Kentucky’s embrace of private Medicaid plans leads to complaints

"Once again, a national media outlet, (this time The Washington Post), uses Kentucky's political decisions as a bad example for the rest of the US to learn from! If people who willingly want to access services and treatments are limited, where does this leave those who 'lack insight to their illness/anosognosia' and aren't able to navigate Kentucky's extremely difficult 'managed care' nightmare? Read how Kentucky medical providers hide behind HIPPA handcuffs". ~  GG Burns, KY Mental Health Advocate

Read the "Managed Care" article here:

By Jenni Bergal, Published by The Washington Post on July 13, 2013:http://www.washingtonpost.com/national/health-science/kentuckys-embrace-of-private-medicaid-plans-leads-to-complaints/2013/07/13/6e0c96d2-e9a8-11e2-aa9f-c03a72e2d342_story.html

View video from the Kaiser Health News here:
http://www.kaiserhealthnews.org/Stories/2013/July/14/kentucky-medicad-managed-care.aspx

Brian Stettin will speak to NAMI Members on the “The Untapped Power of AOT in Kentucky”

Brian Stettin, Policy Director of the Treatment Advocacy Center will be the presenter of two morning workshops titled: “Untapped Power of Assisted Outpatient Treatment (AOT)”, on July 20th at the NAMI KY conference. (For more details see the bottom of this post.)

In his presentations, Brian will cut through the common misconception's surrounding AOT. He will share research on its effectiveness, walk through the Kentucky AOT law and explain how it needs to be improved, and explore strategies for grassroots advocates to mobilize to make AOT those who need it a routine component of the Kentucky mental health care system.

Brian Stettin is the Policy Director of the Treatment Advocacy Center, a national advocacy organization based in Arlington, Virginia that works to remove legal barriers to the treatment of severe mental illness.  In 1999, as an Assistant New York State Attorney General, Brian conceived and drafted the original proposal of “Kendra’s Law,” landmark legislation establishing Assisted Outpatient Treatment (AOT) in New York. He was also instrumental in marshaling critical support for the bill, negotiating revisions with the New York Legislature and Governor, and enhancing the law upon its initial expiration in 2005. After leaving the Attorney General’s Office, Brian worked in Albany as Special Counsel to the New York State Commissioner of Criminal Justice Services, and Counsel to the Health Committee of the New York Assembly.  Since joining the Treatment Advocacy Center in 2009, Brian has been active across the U.S. in fostering the creation of local and regional AOT programs; reforming states’ inpatient commitment standards; and nurturing alliances with like-minded groups and advocates.  Brian is a 1991 graduate of the City College of New York and a 1995 graduate of the University of Texas School of Law.

 
Assisted Outpatient Treatment (AOT) is the practice of placing certain individuals with severe mental illness under court order to adhere to their prescribed treatment while living in the community. The target population is people caught in the “revolving door” of the mental health and criminal justice systems, as a result of their chronic inability to recognize their own illness and seek care voluntarily.
 
AOT has been prove in studies to drastically improve treatment outcomes, by lowering rates of hospitalization, incarceration and homelessness. However, it remains controversial within the mental health community, because some view it as an intrusion on the individual’s right to make his or her own treatment choices.
 
AOT is authorized under law in 44 states (including Kentucky) but is underused in nearly all of them. In the select jurisdictions across the country that employ it, AOT is considered an indispensable component of the mental health system. Typically, once an AOT program is up and running, controversy tends to die down as it dawns on people that the approach is not punitive at all, and offers a true lifeline to those in need.
 

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NAMI Kentucky Annual Conference

July 20, 2013

Christ Lutheran Church

9212 Taylorsville Road

Louisville, KY

$25.00 registration fee

1.) 9:15 or 10:30 am  "The Untapped Power of AOC in Kentucky"  Presenter Brian Stettin, Policy Director of the Treatment Advocacy Center, VA

Assisted Outpatient Treatment (AOT) is the practice of placing certain individuals with severe mental illness under court order to adhere to their prescribed treatment while living in the community.  The target population is people caught in the "revolving door" of the mental health and criminal justice systems, as a result of their chronic inability to recognize their own illness and seek care voluntarily.

