Photo by Issac Geesling

Weekend Legislative Roundup.

The following bills that seek to enhance the well-being of individuals and families with chronic mental illness in Arizona continue to move forward. Here’s where they stand and how you can help:

SB1059 – Clarifies current law requires that a person with mental illness and substance use diagnosis must be evaluated and not summarily dismissed due to the presence of drugs. The intention is to make treatment consistent.

Status: Passed in the Senate. Passed out of House Committees, currently waiting to go to House floor for a vote. Email all House members.

Action: Call and/or email your AZ Representatives. Email the Governor’s office and ask for his support.

SB1142 – A tax incentive bill for employers who hire people with serious mental illness. Sets the credit amount at $2 for each hour worked by an SMI employee during the calendar year, not to exceed $20,000, tax-paying business owner. Government agencies excluded.

Status: Passed in the Senate. To be heard in the House Appropriations Committee this Tuesday, 3/30, for a vote.

Action: Call and/or email the House Appropriations Committee members (emails below) and ask them to support.  Call and/or email your AZ Representatives. Email the Governor’s office and ask for his support.

SB1716 – Currently, only 55 patients from Maricopa County can be at the Arizona State Hospital (ASH) — even when there are empty beds. ASH will no longer limit the number of patients who can be admitted based on the county where the patient lives. Admission should be based on clinical needs.

Reforms the existing ASH Governing Body (Governing Body) to operate without conflicts of interest: Most members will NO LONGER be employees of the Department of Health Services, which oversees ASH. Requires that the Chair of the Independent Oversight Committee (IOC) be invited to Board meetings and provided quarterly reports about human rights violations with patients. Improves transparency — requires Governing Body file annual reports with the Legislature that describe the treatment provides and what is working.

Patient safety improvement: ASH has an outmoded video surveillance system that puts patient safety at risk. We need a better surveillance system.  The bill requires ASH to maintain a surveillance system with video and audio and appropriates $500,000 to do so. ASH administration has requested a new system last year and is currently in a Request for Proposal.

Status: Passed in the Senate. To be heard in the House Appropriations Committee this Tuesday, 3/30, for a vote.

Action: Call and/or email the House Appropriations Committee members (emails below) and ask them to support. Call and/or email your AZ Representatives. Email the Governor’s office and ask for his support.

SB1029 & SB1030 – Psychiatric security review board (PSRB) bill, SB1029, requires more information and reports for the Board to ensure that it treats patients fairly and protects the public. The Board now operates without enough information on patients when it makes decisions. The bill has a retired judge become the Chair, so the Board operates by fair rules.

Because the PSRB Board opposes any changes and claims that it operates perfectly, SB1030 ends the PSRB and sends the functions that the PSRB performs to the Superior Court in each county. This saves the state money and will ensure that patients get a fair hearing in front of a judge who follows the law.

Status: Passed in the Senate. Passed in the House Committees, waiting to go to the House floor for a vote.

Action: Call and/or email your AZ Representatives. Email the Governor’s office and ask for his support.

Here is a link to find AZ Representative’s email:

The Arizona Peoples Lobbyist – Your Voice – Your Choice (azpeopleslobbyist.com)

SB1786 – Prisoner Mental Health Transition Bill.

Status: Passed in the Senate. Passed in the House Committees, waiting to go to the House floor for a vote.

Action: Call and/or email your AZ Representatives. Email the Governor’s office and ask for his support.

SCR1018 – A Concurrent Resolution expresses support for community-based efforts to provide clinically appropriate care to individuals with chronic serious mental illness.

Status: Passed in the Senate. Passed in the House Committees, waiting to go to the House floor for a vote.

Action: Call and/or email your AZ Representatives. Email the Governor’s office and ask for his support.

Here is a link to find AZ Representative’s email:

The Arizona Peoples Lobbyist – Your Voice – Your Choice (azpeopleslobbyist.com)

ACMI would like to thank Senator Nancy Barto, the sponsor of these bills, for her tireless and heroic work on behalf of individuals and families living with chronic mental illness in Arizona! When you have an opportunity, please thank her as well.

