Visionary Law Mandates Mental Health Education in NY Schools

image-20160315-9262-d4fgb3There’s been an important and encouraging new development on the mental health front in New York State.

A new law holds forth the promise that significantly greater numbers of New Yorkers will be seeking out the care they need – and getting this care – in the years to come.

Effective July 1, an amendment to the State’s education law requires that mental health education must be provided in classrooms statewide. All elementary, middle, and high schools in New York State must modify their curriculum to include mental health as part of existing physical health instruction.

The welcome change is largely the outcome of five years of advocacy led by the Mental Health Association of New York State (MHANYS). New York State should be proud to now stand as a national leader in this vanguard modernization of our health education requirements. Virginia is the only other state with a similar law, and, coincidentally, its law went into effect on the exact same day.

However, this attention to actually getting people into care would be insufficient were it not for legislation passed by both houses – and awaiting the Governor’s signature – to strengthen the State’s Mental Health Parity laws. The “Mental Health and Substance Use Disorder Parity Report Act” went beyond the previous law which solely required plans to respond to consumer complaints. The new law requires plans to submit data on key parity measures – such as network adequacy and claims performance – to ensure that people are getting care when they seek it.

Mental heath providers have been painfully aware of the numerous obstacles to care – and we expect these reforms to help overcome some of them. The National Institute of Mental Health says that about 44.7 million Americans aged 18 or older had some form of mental illness in 2016. This represents nearly a fifth of all U.S. adults. Young adults aged 18-25 years had the highest prevalence of mental illness (22 percent) compared to adults aged 26-49 years (21 percent) and aged 50 and older (15 percent). About half of all chronic mental health conditions begin by age 14. About 22 percent of youth aged 13-18 experience serious mental disorders in a given year.

Yet only 43 percent of these adults received mental health treatment that year, with far more women (49 percent) than men (34 percent) getting help. And the percentage of young adults aged 18-25 years with who received treatment (35 percent) was lower than the proportion of adults with mental illness aged 26-49 years (43 percent) and aged 50 and older (47 percent) who got assistance.

Stigma and misinformation about mental illnesses are the most prevalent barriers to people obtaining care but the parity discrepancies have also contributed. To better understand this troublesome gap, Project Access – a study group convened by Roslyn Heights-based North Shore Child and Family Guidance – asked people who had successfully entered mental health care about their experience of obtaining that care. Fifty percent found it significantly more challenging than seeking physical health care. Three out of five said it took between two and 16 contacts to make a connection for mental health care.

Almost 24 percent couldn’t find providers that accepted their insurance. Nearly 39 percent had problems with affordability, 21 percent cited personal indecision as a factor, and 24 percent said their attempts at accessing help were futile.  Regrettably, these obstacles contribute to increasing rates of suicide, substance abuse, addiction morbidities, legal problems, social isolation, and other social and economic struggles.

These new laws represent a good start to helping address many of these barriers.

To help with implementation of the education law, MHANYS will soon launch an online School Mental Health Resource and Training Center that will be available to public and private schools statewide. The Center, supported with funding from the New York State Legislature and Governor Andrew M. Cuomo, will provide assistance and guidance, a hotline for school districts, and a team of experts in education and mental health.

We agree with the Commissioner of the New York State Office of Mental Health, Dr. Ann Sullivan, who said that “by introducing mental health education at age-appropriate levels from elementary through high school, mental health will be normalized just as physical health is, stigma will be reduced, and children and parents will learn about prevention, and when and how they should ask for help.”

Coupled with insurance parity strengthening, this visionary law will encourage early intervention for mental health conditions – breaking from a pattern where too many commence their care after a hospital or ER visit. It can also serve as a catapult to efforts to ensure the repair of access issues. Let’s encourage and support our school districts to all do what they can to make the law a success.