2.) 9:15 or 10:30 am  "How to Effectively Advocate your Legislators"  Presenter Carl Boes, Jr., BA Philosophy Masters of Public Administration

Participants will learn to use their personal experiences to inform and inspire decision makers as they consider the future of public mental health services

3.) 9:15 or 10:30 am  "Counseling SSA Beneficiaries on Work Incentives and Employment"  Presenter: Tim Sloan, a twelve year veteran of counseling disabled Social Security beneficiaries on work incentives and employment.

4.)  9:15 or 10:30 am "Mental Health Courts, both the Enhanced Supervision docket Misdemeanants in District Court, and the Mental Health Court for Circuit Court Felony offenders".  Presenters: Judge Judith Bartholomew, District and Family Courts, Jim Burch of Seven Counties and Susan Jones, with the Jefferson County Attorney office

The workshop is a collaborative effort between the courts and Seven Counties

11:45-12:45Lunch___________________________

12:45-1:00 Break

1:15-2:15 Keynote Speaker Karen Winters Swartz, Author

Where Are the Cocoa Puffs? A Family's Journey Through Bipolar Disorder is Winter's debut novel. Her second novel: Reis's Pieces: Love, Loss and Schizophrenia was released in May 2012. She is an active board member of National Alliance on Mental Illness (NAMI) Syracuse and has traveled throughout the country advocating for mental illness awareness.

 

6.) 2:30 or 3:45 pm   "Caregiving Elderly Parents: How to Navigate the Challenges"  Presenter: Jim Schorch, LCSW, LMFT, has been in private practice for 12  years   
The workshop will focus on the common struggles faced by adult children as they care for the unique needs of their parents failing health and mental health needs, how to provide for their own self-care, and access available resources.

7.) 2:30 or 3:45 pm   "Advocating for a Mentally Ill loved One who is Caught in the Criminal Justice"  Presenter: Rebecca Cotton , Attorney for Protection and Advocacy
Discusses the manual " Mentally Ill persons Caught in the Criminal Justice System:  A support manual for family and friends she wrote in her second year of law school.

8.) 2:30 or 3:45 pm  "NAMI ON Campus"  Presenters:  Marcie Timmerland, NAMI Lexington and Jaxcy Odom, UK Student

NAMI On Campus is an exciting extension of NAMI's mission into the campus community.  NAMI on Campus clubs are student-let clubs that tackle mental health issues on campus by raising mental health awareness, educating the campus community, supporting students, promoting services and supports and advocating.

4:45 Closing 

To register, contact: NAMI KY

Somerset, KY 42501
Phone: (606)-451-6935 or 1800-257-5081
Fax: 606-677-4053
namiky@bellsouth.net
www.ky.nami.org

Has Kentucky Progressed in the Past 21 Years?

This national report was published in the Lexington Heard Leader on September 10, 1992

********************************
Ky. called worst in using jails for mentally ill

Study count non-criminals held not helped

Staff wire reports

Washington- Kentucky is the worst state in the nation for handling people with mental illness because it widely uses jails as substitute holding pens, two advocacy groups said yesterday.

Kentucky has the nation's highest percentage of jails holding mentally ill people who have not committed crimes, according to report by Ralph Nader organization Public Citizen and the National Alliance for the Mentally Ill.

"Kentucky looks like the worse when he comes to misusing, abusing jails as mental health facilities," said Dr. E Fuller Torrey, a research psychiatrist and the principal author of the report.

"Kentucky is using jails as substitute mental hospitals," Torrey said. "This is a practice that should have gone out in the 1800s."

Kentucky and 15 other states expressly allow mentally ill people to be held, at least temporary, in jails Torrey said. Eight states outlaw the practice; others have no blanket rules or laws on the issue.

Kentucky was cited because it has the highest percentage, 81.1%, of jails holding mentally ill people not facing criminal charges, according to the report, which was based on a survey of 1391 cities and county jails nationwide.

The state with the second highest percentage is Mississippi with 75.9%. On average, 29% of jails in the United States hold mentally ill people who haven't committed crimes.

The state with the highest percentage of seriously ill patients among its total population was Colorado, at close to 11 percent.

"We agree, for the most part, that we have a problem in the state," said Brad Hughes, a spokesman for the Kentucky cabinet for Human Resources. "I don't know whether it's the worst in the nation."