We realize that everyone’s life is full; if you are unable to call or email but still want to help the chronically mentally ill, you can partner with us financially. ACMI is a group of dedicated volunteers; no one receives a salary. Your gift will go directly toward improving the well-being of people living with chronic mental illness.

Please contact your legislators by this Monday morning.

Here is a link to find their email:

The Arizona Peoples Lobbyist – Your Voice – Your Choice (azpeopleslobbyist.com)

Or call the Governor’s office at 1-602-542-4331 or email engage@az.gov

House Appropriations Committee members:

César Chávez                     cchavez@azleg.gov

Regina E. Cobb                 rcobb@azleg.gov

Charlene R. Fernandez     cfernandez@azleg.gov

Randall Friese                    rfriese@azleg.gov

Jake Hoffman                    jhffman@azleg.gov

Steve Kaiser                       skaiser@azleg.gov

John Kavanagh                  jkavanagh@azleg.gov

Aaron Lieberman             alieberman@azleg.gov

Quang H. Nguyen             qnguyen@azleg.gov

Becky A. Nutt                     bnutt@azleg.gov

Joanne Osborne               josborne@azleg.gov

Judy Schwiebert               jschwiebert@azleg.gov

Michelle Udall                   mudall@azleg.gov

 

Your partnership in helping the chronically mentally ill and their families in our state is so appreciated, thank you!

Thank you,

 ACMI Board

 Courtesy of Unsplash photography

   Every parent’s worst nightmare is the thought of possibly losing a child in an accident or to a serious illness. An even greater fear is the thought of losing a child to an abduction and never knowing where that child is or who the child is with. Moreover, no parent wants to see their child abused or to be an abuser.

     I have lost a child……. to a serious mental illness and addictions.

     I have lost a child to multiple “accidents” in the current mental health system in which I have tried to participate. I go to bed every night not knowing where my child is or who she is with. I face each new day with the fear that she did not survive the night. Every day I brainstorm and research what else I might do to find her and get her to a hospital where she can be helped. Occasionally, I get a call from a police officer who has had an encounter with her, usually for trespassing or loitering.  The call is a result of recent missing persons’ report that I filed. I am told that she is “okay” by the officer, even if she is demonstrating psychotic behavior, dressed in appropriately for the weather, calling 911 because she believes that she has been run over by a truck, or staying in settings where assaults are frequent.

     Because she has not been given proper care and limits are placed on those of us (family, primarily) who are trying to help her, the results are as follows:  multiple arrests, jail time, cruel solitary confinement, car accidents, fines, court hearings, emergency calls to police and fire departments, hospitalizations for both physical and psychiatric treatment, rehabs, halfway houses, domestic violence calls, petitions, court ordered appointments at clinics, dental repairs from assaults, disease, property damage, job losses, and loss of all meaningful relationships of friends and family.

     My “child” is an adult who is persistently and acutely disabled due to mental illness and addictions.  I am told over and over by physicians, law enforcement officers, counselors and friends, “She is an adult. You can’t force her to get help.” “She has to hit bottom first.” “We can’t tell you if she has been admitted.” “She can be talking to a light pole, but unless she has threatened to harm herself or others, we cannot admit her.” “Since she is already under court ordered treatment, you cannot petition her for pick-up. She has been evaluated already. She just needs to show up for her meds at her assigned clinic.” These comments demonstrate the lack of understanding when it comes to mental health and addiction issues. People who are not thinking clearly cannot make decisions in their best interest. Their brain is lying to them and sending a false narrative. Hitting bottom often means death. What good is court ordered treatment, if once you get it you cannot be evaluated again should you have a setback in your mental stability! Most severely mentally ill people have a very difficult time managing their own medications and even getting to all of the appointments without assistance.

     Based upon calls from the police, my daughter is most likely living in a box on the streets of Phoenix and has been there at least 10 months.  Previous to her leaving my home, she had lived with me for a year. It was one of the nicest years we had spent with her. She had developed a few close friends, interacted with family again, paid off most of her fines, obtained a job, bought a car, traveled with us, and went to all of her appointments at the court appointed clinic.

