I'm writing my story in hopes that it will inspire others to share their story. I don't know if there is a "book" in everyone but I know for certain there is a story in there. I encourage you to share your story of overcoming some of life's challenges. Someone needs to hear what you have to say. They are waiting!
Haslam may submit Medicaid expansion plan in fall
Tom Wilemon, firstname.lastname@example.org and The Associated Press
1 day ago
Larry McCormack / File / The Tennessean
Gov. Bill Haslam said Thursday that the state may soon submit a proposal to Washington to expand Tennessee’s Medicaid program but did not release any new details on how it might work.
The Depression and Bipolar Support Alliance (DBSA) is the leading patient-directed national organization focusing on depression and bipolar disorder. The organization fosters an environment of understanding about the impact and management of these life-threatening illnesses by providing up-to-date,
scientifically-based tools and information. DBSA supports research to promote more timely diagnosis, develop more effective and tolerable treatments and discover a cure. The organization works to ensure that people living with mood disorders are treated equitably. Assisted by a scientific advisory board comprised of the leading researchers and clinicians in the field of mood disorders, DBSA has more than 750 peer-run support groups across the country. Nearly two million people request and receive information and assistance each year. DBSA’s mission is to improve the lives of people living with mood disorders. For more information about DBSA or depression and bipolar disorder, please visit www.DBSAlliance.org or call (800) 826-3632.
Allen Doederlein, President, DBSA
Steve Brannon, State Director, DBSA Tennessee
Healthy Lifestyle May Buffer Against Stress-Related Cell Aging
UC San Francisco Study Suggests Healthy Diet, Sleep and Exercise Can Mitigate Negative Impacts of Stress
Newswise, July 24, 2014 — A new study from UC San Francisco is the first to show that while the impact of life’s stressors accumulate overtime and accelerate cellular aging, these negative effects may be reduced by maintaining a healthy diet, exercising and sleeping well.
“The study participants who exercised, slept well and ate well had less telomere shortening than the ones who didn’t maintain healthy lifestyles, even when they had similar levels of stress,” said lead author Eli Puterman, PhD, assistant professor in the department of psychiatry at UCSF. “It’s very important that we promote healthy living, especially under circumstances of typical experiences of life stressors like death, caregiving and job loss.”
The paper will be published in Molecular Psychiatry, a peer-reviewed science journal by Nature Publishing Group.
Telomeres are the protective caps at the ends of chromosomes that affect how quickly cells age. They are combinations of DNA and proteins that protect the ends of chromosomes and help them remain stable. As they become shorter, and as their structural integrity weakens, the cells age and die quicker. Telomeres also get shorter with age.
In the study, researchers examined three healthy behaviors –physical activity, dietary intake and sleep quality – over the course of one year in 239 post-menopausal, non-smoking women. The women provided blood samples at the beginning and end of the year for telomere measurement and reported on stressful events that occurred during those 12 months. In women who engaged in lower levels of healthy behaviors, there was a significantly greater decline in telomere length in their immune cells for every major life stressor that occurred during the year. Yet women who maintained active lifestyles, healthy diets, and good quality sleep appeared protected when exposed to stress – accumulated life stressors did not appear to lead to greater shortening.
“This is the first study that supports the idea, at least observationally, that stressful events can accelerate immune cell aging in adults, even in the short period of one year. Exciting, though, is that these results further suggest that keeping active, and eating and sleeping well during periods of high stress are particularly important to attenuate the accelerated aging of our immune cells,” said Puterman.
In recent years, shorter telomeres have become associated with a broad range of aging-related diseases, including stroke, vascular dementia, cardiovascular disease, obesity, osteoporosis diabetes, and many forms of cancer.
Research on telomeres, and the enzyme that makes them, telomerase, was pioneered by three Americans, including UCSF molecular biologist and co-author Elizabeth Blackburn, PhD. Blackburn co-discovered the telomerase enzyme in 1985. The scientists received the Nobel Prize in Physiology or Medicine in 2009 for their work.
“These new results are exciting yet observational at this point. They do provide the impetus to move forward with interventions to modify lifestyle in those experiencing a lot of stress, to test whether telomere attrition can truly be slowed,” said Blackburn.
Co-authors include senior author Elissa Epel, PhD, department of psychiatry, Jue Lin, PhD, department of biochemistry and biophysics, both of UCSF and Jeffrey Krauss, MD, division of physical medicine and rehabilitation at Stanford University. Lin, Epel and Blackburn are the co-founders of Telome Health Inc., a diagnostic company measuring telomere biology.
The study was supported by the Baumann Foundation and the Barney & Barbro Foundation. Puterman is supported by the National Heart, Lung and Blood Institute of the National Institutes of Health.
UCSF is the nation’s leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and two top-tier hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. Please visit www.ucsf.edu.
Source: University of California, San Francisco (UCSF)
Exciting news is always welcome. One of our own steps out to bring national attention to those suffering due to lack of medical healthcare coverage. Links to articles in The Tennessean and USA Today are below.
The NBC Today show asked to interview Larry and Linda. The interview is expected to happen today. Airing of their interview is expected some time this week. Let's all send our best wishes and thoughts to this couple as they do all that they can to see that no one else needlessly suffers in like fashion.
Links to Larry and Linda's story:
Decision on Medicaid Expansion holds coverage for many Tennesseans in balance
By Kristi Nelson
Posted June 2, 2013, updated June 4 2013
It was supposed to be one of the strongest tenets of the 2010 Patient Protection and Affordable Care Act. Instead, it became a political football, a metaphor for states’ rights. After the Supreme Court ruled that the ACA could not force states to expand Medicaid, Gov. Bill Haslam was among those who rejected the Medicaid expansion, instead offering his alternative “Tennessee Plan” for federal government approval.
But whether the federal government and the General Assembly will accept Haslam’s plan remains to be seen, along with how well it will work to cover those who currently don’t have health insurance.
“He’s either politically brilliant, or he’s making one of the worst mistakes he could make,” Rep. Joe Armstrong, D-Knoxville, told the News Sentinel in March.
What the ACA intended
Originally, the Medicaid expansion provision was to give state health insurance coverage to a group of people who made too much to qualify for Medicaid but too little to afford insurance on the health insurance exchanges, even with the planned government subsidies.
