Thursday, February 12, 2015
Thursday, February 5, 2015
Kentucky Proposes NEW outpatient treatment bill – HB65, Representative Tom Burch
Please join me in thanking NAMI KY for supporting this important legislation. A special thanks to Dr. Sheila Schuster of the Kentucky Mental Health Coalition, (KMHC) and to Representative Tom Burch for making HB65 a reality.
In 2010, I started a blog campaign to advocate for a law, (similar to what other states had) that would assist an individual into treatment before they became dangerous to self or others, or before their lives were ruined forever … as our son and family has experienced the past 10 years.
Two years ago, in 2012-13, Rep. Burch and Sen. Denton both sponsored identical bills that strengthen and lengthen the current community based outpatient agreed order … under the KRS 202A.081. (This law has been on the books 32 years, but has been underfunded and rarely utilized.)
Talking Points and Summary for HB65 …
Two years ago, in 2012-13, Rep. Burch and Sen. Denton both sponsored identical bills that strengthen and lengthen the current community based outpatient agreed order … under the KRS 202A.081. (This law has been on the books 32 years, but has been underfunded and rarely utilized.)
In 2014, after many testimonies to the Kentucky interim joint committee on health and welfare, 2 additional bills were sponsored. They were HB 221 and SB 50.
At the legislative advocacy day in 2014, NAMI KY asked their legislators to combine both bills and pass a compressive bill that would help people before they reached KY’s strict inpatient criteria. NAMI KY, NAMI LEX, BH providers, advocates, family members and individuals living with a brain disease diagnoses … as well as Dr. Sheila Shuster (KMHC); worked through many tedious meetings, agreeing on language. HB65 is essentially the product of those meetings.
HB65 is in 2 parts. In the first section, Part 1 [Sections 1 – 3]: the language strengthens the already-existing law (KRS 202A.081) which permits persons involuntarily committed to the hospital to be discharged on the condition that they agree to – and comply with – court-ordered outpatient treatment. In section (1 an alternative sentencing is provided, with mechanism that will help connect the system to the patient. In (2) AOT allows someone to live in the community under a court order. Other additions to the first section are as follows:
• Added … a peer support specialist or other supportive person present and “MAY” be asked to support the patient during this process.
• Another addition added to HB 65 is: it renames this outpatient commitment process “a patient agreed order”.
• In [Section 1 (4); p. 1] Requires the Department of Public Advocacy (DPA) to assign an alternative sentencing social worker to develop a treatment plan in collaboration with a community mental health center.
• [Section 1 (6); p. 2] Requires the court to appoint a case management service or team employed by a community mental health center to monitor treatment and the patient’s compliance with the treatment.
• [Section 1 (7); p. 2] It requires that the case management service or team report on the person's functioning, recommend community support services, and assist the person in applying for social services. [This is an important section, as it connects the CMHC to the patient, that may be unable to access housing or basic needs without a MSW.]
• [Section 1 (7); p. 2] It requires that the case management service or team is available 24/7 and is adequately trained.
• [Section 1 (8); p. 2] It requires that treatment providers use evidence-based practices as defined.
• [Section 1 (9); p.2-3] Provides that failure to abide by the treatment plan may result in the patient being re-hospitalized if the hospitalization criteria are met, procedures are initiated via affidavit by the case management service or team, and that a mental health examination of the patient take place at a community mental health center.
• [Section 1 (10); p. 3] With due process, permit the agreed order to be extended up to 3 additional orders of 60 days (total of 180 days) each after a hearing is held, with the same procedures and safeguards as for the initial hearing.
• [Section 1 (11; p. 3] requires that services provided to the patient under the agreed order are covered by Medicaid.
• [Section 1 (12) p, 4] Requires that the courts report each patient agreed order to the Cabinet. [This is very important, because in all my research as to why people can’t access OT … I learned that the state has never collected adequate data on the number of people who had actually received a community based outpatient agreed order.]
