Mental Health Association of Nebraska

Ed Thomas Act: Preventing Crimes by the Mentally Ill

Building on the ignorance and fear of his fellow Iowan's, Representative Bruce Braley (D) is working on a federal version of Iowa's "Ed Thomas Act," which, following the murder of a popular football coach, promises to stop crime committed by people living with mental illness by allowing hospitals to notify police when they discharge patients who have received services within their mental wards.  H.R. 5733 would allow sharing of "officially protected health information" about people who have been "accompanied by law enforcement at the time such individual seeks care" from, presumably, a mental health unit.  According to Braley, the new legislation would help "ensure the future safety of schools and communities not just here in Iowa, but across America."  To read more . . .

Bazelon Center for Mental Health Law on Electronic Medical Records

In acknowledging the importance of effective communication between medical care providers and consumers, especially given the co-morbidity of mental illness and physical illnesses like diabetes and cancer, the Bazelon Center believes that mental health consumers need to have access to and control of their medical records.  "The Bazelon Center . . .strongly believes that consumers with mental illness should  be able to access all of their health and mental health information.  Access to this information is not only fundamental to a person's sense of autonomy, it is also critical to health care improvement efforts that focus on involving patients in their own care and their learning to self-manage aspects of their health. Also, for consent to be fully informed, the consumer must have confidence that the information is accurate and complete and thus may want to know exactly what is being shared."  To learn more, visit the Bazelon Center for Mental Health Law.

New federal rules on hospital visitation

Last April, President Obama called on the US Department of Health and Human Services to develop new rules that "would ensure that hopsitals that participate in Medicare and Medicaid respect the rights of patients to designate visitors, regardless of whether the visitors are legally related to the patient," and that hospitals do not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability."

The new rules will be included in the Medicare Hospital and Critical Access Hospital Conditions of Participation, 42 CFR Parts 482 and 485 subpart F, respectively, and are expected to be published later this fall.  To read more . . .

Given the Nebraska Catholic Conference's belief that any form of therapeutic aid to people who are morally objectionable is, at the very least, tacit approval of immorality; and given the therapeutic benefits for a patient who has visitors; I can't help but wonder if they are working on a "compromise" here too.

Psychiatric Fads

In Normality Is an Endangered Species:  Psychiatric Fads and Overdiagnosis, Dr. Allen Frances, M. D., Professor of Psychiatry and former chairman of the Department of Psychiatry and Behavioral Sciences at Duke University, states that "fads in psychiatric diagnosis come and go and have been with us for as long as there has been psychiatry."  Frances believes that we are currently experiencing at least 3 "false epidemics" including autism, attention deficit and childhood bipolar disorder.  And when the DSM5 finally comes out, there will be more.

Frances believes that "epidemics in psychiatry are caused by changing fashions - the people don't change, the labels do."  Since there are no objective tests for mental illness, "what is diagnosed as mental disorders is very sensitive to professional and social context," including the readily available Diagnostic and Statistical Manual (DSM), which gave "non-clinicians" a tool for good as well as bad.  In addition, Frances identifies other forces contributing to overdiagnosis including pharmaceutical companies, an overly "perfectionistic" society, the internet, and even "patient and family advocacy groups."  The article is an interesting read and Frances places the blame on all within our society.  To read his article, click here.

Elyn Saks on Forced Treatment, Seclusion and Restraint

Elyn Saks, Associated Dean and Orrin B. Evans Professor of Law, Psychology, Psychiatry and Behavioral Health Sciences at the University of Southern California Gould Law School, is considered an expert in mental health law.  In 2009, Saks was awarded the MacArthur Fellowship for her work as a "mental health lawyer expanding the options for those suffering from severe mental illness through scholarship, practice, and policy informed by a life that adds uncommon depth and insight." 

Saks was recently interviewed by Alysa Solomon, Ph.D, of the Los Angles County Department of Mental Health, where she speaks about her experiences growing up with mental illness, including in-patient psychiatric care and the use of restraints.To hear her interview, click here.

In the Introduction of Refusing Care: Forced Treatment and the Rights of the Mentally Ill, Saks writes that "it has been said that how a society treats its least well-off members says a lot about its humanity.  Our treatment of the mentally ill says that American society is inhumane." 

In her book she asks, "when should we treat those who don't want treatment, and when should we respect their choices?"  According to Saks, determining competence is an exercise in "value choices," where societal norms dominate when defining competence.  Saks believes that the standard for competence should be the same for those living with mental health issues as for the healthy, thus in determining incompetence, as in requiring forced medication or seclusion and restraint, standards should be the same for those living with and/or living without mental illness.  "Nobody would dream of authorizing, say a doctor, to force treatment of some kind on a perfectly competent, unimpaired person solely because that would be in his best interests."  Although the book isn't in our city library, you can read excerpts and order it through Amazon.com.

NE Board of Health affirms Board of Psychology’s refusal to adopt compromise ethics language

On Monday, June 21, 2010, members of the Nebraska Board of Health ignored the advice of the state's Chief Medical Officer and voted to approve licensing regulations for psychologists that do not include the so-called compromise language regarding patient referral. 

Unfortunately, this doesn't end the issue.  Although the Board of Psychology is legally responsible for writing the regulations, Dr. Schaefer isn't bound by their decision and can simply refuse to forward the proposed regulations on for administrative (i.e. the Governor's) approval.  

