By now, we know the routine, whether the dateline is Newtown or the Navy Yard or a school in Columbine.
Once the carnage is grimly detailed, the experts are marshaled to explain to us “how it could happen.” Invariably, the usual people will say the usual things about the role of guns. At some point, someone might mention the nation’s broken mental-health system.
And little changes.
Seven months ago, The Dispatch’s Mental Hell series detailed not only the ramifications of an overwhelmed mental-health safety net but also several proposals in the works to improve things.
But after the nation just marked the sad anniversary of the Sandy Hook elementary-school slayings, the record of accomplishments remains decidedly modest in dealing with mental illness, which touches 1 in 4 families.
Polls show that we get it: Gallup found that Americans are more likely to blame the mental-health system than easy access to guns as the main factor behind the mass shootings. Public policy, however, lags behind.
“Has the world changed since the tragedies of Newtown and the other tragedies? Sadly, little has been done to get those who need help the help they need,” said U.S. Rep. Tim Murphy, a clinical psychologist from the Pittsburgh area who introduced legislation this month to shift the focus of the mental-health system to treating the most-seriously mentally ill.
“Those who need help the most are getting it the least because the nation’s mental-health system is broken,” said Murphy, a Republican.
In early June, President Barack Obama told a national conference on mental health: “We can help people who suffer from a mental illness continue to be great colleagues, great friends, the people we love. We can take out some pain and give them a new sense of hope. But it requires all of us to act.”
Here is how the need to act is stacking up at the federal level:
• Early this year, Obama proposed spending $130 million to help teachers and others recognize the signs of mental illness, especially in the young, and help them get treatment. Congress has not yet allocated that money.
• The Excellence in Mental Health Act — bipartisan legislation with Sen. Sherrod Brown, D-Ohio, as a co-sponsor — stalled, as did similar bills in the previous two sessions of Congress. However, this month, the Senate Finance Committee passed a scaled-down version as an amendment to an unrelated Medicare measure.
The act’s main sponsor, Sen. Debbie Stabenow, D-Mich., said she hopes for Senate passage in early 2014. Ten states could set up pilot programs allowing Medicaid coverage for those using community mental-health centers.
• Obamacare outlawed annual or lifetime dollar limits on 10 “essential” health benefits, including mental-health and substance-abuse treatment. The White House says more than 60 million Americans are newly eligible for benefits.
• Rules finally were developed to fully implement the Mental Health Parity Act, passed by Congress in 2008. Simply put, if a health insurer offers mental-health benefits, they must be equivalent to those covering physical health. Generally, that includes inpatient and outpatient services, emergency care and prescription drugs.
In combination, parity and Obamacare “will have tremendous impact of historic significance,” Dr. Jeffrey Lieberman of Columbia University’s Department of Psychiatry said in a webcast.
• On Dec. 13, the day before the first anniversary of the Newtown, Conn., school shootings, Vice President Joe Biden said $100 million is being allocated to mental health: half to the Department of Health and Human Services so community health centers can hire more mental-health professionals, and the rest to the Agriculture Department to improve rural mental-health facilities.
Critics pooh-poohed the amount, noting that some states are spending more than that.
“It’s a good start, don’t get me wrong,” said Dr. John Grohol, founder and CEO of Psych Central, in an online column. “But it’s a drop in the bucket compared to the $4.35 billion taken out of the mental-health treatment economy since 2009.”
He said the money would barely hire one professional for each of the country’s 750 community mental-health centers.
The ongoing need is the key reason that Murphy, the Pittsburgh congressman-psychologist, introduced legislation. It would change federal privacy laws in certain circumstances to give parents and other caretakers access to their children’s medical records if they have a serious mental illness. Another provision would allow involuntary commitment based on “need for treatment” rather than requiring that someone be a danger. It also would redirect federal aid.
“We have fewer psychiatric hospital beds, fewer outpatient-treatment options, restrictions on the use of medications that can and do help those who are mentally ill, too few psychiatrists and psychologists and clinical social workers, especially child and adolescent specialists, and especially ones who are trained and specialize in treating the seriously mentally ill,” Murphy said when he rolled out his bill.
“We have too many barriers that prevent doctors from communicating with parents of the sons and daughters with persistent serious mental illness. We have federal barriers that block treatment, federal dollars that go to grants for programs that do not work.”
Action at the state level generally gets better reviews, although advocates say much more is needed in Ohio.
Parents still struggle to find help for their children, patients wait months for care, and the mentally ill too often find themselves in jails, nursing homes or homeless shelters. Laws can make it hard to hospitalize the sickest against their will, and they prevent doctors from discussing cases with the parents of adult children.
“Since the Sandy Hook tragedy, there has been a lot of talk but little or no investment to help stop these tragedies in the future,” said Terry Russell, executive director of the National Alliance on Mental Illness-Ohio.
“The neglect of the mental-health system for the past 25 years can only be addressed by making sure everything we are currently doing meets the needs of Ohio citizens suffering from mental illness.”
The biggest improvement cited is Gov. John Kasich’s initiative to expand Medicaid, which will provide health coverage to tens of thousands of adults in need of treatment for mental illness and substance abuse, and provide additional state aid for community-based services.
But Laura Moskow Sigal, executive director of Mental Health America of Franklin County, worries the word isn’t getting out. Her organization has an eight-week waiting list for free counseling, but many of those people probably now could get help through Medicaid.
Even with more people eligible for aid, they still need a place to get treatment, Sigal said. The federal Bureau of Labor Statistics found in 2010 that 89.3 million Americans live in areas with an inadequate number of mental-health professionals. “That was a pretty staggering number, in my mind,” she said.
Other state-level efforts:
• This month, the Ohio House approved a bill lowering the barriers to family members seeking court-ordered mental-health treatment for a relative.
“Our goal is to keep our loved ones with mental illness from becoming so ill that they are ready to hurt themselves or someone else,” said Rep. Margaret Ann Ruhl, R-Mount Vernon, one of the two main sponsors of the bill. It’s now in the Senate.
• A month ago, Ohio Attorney General Mike DeWine called for a re-examination of how Ohio treats the mentally ill after a 42-year-old man was shot and killed by police after a three-hour standoff in Yellow Springs, about an hour southwest of Columbus. The man had never received the mental-health treatment he was supposed to get after an earlier run-in with authorities.
A spokesman for DeWine said on Friday the review has not begun.
• Since 2012, 1,200 people with mental-health issues have been moved out of nursing homes and into community-based care.
• This month, state officials announced that $1.5 million would be invested in community projects serving 24 counties to help nonviolent offenders access community-based mental-health and addiction services upon release from jail or prison.
Tracy Plouck, director of the Ohio Department of Mental Health, acknowledged that gaps in care persist, but she said the state is moving in the right direction.
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Article source: http://www.dispatch.com/content/stories/local/2013/12/29/a-few-federal-ohio-moves-seen-as-improving-mental-health-care-this-year.html