It expanded Medicaid to qualify people younger than 65 whose income is below 138 percent of the federal poverty guideline (a little more than $15,860 annually for an individual, a little less than $32,500 annually for a family of four).
It meant that, for the first time, low-income adults who don’t have children could get state Medicaid coverage, and it standardized other qualifications.
Many states, including Tennessee, limit Medicaid enrollment to certain categories of people. To qualify for TennCare, for example, you have to be low-income and pregnant, a child, blind, disabled, aged, or fall under multiple, specific categories.
Tennessee has nearly 1 million uninsured residents, of whom at least 140,000 and maybe more than twice that number, by some estimates, likely would enroll in Medicaid if it were expanded under the ACA guidelines. About three-quarters would have been previously uninsured. Under the ACA expansion, the federal government would pick up the entire cost of new, previously ineligible enrollees for the first three years, phasing to 90 percent by 2020. In Tennessee, federal funds would have amounted to about $1.4 billion in the first year alone.
States could receive federal matching funds for covering additional low-income residents under Medicaid as early as April 2010, with wide-scale enrollment beginning this October and coverage starting Jan. 1, 2014. However, in June 2012, the U.S. Supreme Court ruled that the federal government could not make states expand Medicaid — making a linchpin of the ACA optional.
So far, 20 states have moved forward with Medicaid expansion. Ten have rejected it outright, while 10 others are not doing it now but are looking at alternatives and have not ruled it out for the future (the government gives no deadline, though states waiting much longer to decide stand to lose federal funds for the first year). Three states are still undecided, while seven — including Tennessee — are crafting their own, alternate plans.
On March 27, Gov. Bill Haslam announced that Tennessee would not expand TennCare rolls under the ACA, instead offering up an alternative he called the Tennessee Plan.
“I don’t think just pure expanding of a system that we all agree is too costly for us, is too costly for the federal government to afford long-term, is the right way,” he said then.
The ‘Tennessee Plan’
Haslam’s proposal is that the state use federal funds not to expand TennCare but to purchase private insurance through the insurance exchange for people who would have qualified for coverage under Medicaid expansion.
He outlined the proposal in the broadest terms, including five “key points”:
Individuals identified as being eligible for the Medicaid expansion group would instead be directed to the exchange, where they would be allowed to choose any qualified health plan that offers a certain level of benefits (the Silver Plan).
The state would pay the monthly premiums, matchable with 100 percent federal dollars, for those people to enroll in the Silver Plan.
People in the Medicaid expansion group would be treated like all other people enrolled in the Silver Plan, with access to the same benefits and appeals process as other people in the plans.
People in the Medicaid expansion group would have the same cost-sharing as other Silver Plan enrollees with incomes below 250 percent of the federal poverty guidelines. (On average, Silver Plan policies would pay for 70 percent of health care costs, with the remaining 30 percent paid by the planholder.)
The arrangement would have a “circuit-breaker,” or “sunset,” ending after the three-year period of 100 percent federal matching dollars, and could be renewed only with approval of the General Assembly. (This is true for states accepting the Medicaid expansion as well; they can stop using federal funds and drop the expanded coverage at any time.)
In addition, Haslam would seek to reform the way providers are paid for services, with payment based on outcomes rather than a set fee for services. The money saved, he said, would be enough to cover the state’s 10 percent share of costs after the government’s share goes to 90 percent.
“One option for covering the Medicaid expansion group is simply to add them to the Medicaid rolls, or the TennCare rolls, in our case,” Haslam said of the plan. “We don’t want to do that. There are a lot of federal requirements that come with Medicaid that make it difficult to provide quality care in the most cost-effective way possible.”
But the federal government may not allow Haslam to forgo some of those requirements. While national Centers for Medicare and Medicaid Services guidelines indicate that the main tenets of the plan — using federal dollars to pay premiums for low-income people to have commercial insurance, and reforming payment — meet federal requirements, some of the details don’t align with federal requirements intended to protect Medicaid enrollees.
For example, Tennessee would need to give those with serious health conditions a choice of enrolling in TennCare or private insurance, unless CMS were to grant Tennessee a waiver to that requirement.
The federal government would require supplementation of benefits (sometimes called “wraparound”) to make sure the commercial insurance plans include all services that would be available through Medicaid. Hypothetically, this could be done through a supplemental premium to the Silver Plan insurance provider.
The government also limits co-payments for Medicaid-eligible enrollees.
There is also an appeals process in place, required by past Supreme Court rulings, so that Medicaid patients and their doctors can challenge insurance companies’ refusals to cover “necessary treatments.” Under federal law, Tennessee would have to allow Medicaid-eligible patients this due process.
A federal entitlement program, Medicaid was designed for a population upon whom “poverty imposes special needs and the need for special protections,” said Carole Myers, a nurse practitioner and associate professor in the University of Tennessee’s College of Nursing. “They don’t have the same voice in government as those with different economic statuses and organizational affiliations.”
Haslam acknowledged in April that Tennessee probably would have to limit co-payments and provide the wraparound services for Medicaid-eligible enrollees for the federal government to approve his alternative, but he said he still thinks his overall plan is “workable.”
Haslam’s plan is modeled on a plan by Arkansas, which also wants to use federal matching dollars to pay commercial insurance premiums for those eligible for the Medicaid expansion. But while Arkansas got legislators’ approval before approaching the federal government, Haslam has taken the opposite approach, presenting his plan to CMS first.
Haslam did not ask state legislators to vote on whether to take the federal Medicaid expansion funds this session, though he said he has not ruled out calling a special legislative session later this year to meet federal deadlines for the health exchange enrollment starting in October.
The Medicaid expansion is the only provision in the ACA that provides insurance coverage specifically to those between 101 percent and 138 percent of the federal poverty guideline. If Haslam fails to reach an agreement with the federal government, or does not opt to accept the federal Medicaid expansion plan (which he could still do), that population likely would remain uninsured.
However, the latest word among hospital executives and advocates is that an agreement could be near.
“I think (Health and Human Services) Secretary (Kathleen) Sebelius is really eager to find some alternative plans that meet the goals of the ACA but do so in creative ways and allow states to create plans beneficial to those individual states,” said Jerry Askew, senior vice president for governmental relations for Tennova Healthcare.
