Category Care Coordination

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

Patient Privacy in Mental Health: Balancing Rights while Trying to Ensure Appropriate Treatment

Privacy rights and protection of health information take on special meaning in mental health care, whether because of the stigma associated with mental health conditions, or issues of family dynamics, or a variety of other reasons. The on-going debate takes on increased importance in light of the tragedy this past weekend at the University of California at Santa Barbara.

Before we explore particular instances of how patient privacy has affected people with mood disorders and their families, we’ve asked attorney Jennifer Bernstein to provide an overview of privacy in mental health care. 

What is HIPAA?
The Health Insurance Portability and Accountability Act, commonly referred to as HIPAA, provides consumers with privacy rights and protections for their health information, including mental health information. Though enacted in 1996, HIPAA’s Privacy Rule governing individually identifiable health information took effect in 2001. The Privacy Rule seeks to strike a balance between protecting patient’s privacy by safeguarding sensitive health information and allowing for the sharing of a patient’s health information to ensure the best treatment and the health and safety of the patient or others. The following information applies generally to adult patients.

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On Tuesday, our Expert Perspective advocated for integrated care. Integrated primary and behavioral health care attempts to mold the care system to the whole individual, thereby increasing access to health services by making them more convenient and increasing the quality of care by requiring better communication, coordination, and collaboration among health care providers.

Resources on Integrated Care

To help you learn more about integrated care, we’ve compiled some of the web’s best available resources:

1. The National Association of County Behavioral Health and Developmental Disability Directors wrote of integrated care as being the key to bringing together mind and body.
2. SAMHSA provides a lot of information in their webinar, Integrating Behavioral Health into the Person-Centered Healthcare Home.
3. You can also see how, even five years ago, agencies in the federal government were involved in integration of primary care and mental health care.

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Laura Galbreath, M.P.P., Director
SAMHSA-HRSA Center for Integrated Health Solutions, National Council for Behavioral Health

Walk into a community behavioral health or health center right now and you’ll probably see posters about this great new health care approach called integration. What is integration, though? And what does it look like?

As our health care system strives to improve patient health outcomes, improve the quality of care, and make care affordable, a collective light bulb has gone off. To achieve these three aims—known by the phrase “the triple aim”—we have to recognize and treat people’s physical and emotional health, and that means changing how we deliver care. Integration is one approach receiving a lot of attention for its promise to achieve these aims.

When my friends and family ask what integration is, I explain it like this: Integration improves access to mental health and addictions treatment by making that care a routine part of a visit to primary care, whether at the lowest level of integration (improved communication among providers) or the highest (a merged practice that includes both medical and mental health services). Integration also improves the quality of recovery by addressing the physical health care needs of people with mental illnesses and addictions.

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