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Posted in Depression, Education, mental health, Parity, Schools, Stigma

The Opioid Dens of Medicaid

Today’s post is by guest blogger, Robert Detor, LCSW, a member of the board of the Association for Mental Health and Wellness.  The following column was submitted to the Wall Street Journal.


Robert Detor, LCSW

Everyone needs to be constantly discriminating when reading published information and this editorial is a perfect example of why “Fake News” needs to be taken seriously. That doesn’t mean everything is fake, but everyone must exercise a hyper alertness and understand the source. Often the sources will telegraph the intent and trigger alarms to dive deeper. This editorial is one of those pieces that demands further review. It unabashedly purports to implicate ObamaCare and Medicaid in the Opioid crisis and the resulting deaths. So many deaths that in fact the expected lifespan for Americans has decreased in the past few years!

The basis for your editorial is a report issued by Sen. Ron Johnson from the Senate Homeland Security and Governmental Affairs Committee. What you do not explain is this so-called report, from the Wisconsin Senator, who last week accused the FBI of having a “Secret Society” (like the Illuminati), was authored by the Senate Republican Majority staff. It is not a report from an independent bonafide research entity. Without such a disclaimer it is easy for readers to assume this is fact. Rather, it is interpretation and I would suggest biased.

You write that Medicaid offers cheap access to drugs (as if commercial plans don’t), for a low co-pay, then jump to some anecdotes to morally indict Medicaid beneficiaries complicit in a fraud to dupe unsuspecting pharmacists. Next is an admission “fraud is a feature of any government program” as you jump to a Bronx bodega and a cabal of health-care providers in Miami. (I don’t think you’re referencing the multi-million dollar fraud case of the healthcare company the Governor of Florida ran by Medicare?)

Next, the unbelievable distortion: Obamacare is to blame! Yes, you cite the report where there was a 55 percent increase in criminal cases filed between 2014 and 2017, compared to the four years before the expansion of health care. to the poor and middle class. So it appears there is a causal effect between the expansion of access for the middle class and poor to healthcare and crime?

There is no doubt the opioid crisis has severely impacted our country. The deaths during the past four years have soared; 64,000 deaths in 2016 according to the National Institute on Drug Abuse. NIDA reported synthetic opioids were the leading cause of death, with heroin, natural and semi-synthetic opiates, cocaine and methamphetamines also on the rise. It is a true epidemic of historic proportions. But the link Johnson’s report makes to the increased access to prescriptions doesn’t hold water. According to the National Institute of Health, overdose deaths by prescription drugs peaked in 2011, three years before Obamacare.

I suggest you take a look at the testimony provided at the June 8, 2017 Congressional Joint Economic Committee on the “Economic Aspects of the Opioid Crisis.” In this hearing, factual data is presented that states clearly those most impacted by the crisis are between 26 and 34 years old and historically had the least access to healthcare coverage. 51.4 percent of the people with an OUD (opioid disorder) have incomes below 200 percent of the Federal poverty level ($23,764 for an individual) and have not had access to coverage.  Also…Fact: the drugs fentanyl and heroin, the most frequent causes in overdoses, are obtained illegally, not by prescription or resale of drugs obtained by prescription. And to restate, NIDA clearly shows overdose by prescription drugs peaked in 2011, three years before Obamacare!

It seems to me that any publication with an ounce of integrity should restate its position based upon all the facts. This report by the Senate Majority was released not to further the cause of solving the horrendous problem of the lives being lost to overdose. If it was, it entirely misdirects our efforts.

So, should we wonder why this was released? Or even better, why were our taxpayer dollars used to produce such rubbish? And what was your real point?

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Posted in Addiction, Affordable Care Act, Opioid

Seven ‘Dirty Words’ Words You Can’t Say About Healthcare

Seven WordsSo…how are we now to tell people what’s good or bad mental health care?

This past week, President Trump directed officials at the Centers for Disease Control and Prevention (CDC) to cease using seven terms, including “diversity,” “vulnerable,” “science-based,” and “evidence-based.” While as amusing as comedian George Carlin’s routine, this move leaves many social services, health, and behavioral health leaders befuddled as to what the administration believes should guide professionals and advocates in our responses to people who are seeking help for adversities that have impacted their lives.

