(8-30-17) The debate about patient consent that I’ve highlighted this week has spurred additional interest in the first meeting of the congressional mental health advisory committee scheduled for August 31, Thursday, here in Washington D.C.
I’ve received emails from readers who have asked if involuntary commitment laws will be discussed. That’s highly unlikely because involuntary commitment standards are set by each state – not the federal government – based on a “dangerous” criteria established by a U.S. Supreme Court ruling.
This first meeting will be about introductions of commission members and potential topics to be discussed in the future.
In preparation, I’ve been asking for suggestions about steps that can be taken to improve the federal system. Here are some of the ideas that have been shared with me.
Medication pre-authorization: a suggestion from Dr. Dinah Miller, c0-author of Committed: The Battle over Involuntary Psychiatric Care.
As you probably know, when a patient is prescribed a medication, they may go to the drug store to fill it, only to be told that it requires “pre-authorization.” The pharmacy may then contact the prescriber by sending a form that needs to be filled out, or the prescriber may need to call the insurance company’s pharmacy benefits manager (PBM) to negotiate for the patient to be approved for the medication, a process that often takes 20-30 minutes of uncompensated doctor time. Sometimes it’s just a hoop to jump through, often the PBM wants to know that the patient has failed other, cheaper, medications or that there is a specific diagnosis that requires this specific medications without any leeway to use medications “Off label” as we sometimes resort to. Usually the process is instituted for expensive medications, but not always: one psychiatrist recently mentioned that she spent 30 minutes getting authorization for a sleeping pill — she was not aware that a 90 day supply of the medication could be obtained at WalMart for $10, much less than the cost of her time.
Preauthorization takes time – hours to days to even weeks– so there is a delay in the patient getting sometimes-urgently needed medications. The process often has no regard for medical urgency. It turns patients into guinea pigs, not real people with individual issues that may warrant skipping trials of other medications. Requirements for trials of other medications to be failed first are often measured by the patient filling the prescriptions for those medications by that insurer (so the patient saying that he took the medication years ago and it was intolerable or ineffective does not “count”). And it leaves the PBM in the position of essentially practicing medicine without a license, and without ever seeing or examining the patient before over-riding the treating physician’s medication choice.
Earlier intervention and Promotion of Innovations suggested by Paul Gionfriddo, President and CEO of Mental Health America.
The current suite of evidence-based programs is inadequate to improve the mental health of all people with SMIs, especially children.
Specially, I’d like to see (1) a commitment to implementation of the US Preventive Services Task Force recommendation to provide mental health screening to everyone over the age of 11; (2) a deeper commitment to the offering of evidence-based preventive services in school; (3) a recommendation to include special education reforms in the future reauthorization of the IDEA, so that(a) kids with SED can be more easily identified and gotten into special ed, and (b) mandated special ed services could be covered by insurers, as well as school districts (which would save state and local LEAs millions in implementing the underfunded IDEA mandates); and included in the plan for a reduction in incarceration (4) not just a reduction, but (a) a prohibition of the incarceration of nonviolent offenders with SMIs -as well as (b) a process for reducing felony charges to misdemeanors (or a form of “felony forgiveness”) for all nonviolent offenses committed by people with mental illnesses so as not to prevent them from gaining housing or employment later on.
Changes in federal rules and procedures currently on Rep. Tim Murphy’s (R-Pa.) legislative agenda as cited by chief of staff, Susan Mosychuk.
Repealing 42 CFR Part 2 to end the regulatory separation of substance use records from other medical records to support integrated care and ensure that information about substance use disorders is made available to medical professionals treating and prescribing medication to a patient. Rep. Tim Murphy’s bill (The Overdose Prevention and Patient Safety (OPPS) Act (H.R. 3545) to do just that was included as a recommendation in the interim report released by the President’s Commission on Combating Drug Addiction and the Opioid Crisis. Even with the President’s Commission directly pointing to Dr. Murphy’s bill as an important step improve delivery of medical care for SUD patients unfortunately, once again, a SAMSHA-funded organization is working against Dr. Murphy’ efforts.
Ensuring patients with a dual diagnosis are delivered more than just suboxone or methadone. SUD patients with a psychiatric diagnosis need interpersonal treatment with therapy, not a quick visit to a prescribing doctor for a MAT script or methadone, but full inpatient/outpatient treatment so that medications are coupled with evidence-based therapy.
Repealing the IMD and expanding inpatient care for mental illness & SUD patients.
Expanding the AOT grant program and increasing funding.
Ending the wasteful & anti-science “Alternatives” conferences. Replace with seminars/opportunities for families in addiction & mental health crisis to get engaged and educated on innovative and evidence-based treatments.
Codifying protected drug classes.
Ensuring SAMHSA gets back on track and stops pushing an “Alternatives” far-left, out-of-the-mainstream, anti-science, “2-Spirit non-binary” philosophical movement and focuses on medical care for serious psychiatric illnesses and SUD patients.
Allowing caregivers access to doctors and patient records currently curtailed because of HIPAA.
Elimination of all the silly wasteful SAMHSA endeavors such as 1-800 numbers for snow anxiety and fruit smoothie recipes.
The first meeting of the U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES INTERDEPARTMENTAL SERIOUS MENTAL ILLNESS COORDINATING COMMITTEE will be held Thursday, August 31, 2017, from 9:00 a.m. to 5:00 p.m. (EST) at the Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201. This is a public meeting.
About the author:
