Poll Results Enforces the Need for Specialized Care

aapgChristine M. deVries
Chief Executive Officer
American Association for Geriatric Psychiatry

Care for Your Mind is an excellent example of providing needed information to the public on late life mental illness. AAGP applauds the efforts of Care for Your Mind and its efforts on public education as well as encouraging dialogue through polls and other mechanisms on these critical issues.

The results of the recent poll by Care for Your Mind on mood disorders clearly confirms the need for a well-trained health care workforce to take care of the current and future generations of older adults with mood disorders. This same conclusion was reported by the Institute of Medicine (IOM) in their report released last year entitled, The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? The IOM called for immediate action to promote research and incentivize training in geriatric mental health to adequately meet the needs of an elderly population expected to rise above 70 million people by 2030. We know the need is there, but now it is time to take action. It is critical that people contact their policymakers and urge them to eliminate the gaps in services to the elderly with mental illness including mood disorders by increasing access to quality mental health care and addressing the prevalent stigma associated with these diseases. The White House took a first step when they convened a National Conference on Mental Health in June of this year, but there needs to be more. We must now advocate to the US Congress on the need for a well prepared workforce to provide quality care for the older adults with mood disorders. Following are some specific legislative proposals that have been introduced in this session of Congress:

The Care for Your Mind poll enforces the need for health care professionals with specialized training to treat those individuals with mood disorders and other late life mental illnesses. There is a bill that has been introduced into the Senate that would promote teams of health care providers with this expertise to work with primary care providers.

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Mental Health Care for Older Adults: Survey Results to Date!

august18_2013In connection with our post, “Older Adults Need Specialized Mental Health Care” on July 2, we asked readers to answer a brief survey about mental health care for older people.

We figured it was a good time to bring you the results so far, and to invite you to participate in the survey.

Of all of the results, there were two items of particular interest to us at CFYM.

64.5% of respondents indicated that they know an older person who they believe has a mood disorder but who is not diagnosed or treated. We are hopeful that changes in care under the Affordable Care Act will help to remedy that deficiency, but it’s likely that it will take more than changes in the law. Many older adults will have to reconsider their perceptions of mental health, as well as their expectations of maintaining mental wellness and happiness during their later years. Also, their physicians need to learn more about the special mental health care needs of older adults.

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American Foundation for Suicide Prevention: Thoughtful public policies can reduce the number of suicides

afspCFYM Note: Throughout Care for Your Mind, we provide a platform for mental health care advocates to present their perspectives and proposals for change, with an implicit invitation for interested community members to contact those organizations for more information and opportunities to get involved. Today, we launch a new category of posts: the Mental Health Advocate Profile. Rather than being specific to a discrete issue, the Profile allows CFYM to show an organization’s broader range of advocacy interests and concerns. We’ll start off with a look at the American Foundation for Suicide Prevention, taking note of their Capitol Hill visiting day in June 2013.

Any organizations seeking to be featured in a CFYM Mental Health Advocate Profile should submit information about current legislative interests and activities to info@careforyourmind.org. We welcome your submissions!

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Help! I Need Somebody: How Enrollment Assistance under the ACA Will Make All the Difference

William Tomasko
Enroll America

enroll_americaStart your timer. Count down the days. Open enrollment is coming. On October 1, consumers will be able to start signing up for the new health coverage options under the Affordable Care Act (ACA)—and there will be new opportunities for them to get help finding quality, affordable plans.

Our organization, Enroll America, is a nonprofit, non-partisan 501(c)3 dedicated to spreading the word about Americans’ new health coverage options. Working with our broad array of partners, we’re helping consumers get the facts about how they can get covered and engaging the entire health care community as we all mobilize for enrollment.

Out of those who reported having an unmet need for mental health care in 2011, nearly two-thirds said they went without care because they couldn’t afford it or because their health insurance either wouldn’t cover it at all or insufficiently covered it, according to data from the Substance Abuse and Mental Health Services Administration.

And around 30% of those who will soon be eligible for financial help through health insurance marketplaces or from expanded Medicaid have a mental illness or a substance use disorder. In total, around 11 million in need of mental health and substance use disorder care could benefit from newly enrolling in coverage this fall.

Getting these individuals enrolled will take one of the biggest outreach and public education efforts ever undertaken in the history of public health coverage programs. Why? Our research reveals that 78% of the uninsured don’t know (yet) about the coming coverage options. Our findings point to some of the most important messages to use to compel people to enroll, and the effective ways to reach them.

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Does your community have mental health needs?

The Network for Public Health Law outlines a unique opportunity for consumers, families, and advocates to bring attention to local mental health needs. Every nonprofit hospital is required to participate. Chances are there’s a nonprofit hospital—and a chance to be involved—near you!

Identify and Address Mental Health Needs in Your Community

 

Corey Davis & Andy Baker-White
Network for Public Health Law

networkThe majority of American hospitals are recognized as nonprofit organizations under state and federal law. This permits them to receive a number of financial benefits, including an exemption from the federal income tax. Many states and municipalities also provide nonprofit hospitals with exemptions from property, sales, and other taxes. This favorable tax treatment comes with the responsibility that these hospitals provide certain benefits to the communities they serve.

Community Health Needs Assessment

The Patient Protection and Affordable Care Act (ACA) contains a provision that requires each nonprofit hospital to conduct an assessment of the health needs of its community in order to better understand and help meet those needs. This assessment, known as a Community Health Needs Assessment (CHNA) must be conducted every three years and made widely available to the public. Groups and individuals working in, or advocating for, mental health may take advantage of the CHNA to collaborate with hospitals to help determine whether mental health is a health need for the community.

When conducting the CHNA, the nonprofit hospital is required to collect input from people who “represent the broad interests of the community served” by each hospital facility. Under proposed IRS rules, the hospital must take into account input from the following sources, among others:

  • at least one state, local, tribal, or regional governmental public health department with knowledge, information, or expertise relevant to the health needs of that community;
  • members of medically underserved, low-income, and minority populations in the community, or individuals or organizations serving or representing the interests of such populations; and
  • written comments received on the hospital facility’s most recently conducted CHNA and most recently adopted implementation strategy.

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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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