Mental health and addiction care have forever been magnets for well-marketed remedies without regard to any documentation that they will help or even harm people. Over centuries, these have ranged from sadistic physical measures to some psychotropic medicines that did more damage than good to a bevy of “snake oil” and body-assaulting remedies, some that continue to abound in the marketplace today.

I will never forget conversations I had with a tearful psychiatrist, Dr. William Turner, an early board member at Clubhouse of Suffolk, who painfully lamented his participation in the 1930s in lobotomies at Long Island State hospitals and the VA.  I also recall a tour of our nation’s first public hospital in Williamsburg, opened in 1773 by Virginia’s Governor as the “Public Hospital for Persons of Insane and Disordered Minds” where tools of torture were used – purported science that could cure “persons who are so unhappy as to be deprived of their reason.”  Treatments “consisted of restraint, strong drugs, plunge baths and other ‘shock’ water treatments, bleeding, blistering salves…(and later included) an electro-static machine.” Virginia’s Governor hailed these treatments as “science” for “diseases of the brain and nervous system, and the mentally ill (who) chose to be irrational.”

So, pursuant to this CDC directive, what shall become the most-trusted source for care recommendations to people who ask for help for themselves or loved ones? Some considerations, I guess, might include:

  • Social media optimization: “What treatments are approved as: ‘Facebook-Friendly Care,’ ‘Highly-Twittered Help,’ or ‘Most-Instagrammed Treatment’? Of course, the repeal of net neutrality may mean “pay-to-play” competition among healthcare providers to promote their products and services.
  • Spiritual guidance: “What treatment does God want me to pursue?” (Note: Many wonderful clergy leaders have been working with behavioral health leaders to help ensure that their congregants can access the most responsible information.)
  • Bartender or illegal drug dealer: “Sir, I want to stop using your products and services. Who can best help me?” Or, more progressive:
  • Apple-directed care options: “Siri, who should I go see to help me with my mental health problem?”

To be fair, behavioral health care has not always been adequately directed by “best science.” But, we remain at a time when there are mounting major challenges to helping people access mental health and substance abuse care. These include combating stigma, a workforce that is not sufficiently competent culturally or linguistically, forthcoming Medicaid cuts, and inadequate networks and payment confusion in insurance and managed care companies. (A “shout-out” to the just-released “Project Access” report by North Shore Child Guidance’s CEO Andy Malekoff and his colleagues!).

Amid our nation’s opioid and suicide crises, which includes our military Veterans, this censorship of health care communication imposed on our leading health safety organization just doesn’t seem helpful.

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Posted in CDC, Centers for Disease Control, health, mental health, Politics, Veterans, wellness

An Inspiring Day in Friendly Manitoba Province

My wife, Robin, and I spent Wednesday at a wonderful museum in Winnipeg: the Canadian Human Rights Museum.

It was remarkable by its thorough and historical discussion of human rights abuses around the world, but also by its humble inclusion of Canada’s incursions perpetrated within its own borders. For example, the Museum includes a deep and stirring examination of a “child welfare” system campaign in the 1960’s to “improve” the lives of Aboriginal (“First Nation”) children by removing them from their impoverished family homes and tribal communities and placing them far away in foster care — often with unmonitored and abusive families. Called the “60’s Scoop,” testimonies by these children and their parents, like all the exhibits, are a painful reminder of the consequences of ethnocentric thought.

In fact, the Museum has been a watershed for criticisms in Canada. Groups that feel left out or minimized — i.e. their suffering did not receive fair attention in comparison with that given other incursions against ethnicities, races, religions, gender, LGBTQ communities, people with disabilities, and (an important debate in Canada) linguistic differences (i.e. French vs. English speakers).

