicides.

Sometimes people are in a state of mind that prevents them from making sound decisions. There are mental states (e.g., experiencing psychosis) and physical conditions (e.g., effects from a stroke) that can adversely affect a person’s usual good judgment. We agree with DBSA and others that, ideally, a person with a mental health condition will engage family members and friends as partners in wellness and in crisis. There will be a written plan and the legal documents necessary to ensure that care is pursued and provided according to the individual’s wishes as expressed when he or she was well. Mental health practitioners can make sure that families get information about this and should strongly encourage patients to bring a family member to at least the first appointment.

The Reality

In our experience, all too often these conversations and pre-planning have not occurred, and the family member must navigate the complex medical, insurance, and legal systems to get emergency care for their loved one.

Family members are frequently excluded from mental health care decisions, despite being the ones who often have the most pertinent knowledge and the greatest motivation to get someone the care they need to get well.

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Planning to Protect Our Rights

Depression and Bipolar Support Alliance

colorWhen an individual with a mental health condition in need of intensive psychiatric care is hospitalized, whether voluntarily or involuntarily, the individual, family, and friends may have mixed reactions. They may feel relief that the individual is safe, but they may also feel emotionally, physically, and potentially financially drained. Yesterday on CFYM, Dr. Sederer shared his expertise in navigating what can be daunting legal and medical legalities on patient psychiatric hospitalization treatment rights. DBSA believes that patient protections are important to ensuring individuals are the lead decision-makers in their own wellness. The best wellness outcomes are achieved when individuals living with mental health conditions and their family and friends are educated and prepared for crisis.

Education is Power

DBSA encourages individuals to become knowledgeable about (1) mental health laws in the states in which they reside; (2) options for treatment centers and outpatient programs other than hospitals; and (3) the rules and regulations regarding admission and release in hospitals and treatment facilities, both for voluntary and involuntary entry.

Whether hospitalized voluntarily or involuntarily, individuals have the following rights:

  1. to have treatment explained;
  2. to be informed of benefits and risks of treatment;
  3. to refuse treatment the individual feels is unsafe;
  4. to be informed about any procedures that the individual feels may be unnecessary; and
  5. to refuse to take part in research and experimental treatments, and to disallow students or observers.

DBSA supports adherence to these patient rights in all circumstances.

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The Right to Treatment and the Right to Refuse Treatment

Lloyd I. Sederer, M.D.
Adjunct Professor, Columbia/Mailman School of Public Health
Medical Editor for Mental Health, Huffington Post/AOL

All patients have both a right to treatment and a right to refuse treatment. These rights sometimes become the centerpiece of debate and dispute for people who are hospitalized with an acute psychiatric illness.

The Right to Treatmentsederer

There is a long legal history on the right to treatment. Much of the law derives from court cases in the previous century involving people who were admitted to state psychiatric hospitals where they languished without proper treatment, sometimes for many years. Laws compelling a right-to-treatment law developed and became instrumental to the quality-controlled public psychiatric hospitals that exist today. In fact, in order for public psychiatric hospitals to receive Medicare and Medicaid (and other third-party) payment, they must obtain the same national certification as academic medical centers and local community hospitals. For patients and families, this means that a person admitted to a public psychiatric hospital has a right to receive—and should receive—the standard of care delivered in any accredited psychiatric setting.

The Right to Refuse Treatment

It may seem odd that a person can be involuntarily admitted, or “committed,” to a hospital and then refuse treatment. But the right to refuse treatment is also fundamental to the legal requirements for psychiatric treatment.

Someone who enters a hospital voluntarily and shows no imminent risk of danger to self or others may express the right to refuse treatment by stating he or she wants to leave the hospital. But a person admitted involuntarily, due to danger to self or others, cannot leave, at least not right away. However, despite having the authority to keep the patient in the hospital, the professional staff cannot treat the person against his or her will, except by court order.

The concept of a right to refuse treatment was built on basic rights to privacy, equal protection under the law, and due process. In other words, involuntarily hospitalized patients still have a right to decide what happens to their bodies.

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Five Issues Related to Minority Mental Health

Print
In 2008, the U.S. House of Representatives recognized the need to bring attention to issues around mental health awareness among, and mental health care for, the nation’s minority communities. To further those issues, the House passed a resolution in support of Bebe Moore Campbell National Minority Mental Health Awareness Month.

The implementation of the Affordable Care Act (with the open enrollment period beginning on October 1, 2013) should help address one of the issues outlined in the resolution: the fact that many minority mental health consumers are underinsured or uninsured, and thus receive a diagnosis late in their illness, if at all.

