Post by DJ Jaffe on Pete Early website
The Helping Families in Mental Health Crisis Act (HR2646) was passed by the Health Subcommittee last week. (Unamended version here) But sitting in the room watching, was like attending two separate plays going on simultaneously. One play, about substantive ways to help the most seriously mentally ill was put on by Republicans. Democrats put on the other play. It demonstrated how little they know about serious mental illness and how far they had been misled by the mental health industry. It pains me to say that because I am a Democrat.
The Substance of the Bill
Historically, mental health bills in Congress have thrown money at politically correct, feel-good programs that let mental health industry engage in easy and palatable tasks like “reducing stigma,” “education” or “improving mental health,” but rarely deliver actual treatment to adults with serious mental illness. HR2646 has provisions to improve mental health, but it also has five provisions that start to focus government programs on delivering treatment to adults with serious mental illness. And that makes it important and different. If families of the most seriously ill continue to speak-out, this could be the beginning of a shift towards helping seriously ill adults after decades of shunning them. The support for the shift is coming primarily from Republicans who want to reduce crime, incarceration and tragedies. Democrats tend to avoid those issues for fear of causing stigma. They have been taught to ignore unpleasant truths like not everyone recovers, sometimes hospitals are needed, some seriously ill need the help of families, and yes, left untreated, those with serious mental illness are more violent than others. Following is a preliminary analysis of how the five most important provisions came out of the markup, followed by a discussion of what went on at the hearing.
The Robert Wood Johnson Foundation has issued a Request for Proposals for projects that support the identification and evaluation of promising innovations that improve health and healthcare quality — without increasing costs — in low-resource communities.
Up to ten evaluations will be funded for a total of up to $2.5 million. Priority will be given to evaluations of innovations that are set in and meant to benefit the health of people in low-resource communities; intended to substantially improve a pressing community health problem; and recognize consumers as important arbiters of value.
The primary purpose of the RFP is to support the evaluation of innovations to improve value rather than the implementation of innovations. As such, at least 80 percent of the grant funding should be allocated to activities such as evaluation design, sample selection, data collection and acquisition, analysis, and reporting. Evaluations of existing but untested innovations, or innovations that have undergone small pilot tests, are eligible for funding. Innovations that disrupt or displace less effective practices also are eligible for funding. Modest enhancements or improvements to existing procedures will not be funded.
Preference will be given to applicants that are either public entities or nonprofit organizations that are tax-exempt under Section 501(c)(3) of the Internal Revenue Code (and are not private foundations or Type III supporting organizations). In addition, applicant organizations must be based in the United States or one of its territories.
Organizations evaluating innovations in defined geographic areas are eligible to apply if the innovation takes place in one or more neighborhoods where at least 20 percent of residents are living in poverty. Alternatively, applicants are invited to describe their innovation’s intended target populations in terms of income or poverty status, educational attainment, linguistic or cultural isolation, general geographic setting, or other relevant indicators.
Brief proposals must be received no later than December 10, 2015. Upon review, selected applicants will be invited to submit full proposals by March 22, 2016.
SAMHSA Press Release
SAMHSA believes that evidence-based programs and practices undergird the effectiveness of the services that support people with mental and/or substance use disorders and their families. We are eager to inform you that our National Registry for Evidence-based Programs and Practices (NREPP) has recently been enhanced to include more programs and practices. We encourage you to help us spread the word that NREPP will be accepting submissions from November 23, 2015 to January 26, 2016.
NREPP is a searchable online database of more than 350 mental health and substance abuse interventions. SAMHSA developed this registry to disseminate information about evidence-based substance abuse and mental health interventions that are available for implementation. NREPP interventions help target effective services to the people most in need, and translate research in these areas more effectively and more rapidly into the general health care system.
To be considered for review, interventions must meet the following three minimum requirements:
1) The research or evaluation of the intervention:
- Has assessed mental health or substance use outcomes among individuals, communities, or populations; OR
- Has assessed other behavioral health related outcomes on individuals, communities, or populations with or at risk of mental health issues or substance use problems.
2) Evidence of these outcomes has been demonstrated in at least one study using an experimental or quasi-experimental design.
Note: The following will not be reviewed but may be submitted as supporting documentation:
- Comparative effectiveness trials, in which two interventions, both presumed to be equally effective, are compared;
- Studies in which the effects of the same intervention on various subpopulations are compared or in which various doses or components of the same intervention are compared.