The Museum ends with a floor dedicated to  a hopeful consideration of dozens of emergent leaders and voices in human rights causes, many of whom are remarkable for being “everyday people” who just want to make a difference.

Despite its controversies, Canada should feel proud of its effort to document the path to human rights especially as nations like ours choose leaders with more isolationist views. The slope to indifference, bias, and hate can deepen rapidly should we fail to protect and defend our core freedoms.

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Posted in Canada, Canadian Human Rights Museum, Disabilities, Human Rights

When Your Problem is My Problem, Too: A Timely Flashback to the Road to Mental Health Parity

parity1“I shouldn’t be forced to pay for your health problems and your family’s health problems”

While many opponents perceive that the current health bills are popular among Conservative Republicans mainly because it paves the way for a huge tax benefits for wealthy people, and punishes poor people, there are two real Federalism debates that warrant serious attention here: 1) Should people be forced to buy insurance when they’re healthy and don’t feel the need for it? And 2) Whether health insurance and health care should be regulated closer to home, by States and not by the Federal government.

Aside from major cuts in Medicaid, which pays for nearly 40 percent of all behavioral health services in our country, the most critical issues for mental health stakeholders in the current debate is the preservation of the gains of the 20-plus year crusade to mental health parity and the inclusion of a basic mental health benefit, including addiction treatment, in any public or commercial insurance policy. BEWARE: There’s a “red herring” in the swamp of the House and Senate bills, assuaged by the President, which puts a few dollars into a separate pool for opioid addiction treatment. Such a fracture of the behavioral health benefit is a populist strategy but one that will effectively spell the end of the broader mental health and addiction benefit requirement.

To get a picture of the impact removal of this requirement would look like, all one has to do is remember the days before parity.

MHAW’s ancestral agency, Clubhouse of Suffolk, was founded by six people who had family members affected by psychiatric disabilities. In those days, many family members shared a saga of going to any extent possible to find treatment that held hope of reversing the course of their loved ones spiral. In those times, 38 percent of commercial insurances didn’t cover mental health conditions, 45 percent didn’t cover substance abuse, and many people needing care had both issues. For most of those with policies that did provide coverage for these conditions, there were annual and lifetime caps on treatment services. As a result, many bankrupted their family savings trying to obtain care for their loved one. Family fractures and divorce were common consequences as families wrestled with decisions like state hospital commitment and “tough love” strategies. Many families and people, at their most vulnerable points in their despair, were taken in by charlatans who offered hope through high-priced and unproven, even bizarre treatments.

Many families saw their loved ones end up in jail…prisons like Rikers Island became the newest and largest psychiatric institutions in the nation – a problem that has still not be adequately addressed.

There is much to learn from these times: As State institutions emptied and the paradigm for behavioral treatment in the community pushed forward, it took two leading U.S. politicians who were political polar-opposites to forge a movement that would change behavioral healthcare for the next generation. New Mexico Senator Pete Domenici, a conservative and one of the Republican Party’s elder statesman, and Paul Wellstone, a liberal Democrat from Minnesota, shared the experience that each had family members affected by psychiatric disabilities.

Their efforts led initially to the Mental Health Parity Act of 1996 which provided that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits. Some States, like New York, began to build on this Act and pass their own parity bills. Tragically, Senator Wellstone perished in a plane crash in 2002 and did not live to see what became the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. This Act prevents group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits.

Following the passage of the 2008 law, Senator Domenici – retiring from his position due to a degenerative brain disease, reflected to TIME magazine on the bi-partisanship that led to the adoption of this commitment to mental health care in all health insurance:

“Now when I’m finished with a speech and I’m mingling around — even if the meeting were oil and gas operators in Dallas, Texas — almost always somebody will come up and say, “Hey, keep with it, Pete, I’ve got a nephew…” Or, “My uncle Billy had this…” In other words, it is more prevalent than you think. Out of almost any crowd somebody will tell you a story about their family. Those kinds of things are always coming up. Even President Bush spoke to me personally and very eloquently about it. He said, “You don’t have to convince me, I’m over that hurdle.” Every time we got close [to passing the bill], he’d ask about it.”