     There were two things that I think made the most difference in our daughter’s progress: parental involvement and a longer stay at the mental health hospital initially. Obtaining a lawyer and gaining temporary guardianship was the first step in being able to be more involved in her care. Additionally, the longer stay at the psychiatric hospital allowed her to be evaluated thoroughly, stabilized, and prescribed the correct medication. It was amazing to see the difference in how she interacted with us and life in general following her hospital stay. Previous stays in the hospital had been so short (3-7 days) resulting in her return to the streets.

     What failed? Why are we back where we started over a year ago? I believe when a medication change took place through her clinic there was a set-back in her mental health at that time and her desire for meth increased. We (her legal guardians) once again admitted her to UPC due to psychotic behavior. She was then sent to a different hospital and there they changed her medication again rather than prescribe what she had previously taken successfully a year before. I believe if she had gone back to the same hospital and seen the same doctor, she would be in a different place now. Long term care offers a chance to stabilize and seeing the same doctor offers consistency in care. The out-patient clinics primarily serve as dispensaries of meds, not in-depth evaluation and continued care.  When we sought to renew guardianship, this process was dead on arrival because our paperwork had to be completed by a psychiatrist. All of her appointments at her court ordered clinic had been with the equivalent of a PA.

      We must increase the number of secure, mental health hospitals. Current numbers are grossly inadequate. The length of hospital stays must increase for the seriously mentally ill allowing time for proper evaluation, stabilization, medication, and a proper post hospital plan.   We need supervised housing for the SMI once released from the hospital as a protection for the patient, family and the general public. Currently, many SMI patients find housing in drug rehab settings which are not set up for the SMI population. Others return to the street or with family who are not always equipped to provide adequate supervision and support.

     For change to take place, we must not view mental illness/addictions any differently than we do someone with dementia, Alzheimer’s disease, autism, or delayed mental functions. We make sure that they are in a safe environment and decisions are made with their best interest at heart. The SMI are being neglected and not receiving the help they so desperately need. Just walk around downtown Phoenix to see how many of the SMI are living. We take care of stray dogs better than these precious human beings.

     I hope our daughter can soon get the help she needs before it is too late. We have lived the nightmare and I have only shared a brief summary of this past year, not the previous twenty years.

Anonymous Parent (in order to protect my daughter’s privacy)

 

These are the families that ACMI advocate for. They are the most vulnerable.

Thank you for attending our online webinars; if you missed it, you could find the webinar and slides on our website. You will need to create a free account to view the webinars and downloads.

Who Are We Treating (And Not Treating) And Why?

By Dr. Michael Franczak of Copa Healthcare on Population Health trends in Maricopa County. He brings decades of experience into the conversation.

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ACMI upcoming webinar:

Come learn from Dr. Carol Olson M.D., DFAPA, Chair, Psychiatry Department, Valleywise Health System

Date: February 24th, 6-7 PM MST

Time: 18:00-19:00

Register in advance for this meeting:

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After registering, you will receive a confirmation email containing information about joining the meeting.

Certificate of attendance by Copa Health available.

Crisis Evaluation
Psychiatric evaluation and diagnosis

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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People with SMI on the streetsImage by Geesling photography -SMI people on the streets of Phoenix

Linda Mimms initially shared this article via social media. This article is a brilliant take by Dr. Rob Laitman on what it costs our society monetarily and, more importantly, our humanity. Failure to appropriately treat people with mental illness disorders is caused by not meeting people’s treatable medical brain disorders, in addition to multiple other factors. We have been violating the CIVIL RIGHTS of this neglected group of sick citizens who have needed treatment for decades with disastrous results. The family and community burden is one of these many disastrous outcomes. These members’ lives with serious mental illnesses are often 25 years shorter than the rest of the population. Jails and prisons are treating (though inadequately) our sickest society’s members using our criminal system as an alternative to a therapeutic environment.  They have become a de facto significant psychiatric provider in this punitive setting. We continue to treat the behaviors of mental illness as criminal acts.