SHORT VERSION SUMMARY OF 2nd SECTION of HB65:
This bill creates new “outpatient” language and makes it possible for a provider or family member to commit an individual, who has anosognosia to outpatient services. This is the new section that would provide a person treatment before tragedy instead of waiting until they are homicidal, suicidal or become a felon; sentenced to long-term imprisonment. (In which case, they will lose all civil rights and not likely to receive treatment.)
New outpatient criteria in Section 6:
• 55% fewer recipients engaged in suicide attempts or physical harm to self
• 47% fewer physically harmed others
• 46% fewer damaged or destroyed property
• 43% fewer threatened physical harm to others
• Overall, the average decrease in harmful behaviors was 44%
• 74% fewer participants experienced homelessness
• 77% fewer experienced psychiatric hospitalization
• 56% reduction in length of hospitalization
• 83% fewer experienced arrest
• 87% fewer experienced incarceration
• 49% fewer abused alcohol
• 48% fewer abused drugs
Consumer participation and medication compliance improved with Outpatient Treatment
• Number of individuals exhibiting good adherence to meds increased 51%.
• The number of individuals exhibiting good service engagement increased 103%.
Consumer Perceptions Were Positive after Outpatient Treatment
• 75% reported that AOT helped them gain control over their lives
• 81% said AOT helped them get and stay well
• 90% said AOT made them more likely to keep appointments and take meds.
• 87% of participants said they were confident in their case manager's ability.
• 88% said they and case manager agreed on what is important to work on.
Info from: March 2005 N.Y. State Office of Mental Health “Kendraʼs Law: Final Report on the Status of Assisted Outpatient Treatment.”
At the legislative advocacy day in 2014, NAMI KY asked their legislators to combine both bills and pass a compressive bill that would help people before they reached KY’s strict inpatient criteria. NAMI KY, NAMI LEX, BH providers, advocates, family members and individuals living with a brain disease diagnoses … as well as Dr. Sheila Shuster (KMHC); worked through many tedious meetings, agreeing on language. HB65 is essentially the product of those meetings.
HB65 is in 2 parts. In the first section, Part 1 [Sections 1 – 3]: the language strengthens the already-existing law (KRS 202A.081) which permits persons involuntarily committed to the hospital to be discharged on the condition that they agree to – and comply with – court-ordered outpatient treatment. In section (1 an alternative sentencing is provided, with mechanism that will help connect the system to the patient. In (2) AOT allows someone to live in the community under a court order. Other additions to the first section are as follows:
• Added … a peer support specialist or other supportive person present and “MAY” be asked to support the patient during this process.
• Another addition added to HB 65 is: it renames this outpatient commitment process “a patient agreed order”.
• In [Section 1 (4); p. 1] Requires the Department of Public Advocacy (DPA) to assign an alternative sentencing social worker to develop a treatment plan in collaboration with a community mental health center.
• [Section 1 (6); p. 2] Requires the court to appoint a case management service or team employed by a community mental health center to monitor treatment and the patient’s compliance with the treatment.
• [Section 1 (7); p. 2] It requires that the case management service or team report on the person's functioning, recommend community support services, and assist the person in applying for social services. [This is an important section, as it connects the CMHC to the patient, that may be unable to access housing or basic needs without a MSW.]
• [Section 1 (7); p. 2] It requires that the case management service or team is available 24/7 and is adequately trained.
• [Section 1 (8); p. 2] It requires that treatment providers use evidence-based practices as defined.
• [Section 1 (9); p.2-3] Provides that failure to abide by the treatment plan may result in the patient being re-hospitalized if the hospitalization criteria are met, procedures are initiated via affidavit by the case management service or team, and that a mental health examination of the patient take place at a community mental health center.
• [Section 1 (10); p. 3] With due process, permit the agreed order to be extended up to 3 additional orders of 60 days (total of 180 days) each after a hearing is held, with the same procedures and safeguards as for the initial hearing.
• [Section 1 (11; p. 3] requires that services provided to the patient under the agreed order are covered by Medicaid.
• [Section 1 (12) p, 4] Requires that the courts report each patient agreed order to the Cabinet. [This is very important, because in all my research as to why people can’t access OT … I learned that the state has never collected adequate data on the number of people who had actually received a community based outpatient agreed order.]