“Strangely enough, when I would speak to this among a group of Senators, it took more time than I thought to get some of them to come up and join me and say, ‘I want to work on this because I have a relative or a friend.’ But eventually, four or five Senators came up to me and said, ‘We got to work on this, Pete, because it’s real.’ It took many a month until that first bill got to the floor. Then we just rolled it through the Senate.”

Because of that bi-partisan policy conviction, we have seen significant progress in shortening and reducing hospitalizations and emergency room visits, the evolution of evidence-based practices for more complex conditions including co-morbid addiction and mental health conditions, trauma-informed care (which has been vital for serving our Veterans), and early intervention. And, thanks to increased mental health education and anti-stigma efforts, greater access to behavioral health services. We still have a long way to go – especially when it comes to serving people of color and minority cultures in our country.

But we should have long passed the residue of self-centered thought in health care and mental health care – thanks to courageous leaders like Senators Domenici and Wellstone. We are all inter-connected in health through our shared vulnerabilities, whether that be for mental illness, addiction, heart disease, aging, or cancers.

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Posted in Affordable Care Act, mental health, Parity

Our New Health Policy in 140 Characters or Less

I was listening to a radio talk show early Friday morning after the Republican House and President celebrated the rapid passage of their version of repeal of the ACA. While the radio hosts missed the irony, the program cut to an advertisement for a genetic testing company that was promoting its product, touting that it could tell us with a simple biological test the extent of risk we possessed for all types of cancers.

I recalled hearing testimony as part of the Welfare to Work Commission’s 2012 report on Suffolk County poverty where many people spoke of losing everything owned because they were denied treatment by insurers for a relapse in a health condition like breast cancer. The ACA, of course, subsequently eliminated this line of inconsideration by insurance companies.

Tests that might predict such risk weren’t really in significant use pre-ACA. But its potential repeal now re-opens this question – and many more – of what will constitute a “pre-existing condition.” I have personal and family health histories that amount to a WebMD volume of conditions, encompassing both physical and mental health. I know I’m already screwed with respect to possible excising of coverage for a host of conditions I’ve actually experienced, including two types of cancer. I know my risks of worsening or relapse of my conditions, so I do what I can to maintain a healthy lifestyle in order to minimize my risks.

But, what if I take a test and learn that I also have a 10 percent chance of Alzheimer’s or other conditions I have not yet experienced? Will this new information preclude me from coverage or care by a commercial insurer? If I don’t take the test, and nobody knows my pre-disposition, am I still eligible for coverage for that and related conditions? Or, will my insurer get really “progressive” and require diagnostic tests before telling me how much my insurance will cost?

How about new data from the population health world that indicates that even more than our genetic code, it’s our zip code that is often a strong determinant of our health and our healthcare needs? Just like homeowners and auto insurance, will our access to health insurance vary by the neighborhood we choose? (One gnarly congressman was quoted Thursday, “well you will always have the right to move.”).

I told the financial planners in my Rotary Club that they are in a great place under Trumpcare because we will all have to put off retirement pretty much until death so we can put away more dollars just in case any of our loved ones gets sick or disabled…or worse.

This issue will require a lot of public information at a time when fewer people consider information that comes in a form containing more than 140 characters. Some can endure a Facebook post (especially if there’s a funny video) and a few enlightened people will dig deeper and read a one-page blog or two. Recall how the brief non-fact of “Obamacare death panels” impacted public opinion during the ACA debate.

Another House Member admitted Thursday that he didn’t even read the bill, brief as it was, before voting on it. That’s the new stylistic challenge for the President: To issue a profound Tweet that will make good public policy, be it health care, taxes, immigration, or launching a missile attack.

It sure seems unfair that the people who are making the rules and are responsible for thinking through the all their implications are themselves exempt from the impact of the new rules.