Charles Goldstein, MD

  “The more I look into the horror of our healthcare system, the more outraged I become. Let me give you some perspective as a nephrologist (kidney specialist). End-Stage Renal Disease (ESRD) is the only medical diagnosis that automatically qualifies you for Medicare. Currently, there are 468,000 ESRD patients in the USA. The average expenditure per patient per year is $150,000. The total cost is 70 billion dollars. Employment in ESRD patients is 20% employed to age 55 and less than 3 % thereafter. Now let us look at the psychotic spectrum disorders representing 2% of the population (1 % schizophrenia spectrum and 1 % bipolar with psychosis). This percentage represents 6,620,000 individuals. If we were to support their medical needs fairly and comparably, we would be willing to devote 1 trillion dollars just for their care.

   So what do we spend? When it comes to direct patient care for schizophrenia, the most recent estimate from a 2016 study was 37.4 billion. If you were to assume that the cost of taking care of someone with bipolar with psychosis was similar (actually, we know it is substantially less), the cost would be about 75 billion. Essentially we are only spending less than 1/10 for our patients with psychosis medical care than we have already decided would be appropriate in the ESRD population.

   What is even more outrageous is this lack of support leads to tremendous non-direct healthcare costs, including law enforcement, homeless shelters, and productivity losses of both the patients and the caregivers. Specifically, for schizophrenia, unemployment cost was 59.2 billion, and caregiving was 52.9 billion.

   What drives this tremendous disparity in resource allocation starts with the nihilistic belief that psychotic spectrum disorders are not treatable. Why should we devote resources to a hopeless population? Another component is that 50 % of this population has anosognosia, and therefore does not feel that they need treatment. Given the current status of the laws that “protect” patient’s rights, such as HIPAA and the underutilized and underpowered AOT laws, it is impossible to engage the patient even to start an effective treatment. Where we are right now is less than 50% of all patients with psychosis receive any care. The biggest psychiatric providers are the LA jail, Cook County jail, and Rikers Island jail. It is estimated that 20-40% of the prison population has a psychotic illness. The ever-growing homeless population also has been found to have a similar % of serious mental illness. At present, in those receiving treatment, only 14 % are in meaningful recovery.

   The question is, what are we doing wrong, or is this just a hopeless population? What does the evidence say? As it turns out, there is increasing evidence that early identification of prodromal high-risk individuals can be identified, and by working on their processing speed (REM) the development of the full-fledged psychotic disorder can be aborted. Even after the development of psychosis, early treatment with the most effective treatment and wrap-around social services can change the trajectory of the illness. This is being demonstrated impressively with the Recovery After Initial Schizophrenia Episode (RAISE) study.  Remarkably,  the VA has shown that if patients are switched to clozapine, there is a savings of over $ 20,000 accrue per patient-year initially, and as monitoring becomes less, that saving grows. Switching to clozapine has also led to the best survival, the lowest hospitalization rate, and the best quality of life.  In my hands, I have demonstrated what is possible with optimal clozapine care. 75/103 of my patients treated over six months are in meaningful recovery. I define meaningful recovery as being in school, work, or a PROS program training to work. Hospitalization and, therefore, the cost of care has been minimized. In over 330 patient-years of care, there have been only 1.3 years of hospitalization. This translates out on average 1-2 days/year in the hospital. Medical compliance has been over 90% in those that have been successfully engaged, and overall over 98% of the population considers themselves improved with my care.

   So we need to let our legislators know that they are not throwing good money after bad money. We need to have the resources to change the barriers to care. Specifically, we need a national uniform rational AOT program that gives the provider the ability to treat the patient where the need is demonstrated. Serious mental illness is a team sport, and communication has to be seamless, so we need to reform HIPAA to assure that caregivers are involved in every step of the way. We need to invest in improving access. Taking care of these patients takes a lot of work, and the reimbursement is dismal for the provider. So I return to the ESRD program. For every dialysis patient, the provider is paid a fixed amount for dialysis management. Clozapine is a lot of work and is superior to all other antipsychotics in every setting, and yet only 2% of the population is so treated. We need to invest in these patients and provide a treatment stipend for management. A reasonable fee schedule would be initially $1000/mo for the first six months, $750/mo for the next six months, and then $500/mo after one year. If the patient is hospitalized, the amount should be reduced proportionally to the time spent in the hospital. This is how the ESRD program works, and this carrot has led to superior clinical care. In our population, this small carrot could be a game-changer not only in the quality of care but the end of being a tremendous cost saver. With the cost-saving, we would then be able to devote more resources to all of the appropriate supports.