Through Tennova’s parent company, Health Management Associates, Askew works with hospitals in seven states. All of them, except those in Kentucky and West Virginia, have said no to the expansion.
“They’re all trying to figure out what to do. It’s really interesting to watch how the state is to meet their individual objectives,” Askew said. As for Tennessee, he added, “It is fair to say that the governor’s plan is being built on principles that the majority in the Legislature would agree with. But it’s not a given. It’s a lot of hard work.”
Consumer-advocate groups and hospitals were in favor of the expansion, especially since hospitals stand to lose money on uncompensated “charity” care that would have been partially covered, at least, if more people were insured through Medicaid. The Tennessee Hospital Association has said the state stands to lose 90,000 jobs and nearly $13 billion.
Having that population continue to go uninsured also means higher costs in the long run, Myers said, as studies have shown that those without insurance are less likely to get preventive or early care.
“When you are resorting to getting care only when it becomes so bad you can’t stand it, and you’re in the emergency room, it’s causing a major human toll,” she said. “We know that intervention on the earliest point of the illness trajectory is the most cost-efficient. The true measure of whether we’re successful in what we’re doing in health care is in whether people have long, happy, productive lives.”
Business writer Carly Harrington contributed to this report.
© 2013, Knoxville News Sentinel Co.
The death of the Murphy Bill: On being the national spokesman
The Murphy Bill as we know is dead. The Republican leadership in the House announced a change in strategy. They basically decided to toss in the towel on the more controversial parts of the plan and try to see if they can move forward on elements that seem to have a greater consensus behind them. There may be CPR efforts yet but it appears done.
It was a bill in trouble from the start despite the massive pr campaign that tried so hard to say it wasnt so. It managed to unify groups that might not agree on what kind of reforms they wanted, but were absolutely sure what they didnt want and that was the Murphy Bill.
Part of the problem was Murphy himself. He assumed that as "the only psychologist in Congress" he was the obvious and deserved national spokesman for mental health reform. He wasnt. Being a psychologist certainly didnt qualify for the role. Neither did being a member of the House of Representatives. It seemed that Dr. Torrey annointed him and for some reason they both thought that mattered. In the end it was hard to know where he started and Dr. Torrey ended and that was perhaps a fatal flaw.
He didnt understand that leadership was built or that it was a two way street. He alienated people who had lived mental health reform their entire adult lives. He thought it was about them joining him and never seemed to know it was the other way around. And he never realized that trust was everything and that when he snuck AOT into the medicare bill he destroyed his chances of trust with people whose support he needed.
He was naive. The only people who believe federal laws change everything are federal lawmakers and most of them know better. To say that his law was going to prevent the next shooting was simply ego. He believed his own press clippings and his posturing before the dead were even buried just seemed like rank opportunism.
Mental health reform is an ongoing effort by many, many people with different values and priorities. Sometimes it is its own worst enemy. People who cant stand each other have a hard time standing together for anything. Murphy I hope has to some degree taught people they can find unity despite their differences. And maybe the fragile unity borne of him will be the biggest take-away from the entire thing.
He may indeed try again. He probably will. Dr. Torrey most surely will. He has won many, many short term victories and will doubtless win more, but the big prize has eluded him again. He is not the national spokesman he has annointed himself to be either.
Thanks for the support
by Larry Drain, hopeworkscommunity
The following organizations have offered support of "Dear Governor Haslam". They have put links to this site or printed the letters on their websites. I really appreciate it. I invite you or your organization to do the same.
Tennessee Health Care Campaign.
Tennessee Citizen Action.
Tennessee Disability Coalition.
Tennessee Chapter Depression and Bipolar Support Alliance.
WRITE GOVERNOR HASLAM TODAY
hopeworkscommunity | June 1, 2014
Gun Violence Killed At Least 80 People The Week Prior To Elliot Rodger's Rampage
Sam Stein, Jason Cherkis05/28/14 12:00 AM ET
WASHINGTON --The Memorial Day weekend saw a community eviscerated by gun violence that left several dead and many more injured. But it wasn't UC Santa Barbara that witnessed this particular round of bloodshed. It was New Orleans. By weekend's end, the city had seen 19 people shot, four fatally. On Friday, a fight broke out at a high school graduation party that resulted in one person being killed and seven wounded. On Sunday, three men were shot with an assault rifle. That night, a murder took place at a Cajun seafood joint. On Monday morning, a triple shooting happened right outside a hospital, where people sitting in a car were hit with bullets in their backs, arms and legs. All survived. That same day, a 17-year-old died after being shot multiple times. Even earlier, a man riding his bike was shot under an overpass. The day ended with ahomicide in the Lower Ninth Ward. Outside of New Orleans, the U.S. was pocked with bad news. In the week prior to Elliot Rodger's shooting spree in Isla Vista, there were at least 80 gun-related deaths across the country, according to a Huffington Post analysis of local news reports. That these shootings failed to garner the national attention that the one in Isla Vista did shouldn't shock anyone who has followed the gun control debate. High-profile instances of gun violence are more likely to grab the spotlight than the everyday scourge of gun-related killings. And certainly, the shooting of three (and stabbing of three others) by the 22-year-old son of a Hollywood director who happened to leave a dark, depressing trail of self-made YouTube videos qualifies as high-profile. But instances such as the one at UC Santa Barbara are rare in respect to gun-related homicides. In fact, FBI data shows that there were 900 people who died in mass shootings from 2006 through 2012. By contrast, firearms were used in 11,078 homicides in 2010 alone,according to the U.S. Centers for Disease Control and Prevention. And for those on the frontline of the gun control debate, it's a bit of a head-scratcher as to how the press tends to cover instances of violence. "There's a grim calculus in the heads of journalists about what makes a shooting newsworthy," said Mark Glaze, executive director of the Bloomberg-backed Everytown for Gun Safety. "The total number killed and injured tends to be variable one. The role of young people as perpetrators or victims is a close number two." Glaze argued that press coverage was actually becoming more comprehensive, with reporters "actually paying more attention to the 33 daily gun murders in America than they did five or 10 years ago." That may be true. But, unlike with Rodger's killing spree, there was no national news coverage for the killings in New Orleans. Indeed, unless the shooting involved an athlete or a TV star, the only media that covered gun-related killings the week before Rodger took up arms was in the communities affected. Below are the local stories that The Huffington Post found from the week prior to Rodger's rampage. Alabama:
Why Can’t Doctors Identify Killers?