3) The results of these studies have been published in a peer-reviewed journal or other professional publication, or documented in a comprehensive evaluation report, published within the previous 25 years (1990 or later).
For further information and questions please visit the NREPP website at: http://nrepp.samhsa.gov or contact the NREPP staff by email at email@example.com or by phone at 1-866-436-7377.
SAMHSA is excited to open NREPP to new submissions and looks forward to reviewing them. So please consider applying so that other organizations can adopt promising programs or practices for evidence-based substance abuse and mental health interventions.
Remember, the deadline for submissions is January 26, 2016.
For the month of November, the TA Network will be releasing “The Business Case for Telebehavioral Health in Children’s Systems of Care” presented by John Gale, M.S. and David Lambert, Ph.D. from the Muskie School of Public Service at the University of Southern Maine. The webinar explores terminology, reimbursement and business issues, and provides examples from the field in the development of telebehavioral health (TBH) services. The webinar and accompanying resource were informed by a national study of telemental health in rural health systems conducted by the presenters.
- Past date/time: Recorded on August 7th
- Presentation link: Click here
- TA Network Resource link: Click here
Post by Leah Harris on Pete Early website
I spent several hours reviewing the House Energy and Commerce Health Subcommittee markup of “The Helping Families in Mental Health Crisis” Act (H.R. 2646). Some supporters of the Murphy Bill claim that Democratic objections to the bill should be dismissed as typical partisan wrangling. But this markup was much less a matter of partisan politics and much more a question of just how to fix our broken system. It is a battle about resources: whether to focus on funding a few costly, late-stage crisis interventions that only apply to a very small subset of people, or to reform the system from the ground up with a focus on preventing the very crises that the bill purports to address. It is a battle between outdated, authoritarian approaches to care, versus collaborative, person-centered approaches that represent the latest in science and good medicine.
At the markup, Democrats put forward the same arguments against the bill that have been made by mental health service users and advocates since the first version of the legislation was introduced in December 2013. The laundry list of objections to the bill are far too numerous to reiterate in this piece, but can be found here and here. Arguments against the Murphy bill have rarely been heard in the mainstream media, which overwhelmingly endorse the bill and fail to include critical perspectives. For this reason, I was heartened to see clear critiques of the bill finally make it into the public record.
A two-year postdoctoral research fellowship program in psychiatric rehabilitation and vocational recovery from serious mental illnesses will begin April 1st, 2016 at the Center for Psychiatric Rehabilitation at Boston University. One of these fellowships will be focused on career development and employment success among transition-age youth and young adults (ages 14-30) with serious mental health conditions. The latter practicum will be conducted in collaboration with Dr. Maryann Davis and the Transitions RTC, UMass Medical School (http://www.umassmed.edu/TransitionsRTC/). Didactic seminars provided by the Center for Psychiatric Rehabilitation at Boston University, extensive research practicum and annual stipend of $40,000 are included in the fellowship.
Applications are due December 1st, 2015. Contact: Dr. Zlatka Russinova at (617) 353-3549 or firstname.lastname@example.org. Orientation phone discussions are recommended before submitting applications. More detail about the fellowship program is available at http://cpr.bu.edu/research/postdoctoral-research.
Energy and Commerce Democrats on the health subcommittee this morning will unveil an alternative proposal to Rep. Tim Murphy's mental health care bill that emphasizes workforce training, early intervention and substance abuse treatment.
Unlike Murphy's bill, which dismantles SAMHSA, the Democratic proposal keeps the agency in place and creates an assistant secretary for mental health that would oversee all mental health programs throughout the federal government. That official would also serve as the SAMHSA administrator.
Interesting reading for what will be a busy Wednesday!
Things are moving fast with the pending markup of HR 2646. The manager’s amendment for Rep. Tim Murphy's Helping Families in Mental Health Crisis Act circulated this morning removes a section that would have added certain behavioral health providers to the meaningful use EHR incentive program.
The original bill made psychologists, substance abuse professionals, psychiatric hospitals, community mental health centers and outpatient mental health facilities eligible for the meaningful use payments that most doctors and acute-care hospitals have been able to receive.
Apparently, Congressman Murphy removed the section of the bill because it would be too expensive to implement, making it more difficult to pass the legislation.