   In summary, we need to convince the powers that be to devote appropriate resources. We need bravery to insist on rational laws that help engage our patients and families in therapeutic relationships. Our medical professionals need to be re-educated in what is possible and learn the correct approach to treatment. We need to pay adequately for this arduous but rewarding work. If we do this, we will be able to provide an optimal clozapine based regimen with full wrap-around psycho-social services. With this, we will not only end suffering, but we will see a majority of this population lead lives of purpose and meaning.” Robert S. Laitman, MD

ACMI Board

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Arizona State Hospital

 

 

 

 

 

 

 

The Association of the Chronically Mentally Ill is focused on the sickest group within the SMI population. This group is non-compliant with treatment and often afflicted with anosognosia or the lack of ability to perceive the realities of one’s own condition. There are a number of systemic issues within our public systems that impact this target group. One such issue is the 55 bed limit at the Arizona State Hospital, which was created to incentivize the state to create community-based programs. Long past the usefulness of that policy, Josh Mozell’s November 30th, 2020 article in the Capitol Times help to explain some of the fallout of this policy, and the reasons the 55-bed limit should be eliminated.

   Solving the problems of our broken mental health system often seems so overwhelming that work does not begin. However, there are narrow solutions with broad implications that can be implemented. One such solution is ending Arizona’s long-standing bed limitation placed upon our state hospital.

   It may surprise many to learn that Arizona still has an operational mental asylum. Opened in 1887, it is now known as the Arizona State Hospital. The purpose of the State Hospital is and has always been to provide care for the most mentally ill in our community. For many in that group, months, if not years, of long-term programming is necessary for real recovery. That being the case, the State Hospital becomes the only place in Arizona where they have a chance for meaningful improvement.

   However, the hospital is nearly inaccessible for Maricopa County’s residents due to an arbitrary 55-bed limitation. To provide perspective, health policy experts estimate that a community needs between 40 and 60 beds per 100,000 to meet the demand for state hospital beds. In Maricopa County, however, for those who are civilly committed, we have one bed per 100,000.

   Why? In 1981, a path-breaking class-action lawsuit, Arnold v Sarn, was filed on behalf of Maricopa County’s mentally ill. The litigation lasted over 30 years, finally settling in 2014. During that time, the case revolutionized Arizona’s mental health system. But in 1995, the parties entered into a plan to resolve the litigation. In that stipulation, the parties agreed there would be a cap of 55-beds at the Arizona State Hospital for civilly committed patients from Maricopa County. Due to this limitation, the only pathway to gaining admission is to fail repeatedly, in spectacular fashion, and do it for years.

   The failure looks like this: Because this group of chronically mentally ill does not receive the long-term treatment needed, they transition from one crisis to the next, experiencing more serious decompensation. This results in a constant recycling through the various public systems at an enormous cost to the taxpayers. Year by year the person is increasingly overcome by the disease. There are persistent police and fire interactions, multiple visits to emergency rooms, long medical hospital stays, arrests for petty crimes, and, unfortunately too often for serious crimes. Then there is the involvement of the judicial system, homeless shelters, and the penal system. Rinse and repeat – the cycle continues for years. For this group of people, the system is not just broken, but inhumane.

   The bed limitation also has many downstream effects. For instance, those who need access to Arizona State Hospital do not disappear simply because there is not an available bed. Instead, they consume scarce mental health resources, which otherwise could be provided to others in need. The most serious manifestation is in our civil commitment system. To be hospitalized through civil commitment, a patient receives a bed at Valleywise Health, the one hospital system licensed to carry out the process in Maricopa County. The average length of stay during the process is 22 days, and, during those 22 days, the patient receives very good psychiatric care. But, we have just 343 beds in Maricopa County, which is far less than what is needed to serve the population. Due to that bed shortage, our system is already limited in its ability to treat those who need help.