Kentucky allows people with mental problems to be arrested on involuntary commitment warrants and sent initially to local jails.

Mentally ill people can be held in County and regional jails for up to 72 hours before being sent to mental hospitals, Hughes said. To help mentally ill people more than 48 hours, jails must send in mental health professionals.

"The state Human Resource Cabinet has lobbied since 1986 to outlaw jails as a temporary place to keep the mentally ill,: Hughes said. However the legislature had repeatedly rejected the change, largely because of the $1.7 million cost.

Reacting to the report, the Kentucky Alliance for the Mentally Ill yesterday called on the Governor Brereton Jones to include the issue in the special legislative session on health care slated for November.

"Little will be done to rectify the problem unless the governor, members of the General Assembly and the Public except the moral and physical responsibility for this criminalizing the illness, said Susie McElwain, the groups Executive Director.

The state Human Resource Cabinet will investigate the report claims that Kentucky's 15th community mental health centers are doing a poor job of assessing and treating mentally ill people, Hughes says.

But he rejected claims in the report the Kentucky has cut the number of hospital beds at state mental hospitals to save money, leaving mentally  ill people without treatment.

"We don't have a waiting list he said." "People aren't being turned away."

The report estimated that nationwide 30,000 seriously mentally ill patients are imprisoned in jails, were the causes of illness often go untreated and where they face high levels of physical abuse and rape.

Nearly three in 10 American jails are "surrogate mental hospitals", holding seriously mentally ill people who have not been charged for crime report said. More than 7% of the people held in jail including those facing criminal charges, have severe mental disorders.

Flathead County Mont., Has the worst record along Counties,

Flathead County Sheriff Jim DePont said the two local hospitals, Kalispell Regional Hospital an Glacier View do not accept private emergency psychiatric admissions.

Shane Roberts, chief operating officer at the regional hospital said,
"It is true we do not have dedicated psychiatric unit at the hospital, but for medical need psychiatric patients are accepted."

DePont said the state hospital is about 250 miles away and so crowded that it frequent takes months to get a patient in.

Expert involved with the report gave several reasons for the increasing use of jails as a surrogate psychiatric hospitals, chief among them where the steady deterioration of the network of hospitals, social workers, clinics and outreach programs that used to exist to care for the mentally ill. Police in many parts of the country appeared to pick up the mentally for a variety reasons, such as disturbing the peace or for their own safety and put them in jail in lieu of appropriate psychiatric facility.

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Fast forward to June 2013, watch this video and be the judge if Kentucky has moved foward since 1992! http://www.youtube.com/watch?v=qEu_6miQlx0 

Unpreventable Tragedies and Why AOT laws aren't utilized!

Sadly, there was another preventable tragedy in Knoxville, Tennessee this week! Treatment advocates want to know "why does our new AOT pilot program not seem to be working? There are 9 out of 10 spots still open after an entire year of implementation.... A law only works when it is used."

My response is: "Kentucky's Assisted Outpatient Treatment, AOT law has been on the books for 20 years. As of 2012, 80% of the leaders of state wide mental health organizations, didn't know what it was, had ever known of someone benefiting from AOT or 'worse', even that the law exist! 

Read this horrific story here and one that isn't uncommon in Kentucky, except rarely does Kentucky media outlets revealed the shooter had a long history of 'untreated' mental illness. http://www.knoxnews.com/news/2013/jun/21/lives-of-kcso-deputy-suspect-crossed-in-deadly/

The reason I have lobbied for the

202A.081 Court-ordered community-based outpatient treatment

to be 'strengthen, lengthen and supportive', by KY's state government, through the Dept. of Behavioral Health Development and Intelligent Disabilities is ~ the fact the current law is rarely used.

It's has taken 4 years of effort to get the state NAMI groups to discuss and support this topic! Small wonder the most vulnerable who can't advocate for themselves, due to no fault of their own ~ can't access treatment or resources to find the path to recovery.  

It's not all about stigma that prevents these individuals and their families from 'unpreventable tragedies' ~ it's about how Kentucky law is written and enforced. KY's AOT law needs to be written in a way that it can be funded and implemented! People must get behind it. A squeaky wheel is the only thing that gains attention!