But what about the other issues?

Top 5 Issues Related to Minority Mental Health

Here are Care for Your Mind’s top 5 issues related to minority mental health awareness that remain to be addressed. (All quotes are from the text of the resolution.)

  1. Disproportionate access to services:“adult Caucasians who suffer from depression or an anxiety disorder are more likely to receive treatment than adult African Americans with the same disorders even though the disorders occur in both groups at about the same rate, when taking into account socioeconomic factors”

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Sequestration Update: Feeling the Pain

Care for Your Mind Update


capitol3Two months ago, we shifted from discussing the importance of access and barriers to access to examining how a specific governmental policy, sequestration, was impacting the delivery of mental health services across the country. Even then, we could already point to examples of sequestration’s impact: the closing of a residential treatment center in Alaska, the reduced availability of civilian mental health professionals to military personnel, and the increased wait to receive residential treatment in Utah—not to mention the potentially devastating long-term impact of spending cuts on research, both in terms of treating people during clinical studies and finding effective treatments to mental health conditions.

It is unsettling, though perhaps not surprising, that the most-reported impacts of sequestration have been airport travel delays and the cancellation of air shows at Military bases for the July 4 celebrations. Because these cause discomfort for the general population, they are easy topics for media coverage. However, this does not appropriately reflect the level of real suffering happening as a result of sequestration across the country. This under representation of suffering is probably due to the fact that the populations arguably suffering the most severe consequences from sequestration are in fact underrepresented in general—the poor, people in the military, and minorities (an ironic realization as we reach the end of National Minority Mental Health Awareness Month, which draws attention to the need for mental health awareness, better utilization of services, and the development of culturally competent care for the nation’s racial and ethnic minorities).

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What’s standing in the way of mental health recovery?

Paolo del Vecchio, M.S.W.
Director, Center for Mental Health Services
Substance Abuse and Mental Health Services Administration (SAMHSA)

Yesterday, Paolo del Vecchio told his personal recovery story and shared a set of elements that help define recovery. Today, he puts recovery into perspective with health reform.

Opportunities for Recovery under the ACAdelvecchio

To recover, individuals need access to quality, affordable health care and mental health services. The Affordable Care Act (ACA) expands mental health and substance use disorder benefits and parity protections to an estimated 62 million Americans and heralds a new era of hope for people with mental illnesses.

Beginning January 1, 2014, millions of uninsured Americans with mental health and substance use conditions will have access to health insurance coverage, many for the first time. In addition, thanks to the new health care law, beginning in 2014, insurers will no longer be able to deny anyone coverage because of a pre-existing mental health condition. Individuals will be able to sign up and enroll for insurance beginning in October of this year. People should go to www.healthcare.gov to find info on how to enroll.

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Defining Recovery: From Mental Health Consumer to Policymaker

Paolo del Vecchio, M.S.W.
Director, Center for Mental Health Services
Substance Abuse and Mental Health Services Administration (SAMHSA)

delvecchioWe recover in community. In community, we share stories and spread hope. And in community, we raise our voices so all may have the opportunity for recovery.

For more than 40 years, I have been involved in behavioral health as a consumer, family member, provider, advocate, and now policymaker.

The thread throughout my journey has been opportunity and hope. Over the years, I’ve learned that it is community that provides opportunity, and it is in community that we find hope.

I am pleased to participate in this forum to share stories of recovery and spread the message that recovery is not only possible, it is the expected outcome of services, supports, and treatment. Together, through our shared experiences and with our collective voice, we can change the conversation on mental health and increase awareness of the possibility of recovery.

My Recovery Story

My own story is deeply rooted in the healing power of community. I experienced mental illness early in my childhood.

As a child, I experienced trauma by witnessing domestic violence and alcoholism in the family. As a result, I became withdrawn, depressed and anxious. And, I was alone.

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Older Adults Need Specialized Mental Health Care

David Steffens, M.D., M.H.S.
President, American Association for Geriatric Psychiatry

steffens.August2008

Just as a family with a child suffering from depression, anxiety, or any other illness would want a clinician who specializes in helping children, older adults deserve care from clinicians trained and experienced in diagnosing and treating older patients.

The mental health needs of the elderly differ from the rest of the population.

Why?

In general, older adults have more medical illnesses than younger people and may have cognitive problems that can worsen with depression and other health issues. Older individuals often suffer more losses—such as the loss of a spouse, friends, or independence—and these losses can lead to depression. Older adults may also be reluctant to discuss mental health issues, particularly concerns about memory and Alzheimer’s disease.

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