The most important part of HB65 is public safety. It will save lives.
“It’s better to be ordered to receive medical help, access to resources, housing, etc., in a least restrictive environment ... than forced to become a criminal, trapped in jail/prison where a person will lose all civil rights, and will still not receive treatment.”
SHORT VERSION SUMMARY OF 2nd SECTION of HB65:
This bill creates new “outpatient” language and makes it possible for a provider or family member to commit an individual, who has anosognosia to outpatient services. This is the new section that would provide a person treatment before tragedy instead of waiting until they are homicidal, suicidal or become a felon; sentenced to long-term imprisonment. (In which case, they will lose all civil rights and not likely to receive treatment.)
New outpatient criteria in Section 6:
Section 6.
· No person shall be subjected to
court-ordered AOT unless she would otherwise:
o 1) present a threat of danger to herself or others;
o 2) cause severe mental, emotional, or physical harm;
o 3) have significantly impaired judgment, reasoning, functioning, or
capacity to recognize reality; AND
o 4) have a substantially diminished ability to make informed decisions
regarding his or her need for sustained medical treatment.
o Furthermore, the patient must be unlikely to adhere to outpatient
treatment on a voluntary basis based on a QMHP’s
· 1) clinical observation;
· 2) review of treatment history, AND
·
The AOT must be the least
restrictive alternative mode of treatment available.
Section 7.
·
The QMHP who examines the
respondent must provide a written treatment plan that includes “reasonable
opportunities” for the involvement of both the patient and anyone else she
wants on board, any advance directive already executed by the patient, and evidence-based
practices.
Section 8. New
·
At the hearing, respondent shall be:
o Represented by counsel
o accompanied by a peer support specialist or “other person in a support
relationship” AND
o “Afforded an opportunity to present evidence, call witnesses on his or
her behalf, and cross-examine adverse witnesses.”
·
The court may conduct the hearing in the respondent’s absence
·
The QMHP who recommends
court-ordered AOT shall testify at the hearing.
·
The court must find clear and convincing evidence that the
patient meets the criteria in Section 6 of this bill to order AOT, but the
court is not compelled to do so. In other words, the evidence that the
respondent needs AOT must be clear and convincing to even consider issuing the
order. The court can still choose not to
issue the order even with clear and convincing evidence.
Section 9.
·
After ordering AOT, the court appoints a case management
service or team employed by a CMHC who shall
o Monitor the patient’s
adherence to the order and
o Report to the court
“descriptive of the person’s functioning.”
·
The service or team shall be available 24 hrs/day
Section 10.
·
Failure to comply “may
constitute” grounds for a physician to order a 72 hour hold.
·
Failure to comply is not grounds for contempt of court.
Section 11.
·
At any time during the treatment,
the patient may move the court to stay,
vacate, or modify the order.
·
A QMHP may move the court to change the order
o “material change” means an addition or deletion of one of the services
from a treatment plan.
·
Within 30 days of the expiration
of an order, the original petitioner may
petition for an additional period of AOT.
o The procedure is the same as the first petition, except the parties may mutually agree to waive the
hearing.
Section 12.
·
The services for the order “shall
be authorized by the Department for Medicaid Services [DMS] and its contractors
[MCOs] as Medicaid-eligible services and shall be subject to the same medical
necessity criteria and reimbursement methodology as for all other covered behavioral health services.”
emphasis added.
[Currently, even if treatment programs and resources are available for individuals with brain disease, SMI ... if the patient does not believe they are have symptoms, or has anosognosia, there is little hope they can access services. This in turn, sets the individual and the mental health system up for failure.]
See NAMI Kentucky's sample letter to the Kentuky legislature here:
Danger and Violence Reduced after Outpatient Treatment
• 55% fewer recipients engaged in suicide attempts or physical harm to self
• 47% fewer physically harmed others
• 46% fewer damaged or destroyed property
• 43% fewer threatened physical harm to others
• Overall, the average decrease in harmful behaviors was 44%
• 74% fewer participants experienced homelessness
• 77% fewer experienced psychiatric hospitalization
• 56% reduction in length of hospitalization
• 83% fewer experienced arrest
• 87% fewer experienced incarceration
• 49% fewer abused alcohol
• 48% fewer abused drugs
• The number of individuals exhibiting good service engagement increased 103%.