Treatment of individuals with serious mental illness in jails and prisons - a survey

 
Dear NAMI leader,

We can all agree that individuals with serious mental illnesses do not belong in jails or prisons.
The reality, however, is that many such individuals are in jails and prisons as a result of the increasingly failed mental illness treatment system. Many jails and prisons now report that 20 percent or more of their prisoners have severe mental illness as a primary diagnosis, frequently complicated by substance abuse.
Being in jail or prison when your brain is working normally is difficult enough, but being in jail while you are psychotic is a nightmare. And practices for psychiatrically treating such individuals vary widely, even within a single state. In fact, there appears to be considerable confusion among families, and even among some jail and prison officials, regarding the legal circumstances under which individuals with serious mental illness can be involuntarily treated in jails and prisons when they are psychotic and unaware of their own illness.
For this reason, the Treatment Advocacy Center is undertaking a state-by-state survey of laws and practices for treating jail inmates who refuse treatment for a severe and persistent mental illness. This information is being collected by Mary Zdanowicz, a lawyer. When it is complete later this year, the survey will be permanently posted on the website of the Treatment Advocacy Center and be accessible to everyone, along with the other state-related information already available there.
As part of this survey, we are collecting anecdotal information about the experiences of individuals with serious mental illness (e.g., schizophrenia, bipolar disorder, schizoaffective disorder or severe depression with psychotic features) who should have been treated involuntarily while they were in jail or prison but, for whatever reason, were not treated. I am aware that some of these cases end up as disasters. Conversely, I am aware that some such individuals are involuntarily treated with a good outcome. We are interested in collecting examples of both bad outcomes when involuntary treatment was not provided and good outcomes when it was provided.
Could you please forward this request to any of your NAMI members who may have a family member in jail or prison and may be interested in the involuntary treatment problem? I would like them to send us the details of that treatment situation. In our report, we will not identify the individuals or the jail/prison by name, only by state, except in cases in which the information is already public.
NAMI members who wish to contribute such information can send it to me directly at jailprisonsurvey@treatmentadvocacycenter.org. It should be sent to me by August 1.

Thank you for your help with this survey. When we release it later this year, we will send you a copy.
Sincerely,

E. Fuller Torrey, MD

Congressman Tim Murphy Joins White House Conference on Mental Health Renews request for MH spending and program details

For Immediate Release: June 3, 2013
Contact: Dain Pascocello, 202.225.2301

Washington, D.C. — Congressman Tim Murphy (PA-18), Chairman of the Energy and Commerce Subcommittee on Oversight and Investigations, renewed his call today for the White House Office of Management and Budget (OMB) to ...release information related to the federal government’s funding of programs to treat the seriously mentally ill.

Today, Chairman Murphy is participating in the White House’s National Conference on Mental Health, led by President Barack Obama, to “discuss how we can all work together to reduce stigma and help the millions of Americans struggling with mental health problems recognize the importance of reaching out for assistance.”

In a letter delivered to the President, Chairman Murphy asked that the White House comply with an April 10, 2013 committee request to OMB Acting Director Jeffrey Zients to detail all programs dedicated to the treatment and research of mental illness, the amount each program receives annually, and the amount dedicated to the treatment of serious mental illness. Zients has failed to respond to the Committee request.

“We need to get a handle on how much is spent, where it goes, and if federal tax dollars are being used to effectively diagnose, treat, and research mental illness,” said Chairman Murphy. “An audit of spending on federal mental health programs enables Congress to make informed decisions so we can fix our broken mental health system and hold agencies accountable if funds are not getting down to the level of helping patients and supporting families.”

Murphy has been investigating both the social barriers to mental health reform as well as the effectiveness of existing federal mental health programs in his subcommittee’s ongoing review.

At an May 22 Oversight hearing to examine federal spending on serious mental illness at the Substance Abuse and Mental Health Services Administration (SAMHSA), Murphy and committee investigators revealed questionable spending, including $22,500 to commission a painting, more than $80,000 on a staff-directed musical skit, and hundreds of thousands of dollars on questionable conferences (such as “Unleash the Beast”) during which individuals with serious mental illness were encouraged to stop taking their medications.

