From my presentation to Covered California today, August 23, 2017.
SAMHSA: One in five in the US suffers from mental illness. One in 25 suffers from serious mental illness (SMI) such as schizophrenia (1.15%) and severe bipolar disorder (2.2%). Of the 4% with SMI (11 million), 40-50% have anosognosia or lack of insight into their illness.
In no particular order:
- Reclassify SMI as brain diseases or neurological illnesses so the affected can receive integrated psychiatric/primary care and coverage in the physical health system. Just like Parkinson's, Alzheimer's, and dementia.
- Use Assisted Out Patient (AOT) treatment programs delivered with care and compassion.
- Cut county mental health programs that don’t directly serve the needs of the SMI. I.e. wasteful and ineffective stigma campaigns. Make bussing out of county illegal.
- Rename the system “Mental Illness System.” Mental health and SMI are not the same thing.
- Reconcile the Medical Model (meds and beds) and the Recovery Model (peer support and social services). Make evidence-based programs compulsory for each model.
- End the Institutes of Mental Disease (IMD) Exclusion which limits beds.
- Change Medicare’s 190 day lifetime cap on psychiatric hospitalization.
- Amend outdated and confusing HIPAA laws that prevent families and caregivers from helping their loved ones. Allow caregiver evidence of “best interest.” Pass a Caregiver Rights Bill.
- Require law enforcement to receive and investigate reports from family and community members. Require Crisis Intervention Training (CIT) as routine training.
- Increase FACT (Forensic Assertive Community Treatment) teams to help ill persons remain in treatment during parole and probation.
- Provide beds in facilities that offer long-term psychiatric care. California Hospital Association: 50 mental health beds are needed per 100,000 people.
- Enforce the Mental Health Parity and Addiction Equity Act of 2008, including parity for the 4% on Medicaid. (The 4% don’t receive “essential benefits” under the CA WI Codes.)
- Stop dumping the SMI into jails and ERs. Treatment and Advocacy Center 2014 study: Mentally ill inmates are ten times the number of patients in psychiatric hospitals.
- Eliminate the inhumane standard — “Must be a danger to self or others” before intervening.
- Encourage family advocacy groups and consumer advocacy groups to work together.
- Create supported housing, employment, and education.