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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Five Web Resources on Integrated Care

pcmhOn 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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Will integrated care provide you with better care?

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

galbreathWalk 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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Five Issues Related to Minority Mental Health

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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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