“The wasteful spending and failed programs at SAMHSA need to end. Resources are desperately needed for science and evidence based treatment programs,” said Murphy. “Federal programs intended to help patients are actually endangering the lives and the public by discouraging the seriously mentally ill from taking medication or seeking clinical help. It’s as if SAMHSA doesn’t believe serious mental illness exists.”

Text of the letter follows:

June 3, 2013

The President
The White House
1600 Pennsylvania Avenue, Northwest
Washington, DC 20500

Dear Mr. President,

In the wake of the tragic violence at Sandy Hook Elementary School in Newtown, CT, the link between mass violence and mental illness has received renewed attention. Even more so, we are once again confronted with the fact that serious mental illness is an area that demands greater attention, so that we may help individuals and families in need.

Towards that end, I welcome and commend your efforts through the National Dialogue on Mental Health to work on reducing stigma, fostering greater understanding, crafting appropriate policies, and directing resources to programs that most effectively help individuals with serious mental illness.

As you know, immediately after the tragedy in Newtown, Connecticut, the Committee on Energy and Commerce began examining violence, serious mental illness and federal mental health programs with an understanding that, in nearly every episode of recent mass violence, there is a perpetrator who has an untreated or undertreated serious mental illness.

Members of this Committee have sat down with the nation’s leading researchers and clinicians on serious mental illness. In addition, Committee staff has met representatives from numerous federal agencies involved in mental health research and treatment, including the National Institute of Mental Health (NIMH), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicaid and Medicare Services, and various groups and stakeholders to better understand what federal programs exist and whether they are effective.

On March 5, 2013, the Subcommittee on Oversight and Investigations, which I chair, held a bipartisan public forum, “After Newtown: A National Conversation on Violence and Severe Mental Illness,” to focus on mental health treatment and research into serious mental illness and violence. The Oversight Subcommittee also heard from experts who are on the forefront of treating the seriously mental ill and conducting research. Based on the discussion that took place at this forum, the Subcommittee has held two more hearings: “Does HIPAA Help or Hinder Patient Care and Safety?” on April 26, 2013, and “Examining SAMHSA’s Role in Delivering Services to the Severely Mentally Ill,” on May 22, 2013.

Through the work of the Committee, serious questions have been raised on whether federal resources are being directed to evidence-based programs that are most effective at treating the seriously mentally ill. We know that various agencies across the federal government have different programs for the care and treatment of the mentally ill. To determine exactly what funding and programs exist, the Committee sent a bipartisan letter on April 10, 2013, to Office of Management and Budget (OMB) Acting Director Jeffrey Zients, requesting that OMB compile a list of all programs, the amount each program receives annually, and the amount dedicated to the treatment of serious mental illness. As of today, the Committee has not received a response to this letter.

Mr. President, we know that the seriously mentally ill are far more likely to be victims of violence than perpetrators. We also know, though, from the testimony of experts who have appeared before the Committee that those who suffer from serious mental illness, like schizophrenia, bipolar disorder or major depression, are two or three times more likely to exhibit violent behavior – to themselves or others. They are one of the most vulnerable populations, not only because they are more likely to be victims of violence, but also because there does not appear to be a coordinated system for helping these individuals or their families get treatment. Further, some with the most serious mental illnesses may not even recognize that they are sick and refuse treatment.

Tragically, these violent acts are wholly preventable, but effective treatment and hospitalization has been replaced with homelessness and incarceration. Nearly a third of homeless persons have a serious mental illness, and in some prisons, half of female inmates and twenty percent of male prisoners have a mental illness.

Given our shared commitment in finding solutions, I respectfully ask your assistance, Mr. President, in securing the information requested by the Committee. With this information, we can ensure federal funding is reaching those with serious mental illness and those programs provide the most effective care because tragically, less than half of children and adults with diagnosable mental health problems receive treatment.

Thank you for your attention to this matter. I look forward to working together to fix our broken mental healthcare system so we prevent tragedies like Newtown from occurring again and give families the hope and resources they need to help loved ones suffering from illness.

Sincerely,

Tim Murphy
Member of Congress

Andrew Cohen, "In our zeal to dehumanize criminals we have allowed our prisons to become medieval places of unspeakable cruelty so far beyond constitutional norms that they are barely recognizable."