  The Arizona State Hospital 55-bed limit pours gasoline on a fire. To keep the patient and the public safe, Valleywise is often forced to keep the patient for months until the patient stabilizes, without the infrastructure for true long-term treatment. Therefore, despite maximizing the stabilization possible at a short-term hospital, it is not enough. The patient is often back at Valleywise within weeks after release. This routine can continue for years until the patient finally fails enough for State Hospital consideration.

   Commonly, the amount of failing will total 1,000 days or more at Valleywise – in addition to visits to the ER, jail, crisis centers, etc. Therefore, on just one patient who would be most appropriately treated at Arizona State Hospital, 45 patients could receive a 22-day hospital stay at Valleywise. Consequently, the bed shortage is made worse, individuals do not receive care, and scarce state resources are exhausted. This extends the system to the point of breaking, which cannot be sustained.

  Our system is broken in many ways. But again, there are many narrow fixes with broad positive implications which start the process of improvement. This is one of those narrow fixes. The 55-bed cap is a monumental failure – it should be eliminated.

Josh Mozell is a lawyer with Frazer, Ryan, Goldberg & Arnold, L.L.P.

Josh Mozell

ACMI President

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Come hear from Dr. Rosenberg about his insight into America’s mental health crisis. There will be an opportunity to submit questions prior to or during the webinar. Submit questions prior to the webinar at contact@acmionline.com or in the chat feature during the webinar.

Registration in advance for this meeting is required.
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James Lee Carr, Photo courtesy of Maricopa County Sherriff’s office

Last Tuesday my husband called as I dropped our son off at his group home after spending the morning shopping and enjoying coffee together. He wanted to know where we were, and I could hear the unease in his voice. An officer had just been shot outside of a Federal court building in downtown Phoenix and given the recent escalation in violence, I could understand his concern.

We now know that this incident had nothing to do with our current political climate, but it had everything to do with another person with under-treated mental illness that resulted in a violent outcome and a ruined life. James Carr will likely be forgotten and spend the rest of his life in prison. A Federal court officer’s life has been significantly altered.

What can be done to decrease the number of heartbreaking tragedies? We need a laser-like focus on policy and resource efforts toward the gaps in care for those with more chronic forms of mental illness and who are most at risk. This is why ACMI is committed to the following solutions:

  • a person-centered culture (instead of a program-centered),
  • financial & other incentives, based on performance & outcomes, for providers to better serve this population;
  • more Lighthouse- like homes, i.e. community living properties with 24-hours per day and 7-days per week supportive staff inside these properties,
  • humane, well-regulated facilities for a secure residential treatment, involuntary as medically appropriate, for those who need more intensive care for a longer period of time to gain insight and continue their recovery in a less restrictive setting; and,
  • other possible solutions that include increasing capacity and oversight at the Arizona State Hospital.

I will continue to spend every Tuesday with my son who has a chronic mental illness because he is one of the fortunate few whose family has been able to obtain these appropriate and humane levels of treatment and support. Sadly, James Carr’s family will only be able to visit him in prison along with so many other people in this same situation. We must do better in order to prevent these needless tragedies and keep the general public safe.

By Deborah Geesling

ACMI Board

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Courtesy of Healing Minds NOLA September 16th, 2020.

 

     Hello all, on Friday, September 18th, 2020 I watched a presentation by Healing Minds NOLA on the IMD exclusion with Tim Murphy and Teresa Pasquini, moderated by Janey Hays and Eric Smith. This segment focused on the IMD exclusion;  a part of the original 1965 Medicaid law. I encourage each of you to watch this presentation.

    The Institutions for Mental Disease (IMD) exclusion is an outdated, discriminatory federal rule that creates significant barriers to treatment for adults with severe mental illness. Under this rule, Medicaid restricts payments to states for non-geriatric adults (the exclusion applies to individuals aged 21 through 64) from receiving psychiatric care in a treatment facility with more than 16 beds. This limits the ability of states to provide an adequate number of treatment beds for psychiatric illnesses, especially those individuals with severe mental illness.

