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.

Read More

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.

Read More

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.

Read More

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”

Read More

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).

Read More

To Market, to Market: The Health Insurance Marketplace and You

As of the date of this post, there are 75 days until open enrollment begins on the Health Insurance Marketplace.

With the implementation of the ACA, the Health Insurance Marketplace will be your destination for figuring out how to get the best health care coverage you can within your budget.

Under the Affordable Care Act (ACA), Americans are assured access to health coverage, whether through insurance provided by your (or your spouse’s) employer, a government-administered program, or an exchange (the marketplace).

A Personalized Shopping Cart

The Health Insurance Marketplace provides personalized information about your options for health coverage and provides the mechanism to enroll. You’ll learn whether you can reduce the costs of your monthly premiums from your current coverage through private insurance plans and if you can lower your out-of-pocket costs.

Read More

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.

Read More

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.

Read More