• 75% reported that AOT helped them gain control over their lives
• 81% said AOT helped them get and stay well
• 90% said AOT made them more likely to keep appointments and take meds.
• 87% of participants said they were confident in their case manager's ability.
• 88% said they and case manager agreed on what is important to work on.
Info from: March 2005 N.Y. State Office of Mental Health “Kendraʼs Law: Final Report on the Status of Assisted Outpatient Treatment.”
Wednesday, January 28, 2015
AOT bills move forward in other states
Yesterday, Laura's Law passed in San Diego county. A handfull of NAMI advocates made a difference! http://www.kpbs.org/news/2015/jan/26/san-diego-county-supervisors-consider-involuntary-/
Read more here:
Joel's Law … And AOT law in WA could save lives!
Read more here:
(Feb. 4, 2015) Yesterday, the Contra Costa County Board of Supervisors voted 5-0 to implement Laura’s Law, making it the eighth county in California to embrace assisted outpatient treatment as a tool for making treatment possible for individuals with severe mental illness.
“We believe it’s an investment in helping families and people with serious mental illnesses,” Contra Costa County Supervisor John Gioia said in a statement. “We’ve heard from many families (who want) an opportunity to help their own family members.”
Read more here:
Laura's Law passes easily in S.F. supervisors' vote
Easy passage belies the years of debate on implementation of state measure
Updated 7:10 am, Wednesday, July 9, 2014
Read more here:
Monday, January 19, 2015
Liza Long - "Mental illness is not a choice. But hope is."
Powerful words written today by The Anarchist Soccer Mom and author of The Price of Silence: A Mom's Perspective on Mental Illness
All across the US, we are at a loss for words, as we share the sad news of our friend and Tb4T advocate Laura Pogliano's son tragic passing. Liza has helped us find the right words. WORDS do matter. Many times wishful thinking to decrease stigma, actually discrimaintes against those who need help the most.
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| #worldmournszac |
There's a popular quote floating around mental health advocacy circles: "Mental illness is not a choice. But recovery is." I know people will disagree with me, but today, I'm tired of that sentiment, and I wish we would retire the word "recovery." When local and national mental health policy is shaped by high-functioning consumers who have been able to manage their illnesses rather than by the sickest patients and their families, it's the equivalent of only allowing stage 1 cancer survivors to drive the narrative and take most of the funds. While their courage is admirable and their struggles are genuine, too often, we lose sight of those who are suffering the most. They become invisible to us, marginalized on the streets or in prison. Or they die young, like Zac.
I wish we would stop talking about recovery and replace it with a more useful, less stigmatizing word: hope.
Here are five reasons I wish we would stop using the word "recovery" for serious mental illness.
Read Liza's 5 reasons here:
http://anarchistsoccermom.blogspot.com/2015/01/5-reasons-i-wish-we-would-stop-talking.html?m=1
Sunday, January 4, 2015
Behind the Gates of Gomorrah: An Insane Situation - interview by Julia Robb
A new book was recently published by Dr. Stephen Seager. Below are a few of my favorite quotes from an interview with Julia Robb.
"Here’s some figures: 1% of the population everywhere on earth is schizophrenic so in the US that’s 3.25 million people of which maybe 1 million or so are paranoid.
There are 50,000 state hospital beds nationally.
The real question is why aren’t they in mandatory out patient treatment?
When I said that people don’t care about the mentally ill, I wasn’t kidding. The reason foreign doctors are over represented at state mental hospitals is because most American doctors won’t do it. It’s the same reason inner city clinics are populated by international physicians as well.
Americans don’t care about the mentally ill, so we have out-sourced their care."