And so the sausage making begins...
Mental Health America’s Regional Policy Council is holding a free webinar on the IMD Exclusion. This has been a topic of great interest to many Network faithful. Check it out!
- IMD Exclusion: Its History, Effects, and Future Policy Implications
- Tuesday, November 10th at 2:00 p.m. EST
- Register here
Join MHA’s Regional Policy Council for a webinar examining the IMD (Institutions for Mental Diseases) Exclusion. The IMD Exclusion restricts federal Medicaid financing for patients in large institutions treating mental health and substance use conditions. This webinar will address the history of the IMD Exclusion, rationale from mental health and substance use advocates looking to either maintain or waive portions of the Exclusion, what’s going on at the federal level, and policy implications.
- John O’Brien, Senior Policy Advisor at Centers for Medicare & Medicaid Services (CMS)
Debbie Plotnick, Vice President of Mental Health & Systems Advocacy at Mental Health America
- Rusty Selix, Executive Director of Policy & Advocacy at Mental Health America of California
Soon after moving to Utah this summer, Rainbow Sky Buck ended up at the hospital with a painful ear infection. There, Buck learned she no longer had access to the free health coverage she had in California as a former foster youth.
To pay for the care, Buck emptied out her bank account and borrowed money. “Luckily, I got my antibiotics and I am OK now,” she said. “But what is going to happen next time?”
Under the health law, young adults who age of out of the foster care system are eligible for free Medicaid coverage until they turn 26. The provision was an attempt to give them the same opportunity as other young people who can stay on their parents’ insurance until their 26th birthday.
But these young adults are encountering a major barrier: They are only guaranteed coverage in the state where they were in foster care. States have the option of extending the benefit to all former foster youths, but only about a dozen have done so.
Now, advocates and policymakers are trying to change the law at the federal level, so former foster youths don’t lose access to Medicaid coverage no matter where they move.
Reps. Karen Bass, D-Calif., and Jim McDermott, D-Wash., have proposed legislation that would allow them to qualify for Medicaid, the government health program for low-income Americans, in any state. Sen. Bob Casey, D-Pa., has introduced a similar bill that he said would be a simple clarification of what Congress intended. Meanwhile, advocates are pushing the Centers for Medicare & Medicaid Services to change its interpretation of the original provision.
First Focus, which advocates for foster youths, has been receiving calls from young people who had no idea that they would lose health insurance when they moved.
“We really do feel an urgency about this,” said Shadi Houshyar, vice president of child welfare policy at the organization. “So many people who have aged out have significant health needs and coverage is so important. There shouldn’t be an additional barrier.”
Former foster youths are more likely than their peers to have physical and mental health needs, experts say. Ongoing research in Illinois, Wisconsin and Iowa shows that 22 percent of former foster youths had been hospitalized at least once in the previous year and one-third had two or more emergency room visits.
Just like other young people, former foster youths move to different states for school, jobs or family, said Fatima Morales, policy and outreach associate for the advocacy group Children Now. Morales said they shouldn’t be penalized for doing so.
Morales said her organization is trying to inform youths what they might face if they move. “They need to know how their health coverage might be impacted,” she said. “It’s just something that they need to weigh.”
Lezlie Martinez, 19, is weighing her options now. She is hoping to move from California to Colorado because she wants to live in a place with a lower cost of living. Her boyfriend is already there and she is looking for hospitality jobs to support herself and her 2-year-old son.
But she worries that she may be left uninsured and unable to pay for medical treatment for eczema, allergies and fibromyalgia. “It is causing foster youth to be stuck in the same state they were raised in,” said Martinez, who lives in Oceanside, Calif. “It is really stressing me out.”
Buck said she decided to move to Sandy City, Utah, because of the limited job prospects in the small Northern California town of Crescent City. Before moving, she asked social workers about whether she would still qualify for free health coverage and was told that she would. Buck said she was shocked to learn otherwise.
She is no longer seeing a therapist for depression and said she is weaning herself off antidepressants because she can’t afford them. Buck said she also worries about getting another ear infection and not being able to afford treatment.
“It is just scary to think I am completely on my own,” said Buck, who recently got a job at an automotive shop but doesn’t get insurance from her employer. “I don’t want to leave, but this is almost forcing me to move back to California.”
Story by Anna Gorman, Kaiser Health News