During the meeting, Dr. Schaefer repeatedly accused the professional and advocacy groups in opposition to the so-called compromise of "not being intellectually honest" (in other words lying) in our criticism of the changes, and that "we need to come up with a way to solve the problem."  The real problem for Schaefer and her boss is to find a way to appease the Nebraska Catholic Conference.  The truth is this is a political issue, not a medical one.  When asked by the Board if there has ever been a situation where a psychologist was punished for not referring a client for a specific issue, Jim Cunningham, executive director of the Nebraska Catholic Conference, replied "No."

During the debate, a number of Board of Health members agreed that the need for compromise was a "solution looking for a problem."  The Board voted 12 to 1 to affirm the decision made by the Board of Psychology last March.

Now it's back to the Board of Mental Health Practice, and a special meeting on changes to their rules and regulations (172 NAC 94) is scheduled for Thursday, July 1, 2010, at 2:15 PM, in the State Office Building's 1st Floor Meeting Room "Y."  Come by and hear what they have to say.

To read Nancy Hicks' 6/22/2010 article in the Lincoln Journal Star, click here.  Check out the discussion comments that have been posted.  If nothing else, this issue has provided fodder for a spirited public debate.

Music video addresses more than just ADHD

Rapper Chill E.B. has posted Ya'all Busted, a music video raising questions around the diagnosis and treatment of Attention Deficit Hyperactivity Disorder (ADHD) on YouTube.  The video includes segments featuring noted experts on ADHD discussing the issue at a 1998 National Institutes of Health Consensus Development Conference.  The NIH website provides a disclaimer that states that given the age of the conference, the information is provided for historic purposes only, and "some of the material is likely to be out of date, and at worst simply wrong."

However, the video raises important issues regarding diagnosis, treatment and medications that can be applied to other mental illnesses:

    "Free your mind from mis-education, misinterpretation yo they tryna control.

    You and me both with dose after dose.

    A comatose and roast ya, enslave the culture.

    Insulin shock 10,000 has to stop.

    Lobotomy cuttin' up brains 11,000 dropped.

    And you wanna know who gansta? Who da dope man?"

For a copy of the lyrics,  click here.

For more information on ADHD, visit NIH's MedlinePlus.

Anti-Stigma PSA from New York's Rockland Psychiatric Center

With the assistance of filmmaker Alicia Salzer, MD and Nikole Cattell, Consumers at New York's Rockland Psychiatric Center have produced a series of public service announcements to raise awareness and reduce stigma around mental illness.  To watch their messages click here.

Patient Rights v. Provider's Moral Beliefs: The Battle Goes On

Last March we told you about the Nebraska Department of Health and Human Services and the Nebraska Catholic Conference's attempt to change the ethics language within  Title 172 NAC 155, changes that would allow a psychologist to drop a patient if and when the therapist discovers something about their patient that goes against their religious or moral principles (see Nebraska Board of Psychology votes not to change ethics language).  Unfortunately that wasn't the end of it.  On May 6, 2010, the Board of Mental Health Practice held a public meeting to collect public commit on the language changes that this Board had approved earlier.  Testimony was overwhelmingly against any changes to existing ethics language in  Title 172 NAC 94, and that the clinician's responsibility to cause no harm trumps the practitioner's particular bias and prejudices.  In the middle of the hearing, Dr. Susan Meyeral, PhD, after identifying herself as a current member of the Board and speaking as such, inappropriately chastised those speaking against the proposed changes and argued that the "compromise language" must be allowed to pass (see Letter to Board of MH Practices 5-7-10).

On Tuesday, June 8, 2010, the Board of Mental Health Practice will review the testimony they received during the public hearing, and make their final decision regarding the language changes, and on Monday, June 21, 2010, The State Board of Health will meet and make their decision on this important matter.  In her article published in the Saturday, May 15, 2010, edition of the Lincoln Journal Star, Nancy Hicks reports that Dr. Joann Schaefer, the State's chief medical officer, "can refuse to send on any regulation package that doesn't have compromise language, effectively stopping any licensing board from modifying its rules," thus nullifying any outside involvement in the rule making process.

On May 19, 2010, the Mental Health Association of Nebraska, the Nebraska Chapter of the National Association of Social Workers, the Nebraska Association of Marriage and Family Therapy, and the Nebraska Psychological Association sent a  letter to the Journal Star outlining our belief that any changes to existing language within Title 172 NAC 94 or 172 NAC 155 was unacceptable because of the potential for harm to those these professions are sworn to help.

If you have any questions about this important issue, or would like more information on the upcoming meetings or who to contact to voice your concerns, please contact MHA-NE at (402)441-4371.

Google and Facebook raise new issues for therapists and their clients

Should doctors check up on their patients via social networking sites like Facebook or internet searches without the patient's expressed consent?

Is it appropriate for a therapist to put personal information about themselves on a blog or web site?

What are the risks of having patients and therapists interact online?

These questions were raised at the American Psychological Association Conference last year and received mixed response.  According to Stephen Behnke, ethics director for the APA, "we are just beginning to understand what ethical issues the internet is raising.  To write rules that allow our field to grow and develop and yet prevent [patient] harm at the same time."  To read more . . .