When you strip away all the fancy words and the tons and tons of rhettoric about what the Murphy Bill says and simply ask yourself "What is the plan?" you get a few core ideas. What does Rep. Murphy think we actually need to do to serve the severely mentally ill? There are many other provisions of the bill that has nothing to do with what I am about to talk about. Many of them are the most positive features of the bill. But this is what I think the essence of the Murphy plan is. These are his bottom lines. These are his "new ideas."
He believes, in effect, that many of the severely mentally ill suffer from a defiency of psychiatric hospitalization. He seems to see that as the answer to so many people with "mental illness" being in jails and prisons. He thinks that way too many hospital beds are gone and it is time to increase hospitalization radically.
Perhaps I am wrong but I believe that ship has sailed. A mental health system with psychiatric hospitalization as its corner stone is not financially sustainable in this country. Insurance companies pay less and less for it. They do not see it as medically necessary but in the most extreme circumstances and then for brief periods of time. In Tennessee I believe most psychiatric hospitals are struggling to break even and most of them are losing that struggle. States are getting out of the business. They realize that a large hospital system leaves them unable to finance a community system and if you dont have a community system to serve the people coming out of the hospital what is the point of the hospital. If you look at how often and how quickly people leaving the hospital system end up back there you begin to realize the impact of disemboweling the community system. I cant even imagine the circumstances under which Tennessee would act to increase the beds in any kind of dramatic way, indeed in any way at all. It is far too little bang for way too many bucks.
His method for making psychiatric hospitalization possible is to remove the IMD exclusion on medicaid funding. Basically it makes it possible for medicaid to then pay for state psychiatric hospitals. One question comes to me immediately. If Congressman Murphy thinks that medicaid funding is such an important part of mental health reform why did he vote to repeal the ACA over 50 times? That bill through its provisions for medicaid expansion would have given millions of people with "mental illness" access to programs and services that if he has his way they will never access.
A couple of other questions come to mind. What about the people who dont have medicaid access? Many people with "mental illness" and particularly many people who are having serious problems in life simply dont have insurance. Another question is the response of states to finding out now that medicaid funds can pay for psychiatric hospitals. In most states that I am aware the medicaid program eats up a considerable portion of their state budget and I really question, particularly in the states that choose not to expand medicaid, how receptive they will be to finding out that medicaid expenses are about to soar through the roof. In Tennessee the most likely two responses are to adopt the private insurance definitions of medical necessity and decide not that many people need hospitalizations and/or cut benefits and provider payments to pay for any any expenses the increase in hospitalization is likely to cause. The provider rates for psychiatric care, at least in Tennessee, are so low that very few people will even provide services anyway and there is a serious real question about where the professionals to do all this treatment are to come from.
Even if you start to use medicaid funding it does not begin to pay for all the new costs. The state institutions in Tennessee for example are aging. There is a need for new buildings and new spaces if beds are added. Who pays for new hospitals?? What about the cost of new staff?? Who pays? I can only speak to Tennessee but there is no commitment to psychiatric hospitalization, especially on a massive scale, as the answer to anything by state officials, by mental health professionals. by anyone that I know and removing the IMD exclusion is unlikely to change that. The strong perception is that the community system is the most cost effective and effective means to help people meet their needs and that it is defiencies in that system that lead most to people falling through the cracks.
And even if it was possible would it work?? I know of no evidence, that other than providing a place for stabilization, that psychiatric hospitals work in any enduring fashion. They dont, if you look at return rates, even work well enough to keep people out of psychiatric hospitals.
I dont know but would be willing to hazard a guess that many of the "mentally ill" in the prisons and jails have had considerable psychiatric experience with little or no solid gains. Criminal behavior is not a symptom of mental illness and the "put them in the hospital" solution ignores things like poverty, drug addiction, racism, lack of work, homelessness and history of trauma and other adverse events that lead to someone actually committing criminal acts. The other thing to consider is not the degree to which "mental illness" causes criminal behavior but the extent to which incarceration causes "mental illness." Is treatment needed?? Are mental health resources needed and might for some people those resources be inpatient resources??? Of course. I wonder what percent of those people in jail would even meet the criteria for hospitalization?? I dont know the answers but tend to believe it is the lack of effective and accessible community resources that engender emotional involvement with the people they serve that is the root of the great numbers of "mentally ill" in jails and prisons.
Another core point of Murphy is that he believes that too many people get mental health services and that it is the "worried well " that are basically stealing resources that are better used by the severely mentally ill. Given the fact that most mental health systems have been starved and cut back over the last few years it seems a little like telling one person eating bread and water that the the person next to him is eating too much bread and water and not considering that the problem is the diet of bread and water. It is an argument of little integrity that resorts to an us vs. them argument as a pseudo explanation. It ignores totally the fact that state legislature after state legislature has sacrificed their mental health system on the fires of "financial responsibility" over the last few years.
There are without question people who are victims of a psychiatric system eager to diagnose every event in life as an enotional illness. There is a reason that pharmaceutical companies make money. But there are also people who struggle every day with serious mental health issues, trauma, and distress and to dismiss those people as dupes or malingers is stupid, dishonest and evil. If you think the biggest problem in the mental health system is that too many people need or are seeking help then you are a simple minded person not worthy of being taken seriously.
If you take the notion of "worried well" seriously it takes you to some strange places. How do you decide who is "worried well"? Who decides? Based on what criteria? What do you do to the "worried well"? Do you limit their access to services? How? How much and why? If you dont limit their access to services arent you being complicit in the people who need help being hurt?? And how much is all this going to cost?? Do we need programs to make sure that people who need services get them and another program to make sure those that dont are kept out. This is a treacherous notion that if you take serious leads to nightmares.
Another core notion is making assisted outpatient treatment a law in every state. They tell you that aot is a major problem solver but dont really explain why most of the 45 states that have it dont really use it. And they dont really explain why you need to make something a federal law that is already a state law. And they dont really explain why if 45 states can choose to have it 5 states cant.