Read the entire interview here: http://juliarobb.com/author/julia/
Purchase Dr. Seager's book here: http://www.amazon.com/Behind-Gates-Gomorrah-Criminally-Insane-ebook/dp/B00GEEB17MThursday, January 1, 2015
"Shot in the Head”, by Katherine Dering - Brutally honest, can't-put-it-down-kind-of-book
By G.G. Burns, Book Review
Katherine does as excellent job describing the devastation we feel with raw emotion that puts the reader in the shoes of Paul as he is "institutionalize", then later released to a world of insanity much worse than his disease.
I began reading the book on my flight home from Washington, D.C., in early September after attending the national NAMI conference, where I was delighted to meet both of Paul’s sisters, Katherine and Ilene. I believe our paths have crossed over the years for a positive reason, as I know Paul’s story will help mental health policy to change one day.
"Shot in the Head" also allowed me to develop humanity for those dying a slow painful death with “mental illness” and how at times we need hospice care, just as dying slowing with cancer. It brought me to tears and laughter – sometimes on the same page.
The writing of Paul’s story inspires me to attempt the unthinkable – to write a book about my son because his right to deny treatment trumps his health. It will be a story of anosogosia or lack of insight of ones own illness is definitely not something one can easily find on a shelf or online.
I just finished an incredible book, "Shot in the Head”, by Katherine Dering about the Flannery family and the life and death of their dear brother Paul. Paul is blindsided by the onset of Schizophrenia in his late teens and like other families the disease impacts the entire family unit.
Katherine does as excellent job describing the devastation we feel with raw emotion that puts the reader in the shoes of Paul as he is "institutionalize", then later released to a world of insanity much worse than his disease. "While picking up the pieces after Paul's Mother died, Katherine (and her eight siblings) learned how dysfunctional and fragmented the "mental health system" is. Along the way, her perception of her ill brother, Paul, changed as well."
Over the past 10 years, I have read dozens of books about “living” with serious mental illness, some by psychiatrists or psychologists, others by research scientist, family members or individuals impacted themselves. In all the books describing tragic deaths or suicides, none touched me in the way "Shot in the Head" did.
Perhaps it was because I had just left my fagile 84-year old Mother, who like Paul in his final days suffered with cancer in a nursing home.
My Mother suffers not only with dementia, depression and social anxiety that has paralyzed her much like horrible neurological disorder, but she has also survived breast cancer this year. For years, she lived in fear of "what if a bad thing happens" and now it has. Just as Paul believed he was James Bond or he had been shot in the head.
Another reason this book was so impactful, my son is surviving his serious brain disease with "no treatment" due to his civil rights to say no! Like Paul, he too believes he works for the FBI.
Perhaps it was because I had just left my fagile 84-year old Mother, who like Paul in his final days suffered with cancer in a nursing home.
My Mother suffers not only with dementia, depression and social anxiety that has paralyzed her much like horrible neurological disorder, but she has also survived breast cancer this year. For years, she lived in fear of "what if a bad thing happens" and now it has. Just as Paul believed he was James Bond or he had been shot in the head.
Another reason this book was so impactful, my son is surviving his serious brain disease with "no treatment" due to his civil rights to say no! Like Paul, he too believes he works for the FBI.
"Shot in the Head" also allowed me to develop humanity for those dying a slow painful death with “mental illness” and how at times we need hospice care, just as dying slowing with cancer. It brought me to tears and laughter – sometimes on the same page.
As soon as I read the last page, I wrote a note to Paul’s sisters on my iphone as my husband and I traveled north to Kentucky on I-75. My first message: “Thank you for writing your eloquently written memoir and for sharing Paul’s story.” My second message: “Thank you for inspiring me (and hopefully others) to write about the challenges we face."
The writing of Paul’s story inspires me to attempt the unthinkable – to write a book about my son because his right to deny treatment trumps his health. It will be a story of anosogosia or lack of insight of ones own illness is definitely not something one can easily find on a shelf or online.
Bravo to Katherine and Ilene for their efforts to help families like ours by creating Paul’s Legacy Project and for writing, "Shot in the Head".
It is a must read.
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