SMI Advocate Pushing His Agenda With White House & Democrats: AOT, HIPAA Reform, More Hospital Beds

(12-13-19) Advocate and Author D. J. Jaffe is pushing an agenda with both the White House and Democrats that calls for creating more hospital beds for the seriously mentally ill, increasing the use of Assisted Outpatient Treatment, and revising HIPAA regulations that often prevent caregivers from obtaining information.

Jaffe’s fingerprints were all over Democratic presidential candidate Sen. Kamala Harris’s mental health policy, which I recently posted. After she dropped out, I learned that her staff had been in the midst of rewriting that policy because of concerns raised by the Bazelon Center for Mental Health law and others, who generally oppose Jaffe’s agenda. A compromise version was in the works but became moot once Sen. Harris ended her campaign. Yesterday, Jaffe posted an Op Ed in The Hill newspaper urging other candidates to adopt the plan that Harris originally released.

Jaffe will be presenting his ideas Dec. 19th at a White House Summit on Transforming Mental Health Treatment to Combat Homelessness, Violence & Substance Abuse. Here is part of a press release about by-invitation-only event.

DJ Jaffe, who has a seriously mentally ill family member, will make the case that due to mission-creep, the mental health system no longer focuses on the most seriously mentally and that explains why homelessness and incarceration are increasing in spite of increased spending. He will describe ideas states, and ideas localities can use to replace politically correct but ineffective programs with ones that will help improve care for the seriously ill. He will describe the need to increase use of Assisted Outpatient Treatment (AOT), increase the availability of hospital beds and free families of seriously mentally ill from the HIPAA Handcuffs that prevent them from helping mentally ill loved ones.

Around Washington, there has been much supposition about what the Trump Administration will announce during its upcoming summit.

Some are speculating that much of it will focus on identifying our broken mental health care system as the cause for gun related violence and finding ways to move chronically homeless individuals with mental illnesses off the streets into shelters, including tent cities or unused federal buildings.

Jaffe was frequently seen at the U. S. Capitol when former Rep. Tim Murphy (R-Pa.) was pushing the Helping Families in Mental Health Crisis Act through Congress and into law.

Now, it appears that he and his book, Insane Consequences How the Mental Health Industry Fails the Mentally Ill, are continuing to influence both Republicans and Democrats.

Kamala Harris dropped out, but let’s keep her mental health plan alive

By D. J. Jaffe, author of Insane Consequences.

In spite of the federal government spending $150 billion to address mental health, rising numbers of mentally ill people are going homeless and being incarcerated. This is largely because of a multi-year trend: Parts of the mental health industry convinced legislators to move spending away from hospitals and programs that serve the most seriously mentally ill and fund instead soft programs designed to improve “mental wellness” in the masses.

California and New York City have massively increased mental health spending. But because they fail to focus the spending on the seriously ill, both are experiencing increases in homelessness and incarcerations. The resultant community outrage is making the siting of facilities more difficult, further compounding the problem.

Harris’s plan — and that of former candidate, Montana Gov. Steve Bullock — included the four most important reforms the federal government can make to help the most seriously mentally ill. They are expanding the number of psychiatric hospital beds, reducing the use of involuntary inpatient commitment by supporting outpatient versions, freeing families of HIPAA handcuffs, and evaluating programs based on the most important outcomes. Those same reforms seem to be supported by President Trump, meaning they perhaps could become law.

In spite of advances in medications and other treatments, some seriously mentally ill do not get better. This is a sad, politically incorrect reality. Even with perfect community services, the country still would be short 95,000 hospital beds to serve those not yet ready to live in the community. Many likely are among the 400,000 who are incarcerated or 140,000 who are homeless.

Like candidates Pete Buttigieg, the South Bend, Ind., mayor,  and Sen. Amy Klobuchar (D-Minn.), Harris acknowledged that we must fix the bed shortage by eliminating Medicaid’s Institutes for Mental Disease (IMD) Exclusion. This exclusion prevents states from accessing Medicaid funds to hospitalize adults with serious mental illness. If Democrats are for “parity,” they must support eliminating this federally mandated discrimination. The IMD exclusion is what causes states to kick the mentally ill out of hospitals, thereby increasing homelessness and incarceration. Ending the exclusion could improve those metrics and give hospitals enough funding to offer care that is truly therapeutic.

Harris also laid out a way to reduce inpatient commitment and incarceration by expanding the use of Assisted Outpatient Treatment (AOT) for a tiny subset of the most seriously ill who do well in treatment but deteriorate because they refuse to stay in it. With due process protections, AOT allows judges to order them to stay in mandated, monitored treatment for up to one year without giving up their rights or their homes.

The results have been extraordinary. AOT reduces homelessness, needless hospitalizations and incarcerations by approximately 70 percent, saving taxpayers 50 percent of the cost of care. AOT is endorsed by groups as diverse as the Treatment Advocacy Center, National Alliance on Mental Illness, the National Sheriffs Association and the U.S. Conference of Catholic Bishops. Seventy percent of those in AOT say it helps them get well.

Harris called for tweaking HIPAA, the Health Insurance Portability and Accountability Act. The privacy law already allows limited information to be disclosed to companies that provide case management, transportation and housing to the seriously mentally ill for money. She proposed giving families who provide those services, for free, the same access to limited information that paid providers receive. Without that information, parents are prevented from knowing the diagnosis, medications, appointments and rehabilitation needs of mentally ill loved ones. They can’t get prescriptions filled, arrange transportation, or see that appointments are kept. These HIPAA restrictions can turn patients with loving families into wards of the state.

Finally, Harris’s plan requires the National Institute of Mental Health to focus its research on medications and other interventions that reduce the most important metrics: the number of seriously mentally ill who are homeless, arrested, incarcerated, violent and needlessly hospitalized. She would require the government to use existing funds to collect and publish those metrics. That would encourage government to send the most seriously mentally ill to the head of the line for services, rather than to jails, shelters, prisons and morgues.

All campaigns should adopt Harris’s proposals and the Democratic National Committee should make them part of the party platform. Sen. Bernie Sanders (I-Vt.) has said his “Medicare for All” plan will solve the problem, but it doesn’t address what to do about people with serious mental illness who don’t know they are ill — a condition called “anosognosia” that affects 40 percent of the seriously mentally ill. Having insurance doesn’t mean they will access it.

Sens. Cory Booker (D-N.J.) and Elizabeth Warren (D-Mass.) have yet to issue plans to address serious mental illness. Will they let political correctness triumph over science, or will they support AOT, repeal of the IMD exclusion, and freeing parents of HIPAA handcuffs and reporting on important metrics?

It is true that some believe that being psychotic and delusional is a right to be protected, rather than an illness to be treated. Others believe it doesn’t exist at all. But we are no longer in the Stone Age, and it’s time our policies reflect that.

DJ Jaffe is an adjunct fellow at the Manhattan Institute and executive director of Mental Illness Policy Org. He is the author of “Insane Consequences: How the Mental Health Industry Fails the Mentally Ill.” Follow him on Twitter @MentalIllPolicy.