I think the truth is that most states who are not willing to throw $32 million a year at it like New York find it more irrelevant than anything. It costs too much and does too little and in an environment of increasingly limited resources is not something that a lot of people are going to turn to to solve many things. And none of this even begins to touch on the questions of choice and coercion that so many people find so fundamentally troubling.
Another core notion of the Murphy Bill is that too many people complain about the human rights of people in the system being important and those people need to be quiet. It would basically eviscerate the protection and advocacy programs like Paimi and legislate away their voice. The idea that people in the system dont need protection is naive and self serving and something you might figure a psychologist or psychiatrist might come up with. Ask anybody in the system. See how safe they feel in the system.
The final key element is to do away with the notion of recovery and the best way to do that is to cut the legs out from under Samsha. Samsha is as close to a boogeyman as there is in this play. They are blamed for everything bad that has happened or will happened. The fact that thousands of people have found recovery to be a real thing is explained away by saying they probably didnt need help anyway or that they are in a remission that would have happened anyway regardless of what they did. If you dont like what you see it works really well to convince yourself that it was really something else.
Samsha is blamed for many things it doesnt decide about. The state of Tennessee decides what kind of services it will offer the people it serves....not Samsha.
Like I said at the start there is more to the Murphy Bill than what I have described here. He took a lot of peoples good ideas and made them part of his bill. None of them seem though to be core elements that define the bill and that is a shame. He has told people he will work with them on a better bill but no one knows what that means because he has compromised on nothing. I have been told by a lot of people I know that is bill is in trouble and very unlikely to be passed as written. I dont know how true that is, but know it is in everybodies best interest to know the bottom lines of what he proposes and decide what that means for them and the way they would like to see the mental health system change.
hopeworkscommunity | May 16, 2014
TMHCA is, once again, excited to announce an upcoming FREE WRAP® “refresher” course in Nashville, Tn. This training is funded by TDMHSAS.
Location: TAADAS Conference Room
1321 Murfreesboro Pike
Nashville, Tn.; Office 155 37217
COURSE DESCRIPTION: The WRAP Refresher Course is a three day, interactive course co-facilitated by TMHCA Advanced Level WRAP® Facilitators. The primary purpose of this Course is to sharpen & expand facilitation skills to further engage students in Wellness Recovery Action Planning.
Through attendance in this course, WRAP® Facilitators will:
1. Recognize expanded options on how to give group introductions.
2. Identify additional knowledge areas, Values & Ethics of WRAP®
3. Apply new skills to sharpen & expand group facilitation skills.
4. Develop new, creative approaches to Facilitation to accommodate participant challenges & different group needs.
The Copeland Center strongly recommends that WRAP® Facilitators attend a Refresher Course @ least every two years to stay up on new developments and best practices.
If the mental health system was sane…
There would be a range of services availible reflecting the human needs of those it serves.
Those services would be availible to those that need them.
Those services would be based on what works, not what makes money, reflects any particular philosphy or interest, and not because it is what we are used to doing.
Asking for help would not label someone, brand them, be a cause of shame, a source of discrimination. Asking for help should not be a problem.
It would realize that lack of a place to live, lack of food, lack of adequate clothing, lack of a job are frequently barriers and problems for the people they serve and address them in a direct and effective manner.
It would know that inadequate health and inadequate health care are common problems for the people they serve and be part of an effort to serve the entire person in an integrated fashion.
The goal would be to empower, educate, and support people towards gaining control over their lives so as to maximize their chances of leading happy, meaningful and successful lives.
This would not be empty words, but a passionate conviction that fuels and structures everything done in the system.
It would not mistake the people it serves for the labels it places upon them.
It would know that the most important thing about help is that it is what you do with people and not what you do to them. It would see itself as partnering with the people it serves.
It would know that people can say no and that not be a symptom of illness or distress.
It would view peoples values, hopes, thoughts, and aspirations as a source of strength and not a symptom of illness.
It would take substance abuse ultimately seriously. Drinking and drugging are the two primary ways people with mental health issues try to treat themselves.
It would make sure that one of the core experiences that someone seeking help has is contact and interactions with others who have dealt with similiar issues. It would treat seriously the idea that you can learn from the experience of others and them from you.
It would not tell people who have hard times or more problems they have failed or are failures.
It would take the issue of trauma seriously. Knowing how people have been hurt and not being part of hurting them further should be cornerstones of the system.
It would treat the issue of what happens in jails and prisons to people with mental health issues as a moral outrage and the impulse to do something about it as a moral necessity.
It would be honest about the risks and benefits of psychotropic medication. Help people to make real and informed choices.
It would treat families as important and not as irrelevant or a threat to what it is doing.
It would treat justice as a driving force and value in everything it does.
It would be honest with the people it serves about what it doesnt know if it wants them to have trust in what it does know.
It would attack the issue of suicide with passion. No one should ever feel like death is the best solution to life.
It would tell people that no problems make you less human,
It would view hope as realistic and know that when they dont they do more harm than good.
Target Zero to Thrive This April
DBSA targets raising expectations for mental health treatment.
A month-long social media campaign, Target Zero to Thrive, challenges mental health care professionals, researchers, and individuals living with or affected by mood disorders to raise treatment goals to complete remission—to zero symptoms.
Of course the first priority for treatment is ensuring a person living with depression or bipolar disorder is out of crisis. However, too often the end goal established for successful long‐term care is for the person to maintain a stable mood. Better, or even stable, is not always well. Every person deserves the opportunity to not just survive but thrive, and to do that we need to ensure true wellness is the end‐goal for mental health treatment.
Consider this, successful treatment for cancer proceeds with the goal of removing every cancerous cell—to achieve complete remission. Why then, do we consider treatment for depression or bipolar disorder to be successful when symptoms persist, even if the person is considered to be stable?
The cost of settling for reduced symptoms is simply too great. It is, in fact, a matter of life and death—for when symptoms persist, individuals who have mood disorders are:
DBSA President Allen Doederlein shares, “Living with a mood disorder can damage hope and lower expectations; so a person may not expect or think they deserve a full life. We, as peers, clinicians, researchers, and family, need to help them expect and achieve more—by raising the bar for treatment. Targeting zero symptoms may seem like a formidable goal, but there are over 21 million reasons and Americans living with depression or bipolar disorder to make it a goal worth pursuing!”