    Tim Murphy, Ph.D. a psychologist, and former Pennsylvania State Senator and U. S. Congressman, was the primary author of “HELPING FAMILIES IN MENTAL HEALTH CRISIS ACT 2015 HR 2646” (“HFMHCA”).  The HFMHCA requires the Assistant Secretary of Mental Health to focus on improving the most important metrics associated with mental illness and particularly severe mental illness, including rates of suicide and attempts, emergency psychiatric hospitalizations, emergency room boarding, arrests, incarcerations, victimization, and homelessness. The bill dramatically adjusts the threshold to be used in determining the efficacy of programs. It establishes a coordinating committee to advise the Secretary that includes significant representation from criminal justice, a needed addition of an important stakeholder to the national conversation.
Read more at: https://mentalillnesspolicy.org/federalmentalillnesslegislation/hr2646/hr2646narrative.html

   Representative Tim Murphy worked with many families on the HFMHCA legislation.  Unfortunately, the final version of the legislation HFMHCA included measures to repeal the IMD exclusion, but these provisions never made it into the final law. Also left on the cutting room floor was a more precise and transparent definition of “grave disability”.  These are important items for consideration going forward.

 

This webinar is about the IMD exclusion, but it goes much further explaining the history of mental illness, severe mental illness, and many of our behavioral health system’s shortcomings. This video is a straightforward exposition of how our behavioral health system fails people with serious mental illness. I urge everybody to watch it. In addition, Representative Tim Murphy makes a very impassioned plea for advocacy.

 

For this and several more informative webinars, I urge you to visit Janet Hays, Director (Healing Minds NOLA) & Eric Smith (Mental Health Advocate and Graduate Student). They are co-hosting an 8-part series on Implementing a Full Continuum of Coordinated Psychiatric Treatment and Care.

 

   Learn about the IMD exclusion; which is Medicaid Institutions for Mental Disease (IMD) exclusion is an outdated, discriminatory federal rule that creates significant barriers to treatment for adults with severe mental illness. Under this rule, Medicaid payments to states are prohibited for non-geriatric adults receiving psychiatric care in a treatment facility with more than 16 beds.

By Dr. Charles Goldstein

What Is the IMD Exclusion?

   The IMD exclusion is a long-standing policy under Medicaid that prohibits the federal government from providing federal Medicaid funds to states for services rendered to certain Medicaid-eligible individuals who are patients in IMDs (§1905(a)(30)(B) of the Social Security Act [SSA]). When a Medicaid-eligible individual is a patient in an IMD, he or she cannot receive Medicaid coverage for services provided inside or outside the IMD. Due to the exceptions explained in the “Legislative History” section, the IMD exclusion applies to individuals aged 21 through 64. Determination of whether a facility is an IMD depends on whether its overall character is that of a facility established and maintained primarily to care for and treat individuals with mental diseases. Examples include a facility that is licensed or accredited as a psychiatric facility or one in which mental disease is the current reason for institutionalization for more than 50% of the patients. For the definition of IMDs, the term mental disease includes diseases listed as mental disorders in the International Classification of Diseases, with a few exceptions (e.g., mental retardation). (See Centers for Medicare & Medicaid Services [CMS], State Medicaid Manual, Part 4, §4390.) Under this definition, substance use disorders (SUDs) are included as mental diseases. If the substance abuse treatment follows a psychiatric model and is performed by medical personnel, it is considered the medical treatment of mental disease.

   However, even with the IMD exclusion, states can receive federal Medicaid funding for inpatient mental health services for individuals aged 21 through 64 outside of an IMD. States can provide Medicaid coverage for services rendered in facilities that do not meet the definition of an IMD, such as facilities with 16 or fewer beds and facilities that are not primarily engaged in providing care to individuals with mental diseases. https://fas.org/sgp/crs/misc/IF10222.pdf

 

 

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