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Posted in Affordable Care Act, health, mental health, Politics, wellness

Salve for the Sensibilities

I am a recovering news junkie…one who is struggling to stay on course in the current storm of political wrangling about social, economic, environmental, and overall  leadership issues.

For many years, my home lifestyle included watching cable news and TV newsmagazines early in the morning and in the evening.  The greatest “high” was Sunday mornings with coffee (after a run-through of the Sunday e-NY Times “Top News” and “Opinion” sections) – Fareed Zakaria, Meet The Press, etc. While driving, it would be NPR and maybe a little (mostly mindless) sportstalk radio. At the gym, a favorite hideout of mine for nearly 40 years, I’d often listen to podcasts of my favorite “talking heads,” at least until my daughter added a few health-related shows about brain and behavior science stuff (Invisibilia and many TED Talks).

Around the time of the two national political conventions, the sense of tension throughout my brain and body peaked. The verbal adrenaline that I could unleash when someone raised a political topic would, more often than not, leave others shrugging their shoulders and rolling their eyes with frustration of the topic – or maybe with me. Some new news, or more often political spin on critical events and issues, would make me lose sleep and affect my focus at work and in my relationships.

I knew I had a problem, and I admit that I still do. But, a new substance has fallen into my path in the form of e-books through my local library.

I have listened to well over a dozen books since the election. These include biographies (loved The Wright Brothers), fiction (okay, one was based on current Middle East conflicts), leadership, brain science, history, and a smattering of old political stuff (JFK, Patton, Lincoln).

A most recent “listen” was real salve for my sensibilities, Born to Run, Bruce Springsteen’s autobiography.  Stories “The Boss” told of his journey awoke my memories of college days. I first heard Springsteen in concert in 1975 in my school’s dining hall, an incredibly visceral event in my late adolescence that led me to follow his music and career. Listening to his book – recorded in his own voice – was moving, compelling, and reaffirmed for me that there are caring, moderate, humble, and sensible people who walk among those we today label as stars and celebrities.

Springsteen mixes his stories with an oft-painful self-awareness that brings the listener into his world of chronic perfectionism, which is the source of his brilliance yet also the fuel for his depression. He artfully describes, in impoverished and yet hopeful language, his lifelong journey with depression that spanned his early struggles to find himself musically as well as his rise to fame and acclaim. Springsteen also discloses how years of therapy and the use of meds allowed him to find freedom from his harsh self-criticism. His relationship with his father, diagnosed late in life with schizophrenia, adds dynamism to this journey.

A really engaging part of his ride to inspiration was his relationship with Veterans, achieved through a fortuitous meeting with Ron Kovacs, author of the best-selling autobiography and Academy Award winning movie Born on the Fourth of July. Springsteen, who has enjoyed a lifelong friendship with Kovacs, shares his guilt for not having served in the military and the pain of losing close high school friends to Vietnam combat. He beautifully weaves his sincere admiration for wartime and post-wartime courage and convictions, which resulted in Born in the USA and thousands of reprisals of Woody Guthrie’s This Land is Your Land.

I must admit that this new e-book addiction of mine is every bit as engrossing as my political news affliction, but somehow feels healthier in its breadth and depth. It is often said that overcoming addiction is a journey of replacing the bad, damaging, “drugs of choice” with healthier compulsions.

Unfortunately, an avalanche of new issues in our political environment has threatened to retrigger me:  Rapid-fire proposals of health insurance reform, huge transitions in Federal spending priorities toward defense and away from social and environmental needs, and international instability — all engrossing and also extremely important to me on many personal and professional levels.

Now my challenge is finding new balance. I hold out hope that as I enter my senior years, I’m at least on the right path toward learning how to re-generate other parts of my brain that may be being wrecked by my obsession with political news.

Of course, with spring looming, I’ll also need time for golf . . .

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Posted in Addiction, Politics, Tension, Veterans
Association for Mental Health and Wellness

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