(1) Am J Psychiatry. 2000 Sep;157(9):1501-4.
(2) J Clin Psychiatry. 2007 Aug;68(8):1237-45.
(3) Bipolar Disord. 2004 Oct;6(5):368-73.
(4) Psychiatr Serv. 2013 Dec 1;64(12):1195-202. doi: 10.1176/appi.ps.201200587.
Larry Drain, Legislative Liaison for DBSA Tennessee, offers this blog with its many references that provides points for and against the Murphy bill. Please take time to self educate. Larry gives us a good start.
[Children's Mental Health Network
The Morning Zen]
Congressman Tim Murphy introduces controversial Helping Families in Mental Health Crisis Act of 2013
2 Comments | Posted December 15, 2013
On Friday, one day before the anniversary of the Newtown school shooting tragedy and on the same day of yet another tragic shooting at a school in Colorado, Congressman Tim Murphy introduced the Helping Families in Mental Health Crisis Act of 2013, a bill that would effectively rewrite how the Substance Abuse and Mental Health Services Administration (SAMHSA) operates and significantly narrow the focus of the types of mental health services and supports it helps promote through its grant programs. While the bill is at this point just a proposal, it is an important read for Network faithful as it sheds a light on the thinking of many individuals across the country about how to improve mental health services in America. Unfortunately, with the continued tragedies occurring at schools across the nation the tendency to equate guns and violence with mental illness leads to recommended solutions in this bill that are narrow in focus and could potentially set back the advances in the field of mental health 20 to 30 years.
What makes writing this Morning Zen piece difficult for me is that I have the utmost respect for Congressman Murphy. A child psychologist by training, co-author of two books ("The Angry Child: Regaining Control When Your Child Is Out of Control" and "Overcoming Passive-Aggression), it is obvious that Congressman Murphy cares deeply about improving mental health services. For that he is to be applauded. But what is in this proposed bill for the most part is either mystifying or antithetical to what the research tells us works best for young people with emotional challenges and their families. In fairness, at the end of this post I have included links to position statements on the proposed bill from national organizations and thought leaders both for and against the bill. As always, we pride ourselves on providing as many perspectives as possible so that our educated readers can make up their own minds and respond to their elected officials accordingly.
The response from mental health advocates and provider groups both for and against the bill was swift. As is the general approach of the Children's Mental Health Network we took the weekend to read and digest the 135-page bill before making our comments. The list is long so grab a cup of coffee for this one.
The proposed bill is complex in that mixed in with proposals that are administratively bureaucratic, relying on reference resources that in some cases are twenty years old and frankly dismissive of anything outside of the realm of narrowly defined evidence based practice, are some excellent proposals such as continuing funding for the Garrett Lee Smith and National Child Traumatic Stress initiatives.
However, overwhelmingly the recommended changes in the bill set the advances made in knowledge about what works for youth with mental health challenges and their families back a good twenty to thirty years.
Clouding the picture of how to interpret this proposed bill was the timing of its release – on the eve of the anniversary of the Newtown tragedy and on the day of yet another shooting at a school in Colorado, where emotions were already running high and the popular press was flooded with news stories about guns, violence and mental illness. Even though research shows that those with a mental illness are significantly more likely to be a victim of violence than a perpetrator of violence, discussions in Congress about what to do tend to fall too easily into the guns + violence = mental illness equation.
Okay, with all of this in mind as a backdrop for what is in the proposed bill, let’s take a walk through some of the highlights. The 135 page document is one I encourage you to read to get your own sense of its merits and drawbacks. In this post I will focus on some of the key areas that are important to highlight. Page numbers of the bill are cited so that you can read the full text in the copy of the proposed bill that you can download here.
Additional layers of bureaucracy added while diminishing the decision-making role of key SAMHSA personnel (Page 4)
National Mental Health Policy Laboratory (page 7)
The description of the NMHPL goes on to say that "In selecting evidence-based practices and services delivery models for evaluation and dissemination under paragraph (2)(C), the Director of the NMHPL
On page 10 the language continues with "In carrying out the duties under this section, the Director of the NMHPL shall consult with representatives of the National Institute of Mental Health on organization, hiring decisions, and operations, initially and on an ongoing basis; (B) other appropriate Federal agencies; and (C) clinical and analytical experts with expertise in medicine, psychiatric and clinical psychological care, and health care management.
The Children’s Mental Health Network is troubled that there is no mention of youth and family involvement in such a consulting pool, especially with the impressive track record achieved by SAMHSA in cultivating a family-driven, youth guided approach through its system of care grants and cooperative agreements over the past 20+ years.
Interagency Serious Mental Illness Coordinating Committee (page 14)
The responsibilities of this Committee include:
There is a long list of required members for this committee (page 15), including the Director of NIH, the Attorney General of the United States; the Director of the Centers for Disease Control and Prevention and more. Members of the Committee serve 4-year terms and would be required to meet a minimum of two times per year. In addition, the Committee “may establish subcommittees and convene workshops and conferences "to enable the subcommittees to carry out their duties."
And finally, with regard to administrative duties, on page 70 it is noted that the administration of block grants would be removed from the Director of the Center for Mental Health Services and shifted to the Assistant Secretary for Mental Health and Substance Use Disorders. Gonna be one busy Assistant Secretary if this proposal goes through!
I can't help but think that if this plan were to come to fruition there would be bureaucratic gridlock. Two new significant leadership positions assuming key duties of currently existing high ranking officials within SAMHSA and a large Committee with sub-committees to "assist the Assistant Secretary in carrying out the Assistant Secretary's duties" (Page 14). In my mind, this is a huge duplication of duties already ascribed to the SAMHSA Administrator, the Director of the Center for Mental Health Services and others within SAMHSA.
Let's move away from administrative duties to some of the new grant programs proposed, specifically the Assisted Outpatient Treatment Program. The proposed bill calls for up to 50 grants each year for a 4-year pilot program to focus on assisted outpatient treatment programs (Page 19). Each grant would be eligible for one million dollars per year for four years - $15,000,000 per year would be authorized totaling $60,000,000 over the four-year period.
Assisted outpatient treatment is a controversial topic, with some saying it is the best option for an adult with a mental illness who "lacks capacity to fully understand or lacks judgment to make informed decisions regarding his or her need for treatment, care, or supervision." Others, including the Children's Mental Health Network, see this as a potentially dangerous road to travel in that it could have wide-ranging impact on those who might be swept up unnecessarily. You can review both sides of the argument regarding Assisted Outpatient Treatment at the end of this post.
Number of seriously mentally ill who are imprisoned (page 63)
Reducing the stigma of serious mental illness (page 79)
Title XI-SAMHSA Reauthorization and Reforms (page 99)
In addition, it would be required that "Before awarding a grant, cooperative agreement, or contract, the Secretary shall provide a list of the members of the peer review group responsible for reviewing the award to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate." This is yet another opportunity for delay and bureaucratic red tape.
Transfer of all functions and responsibilities of the Center for Behavioral Health Statistics and Quality to the National Mental Health Policy Laboratory (page 102)
Establish a clearinghouse of evidence-based practices (page 106)
Unfortunately there is no mention of consumers, families or youth involved in this review.
Limitations on Authority (page 133)
No financial assistance to any program without evidence-based practices (page 133)
If you have made it this far in this lengthy post you know that this leads back to the question "What is an evidence-based practice and who is involved in deciding that?" From reading the full text of the proposed bill the decision makers are definitely skewed toward the medical community with a strong focus on a narrow slice of the overall population of individuals needing mental health services.
Elimination of unauthorized SAMHSA programs without explicit statutory authorization (page 134)
The proposed bill goes on to say "The Assistant Secretary for Mental Health and Substance Use Disorders shall seek to enter into an arrangement with the Institute of Medicine under which the Institute (or, if the Institute declines to enter into such arrangement, another appropriate entity) agrees to submit a report to the Congress not later than July 31, 2014, identifying each program, project, or activity to be terminated under subsection (a).
So, there you have it. Quite a bit to chew on and I cut this post down significantly. Please take the time to read the proposed bill. Whether it gains traction in the House or not it is important to remember that this proposed bill reflects the thinking of many. If you are concerned about this, as we are, then you might want to consider an education campaign.
Next week we will share our collaborative efforts with Maryland-based mental health providers, adult and youth representatives with experience receiving mental health services, and family advocates and other agency representatives to put together a site visit for Senate and House Appropriations Committee staff to not only show them what a coordinated system of care approach looks like in the effective provision of services and supports for young adults with mental health challenges, but also to provide them the opportunity for one on one dialogue with youth and adults who utilize mental health services, families and the amazingly dedicated professionals who work side by side with them. We began organizing this effort for Senate Appropriations staff as a result of our inquiry into the Healthy Transitions Initiative in August of this year. Senate Appropriations Committee staff have agreed to come and we will be extending an invitation to House Appropriations Committee staff this week. I will give you full details in the Morning Zen post this coming Friday.
What is so important about our education campaign is that it is not focused on one grant or particular service. We are not bringing staffers to a visit to ask for money. We are bringing staffers to a visit to let them experience firsthand the importance of a comprehensive approach to meeting (in this case) the needs of young adults with mental health challenges. Sounds like a systems of care approach to me!
And finally, here is a sampling of different individual and organizational analyses and reactions to the proposed bill, both pro and con. Remember, an educated voice is a powerful voice.
For the proposed bill
Against the proposed bill
Submitted by Jennifer Dochod, Legislative Liasion for DBSA Tennessee. The brief summary by Mr. Murphy's office highlights the points in the proposed Bill he drafted.
for the 18th District of Pennsylvania
Short Summary of The Helping Families In Mental Health Crisis Act (H.R. 3717)
Ensuring Psychiatric Care for Those in Need of Help the Most Rep. Tim Murphy, PhD
Mental illness does not discriminate based on age, class or ethnicity. It affects all segments of society. More than 11 million Americans have severe schizophrenia, bipolar disorder, and major depression yet millions are going without treatment as families struggle to find care for loved ones.
To understand why so many go without treatment, the Energy and Commerce Subcommittee on Oversight and Investigations launched a top-to-bottom review of the country’s mental health system beginning in January 2013. The investigation revealed that the approach by the federal government to mental health is a chaotic patchwork of antiquated programs and ineffective policies across numerous agencies.
Not only is this frustrating for families in need of medical care, but when left untreated, those with mental illness often end up in the criminal justice system or on the streets. The mentally ill are no more violent than anyone else, and in fact are more likely to be the victims of violence than the perpetrators, but individuals with untreated serious mental illness are at an increased risk of violent behavior. Tragically, undertreated mental illness has been linked to homicides, assaults, and suicides.
The Helping Families In Mental Health Crisis Act (H.R. 3717) fixes the nation’s broken mental health system by focusing programs and resources on psychiatric care for patients and families most in need of services. The legislation:
EMPOWERS PARENTS AND CAREGIVERS
What the investigation found:
Physicians are often unwilling to share or receive information with loved ones about an individual who has a serious mental illness and is experiencing a psychotic break because of complicated federal rules on communicating with immediate family members and caregivers. This scenario is especially problematic for parents of young adults with mental illness because psychosis begins to manifest between ages 14 and 25.
Clarifies Health Information Portability and Accountability Act (HIPAA) privacy rule and the Family Educational Rights and Privacy Act so physicians and mental health professionals can provide crucial information to parents and caregivers about a loved one who is in an acute mental health crisis to protect their health, safety, and well-being.
2332 Rayburn House Office Building | Washington, DC 20515
The Helping Families in Mental Health Crisis Act (H.R. 3717), Rep. Tim Murphy 2
FIXES THE SHORTAGE OF INPATIENT PSYCHIATRIC BEDS
What the investigation found:
There is a severe lack of inpatient and outpatient treatment options. Seventy years ago, the country had 600,000 inpatient psychiatric beds for a country half the size. Today, there are only 40,000 beds.
What the legislation does:
Increases access to acute care psychiatric beds for the most critical patients by making two narrowly tailored exceptions to the Institutions for Mental Disease (IMD) exclusion under Medicaid. The IMD exclusion is what originally caused the shortage of psychiatric beds.
ALTERNATIVES TO INSTITUTIONALIZATION
What the investigation found:
Approximately forty percent of individuals with schizophrenia do not recognize they have a mental illness, making it exceedingly difficult for them to follow through on a treatment regimen.
REACHING UNDESERVED AND RURAL POPULATIONS
What the investigation found:
The delay between a first episode of psychosis and the onset of treatment averages 110 weeks. Early diagnosis and medical intervention improves outcomes dramatically, but there is only one child psychiatrist for every 7,000 children with a mental illness or behavioral disorder.
What the legislation does:
Modeled on a successful state project in Massachusetts, the bill advances tele-psychiatry to link pediatricians and primary care physicians with psychiatrists and psychologists in areas where patients do not have access to mental health professionals.
DRIVING EVIDENCE-BASED CARE
What the investigation found:
The federal government spends $125 billion annually on mental health, but there is little interagency coordination on programs, nor does the federal government collect data on how mental health dollars are spent or whether those dollars are resulting in positive health outcomes.
What the legislation does:
Creates Assistant Secretary for Mental Health and Substance Use Disorders within the Department of Health and Human Services to coordinate federal government programs and ensure that recipients of the community mental health services block grant apply evidence-based models of care developed by the National Institute of Mental Health. The Assistant Secretary will ensure federal programs are optimized for patient care rather than bureaucracy.
The Helping Families in Mental Health Crisis Act (H.R. 3717), Rep. Tim Murphy 3
What the investigation found:
STABILIZING PATIENTS BEYOND THE ER
Access to physician-prescribed medication is vital for vulnerable individuals in avoid acute mental health crisis. Current policies that permit only “one drug” per therapeutic class policy ignore the clinical needs of individuals with mental illness who rely on vital, non-interchangeable prescription drug therapies.
What the legislation does:
Protects certain classes of drugs commonly used to treat mental illness so physicians have prescribe the right medication for those on Medicare and Medicaid similar to the protected classes for persons with epilepsy and cancer.
ADVANCES CRITICAL MEDICAL RESEARCH
What the investigation found:
The National Institute of Mental Health measures public health outcomes to develop medical models of care. For example, the Recovery After Initial Schizophrenia Episode (RAISE) project shows earlier intervention with treatment for a person at risk of developing full-blown schizophrenia allows patients to lead functional lives. The NIMH also excels at basic medical research, but lacks the financial resources.
What the legislation does:
Authorizes the BRAIN research initiative at the National Institute of Mental Health and encourages the agency to undertake additional research projects on serious mental illness and self- or other-directed violence.
HIGH QUALITY COMMUNITY BEHAVIORAL HEALTH SERVICES
What the investigation found:
Community Mental Health Centers receiving funds from the federal government receive lower reimbursements federal insurance programs than comparable care facilities.
What the legislation does:
Applies rigorous quality standards for a new class of Federally Qualified Community Behavioral Health Clinics (FQCBHC), requiring them to provide a range of mental health and primary care services.
DEPARTMENT OF JUSTICE REFORMS
What the investigation found:
Between twenty and fifty percent of the incarnated system inmates have a mental illness. Mental health courts have provided a cost-effective and responsible alternative to incarcerating the mentally ill.
What the legislation does:
So patients are treated in healthcare system and not warehoused in the criminal justice system, the bill reauthorizes mental health courts and requires the Department of Justice to collect more data on interactions between the police and the mentally ill. The bill also authorizes Byrne Justice Assistance Grants (JAG) to be used for mental health training of law enforcement and corrections officers.
The Helping Families in Mental Health Crisis Act (H.R. 3717), Rep. Tim Murphy 4
BEHAVIORAL HEALTH AWARENESS FOR CHILDREN AND TEENS
What the investigation found:
Despite increased medical and scientific research into the nature and source of serious mental illness, a mental illness stigma persists.
What the legislation does:
The Department of Education, working with mental health stakeholders, will undertake a national campaign aimed at reducing the stigma of severe mental illness in schools. The bill also reauthorizes the Garrett Lee Smith suicide prevention program.
INTEGRATES PRIMARY AND BEHAVIORAL CARE
What the investigation found:
Low-income individuals with serious mental illness and addiction disorders have high incidences of cancer, heart disease, diabetes and asthma. Untreated depression increases the risk of chronic diseases, and can double the cost of healthcare for health disease and diabetes. Integrating mental healthcare providers into electronic medical records systems will result in better coordinated care for patients as well as cost savings.
What the legislation does:
Extends the health information technology incentive program to mental health providers so they can communicate and work with primary care clinicians.
INCREASES PHYSICIAN VOLUNTEERISM
What the investigation found:
Health centers and mental health clinics are experiencing a staff shortage. Clinicians and healthcare professionals can volunteer at federal free clinics, but federal legal barriers and the high cost of medical malpractice insurance prevent them from doing so at community health centers and mental health clinics.
What the legislation does:
Eliminates federal legal barriers under the Federal Tort Claims Act preventing physician volunteerism at community mental health clinics and federally-qualified health centers.
REFORMS THE SUBSTANCE ABUSE & MENTAL HEALTH SERVICES ADMINISTRATION
What the investigation found:
Unauthorized in the last decade, the Substance Abuse and Mental Health Services Administration has lacked mission focus. Grant programs are not evidence-based or guided by the best available medical science.
What the legislation does:
Emphasizes evidence-based treatments, sunsets unauthorized programs, and strengthens congressional oversight of all federal behavioral health grants.
by Larry Drain
GOP Newtown bill hits impasse | TheHill
It sounds based on reports like these that the Murphy Bill is not going to pass as written. Things change I know, but it looks that way. There is I understand a democratic bill being written by Rep. Barber. Things dont seem to look really great. The really interesting thing is that it might not matter rather or not the Torrey crowd thinks they have made a great case. It may only matter whether or not they find common ground with people up to now they have shown no interest in finding common ground with. Rhettoric that they are so good with may not be their friend. Winning the battle may cause them to lose the war.
The next few weeks, next few months may be interesting. Common ground.... what a weird approach to American politics.
hopeworkscommunity | April 23, 2014
S.L. Brannon D.Div..