Can Health Care Reform End Stigma Toward Mental Illness?

This article addresses the destigmatization of mental health through health care reform by incorporating antistigma efforts—a destaining of mental illness—through prevention and early intervention in community-based programs that would be mandated and funded through the auspices of Patient Protection and the Affordable Care Act (ACA). Mental health care policies under the ACA and the Mental Health Parity Act are briefly described, following a definition of mental health stigma and its impacts. Recommendations for statutory mandates in stigma reduction at the community and federal levels and guidelines for mental health/behavioral health providers form the article’s conclusion.     

'In the real world we're all put on the spot at some time or other,so you need to be prepared for it': An exploratory study of an oral method of assessing knowledge of mental health law

The education and training of Approved Social Workers (ASWs) involves at least 60 days of college and practice-based learning. A major component of the college-based curriculum is the teaching and assessment of knowledge of mental health law. One programme in England assesses student knowledge of law by an oral examination that includes a case discussion and questions about the Mental Health Act 1983. Oral assessment of knowledge of law is commonplace for those entering legal professions. Oral assessment of clinical knowledge in professions such as medicine and psychiatry is similarly frequent. However, examination by oral assessment is not usual in social work education. An exploratory study by postal questionnaire of all past students of the programme and their line managers was undertaken to establish their views of this means of assessing knowledge of law. This paper considers the results of the research and outlines student perceptions of the law oral assessment as preparation for practice as an ASW. The paper focuses on three distinct but interlinked areas--education, assessment and practice--and suggests some implications for educators and practitioners, which are especially relevant in the light of the current review of mental health legislation.     

From here to Recovery: One Service User’s Journey through a Mental Health Crisis: Some Reflections on Experience,Policy and Practice

This article documents the experiences of a service user through a mental health crisis, the experience of detention under Section 136 of the Mental Health Act, admission to hospital and eventual recovery. It gives a unique first person account of the experience of a psychotic episode together with a reflective commentary based upon the service user's auto-ethnographic analysis of both the event itself and her medical records, which were obtained post-recovery, as well as interviews with professional practitioners. The reflective commentary considers the practice of various professionals encountered during the service user's illness, treatment and recovery. The service user, whilst critical of some of the treatment she received, has engaged in a positive way with her local police force, involving herself in training sessions for officers about good practice under the Mental Health Act.     

The meaning of mental illness within the Victorian Mental Health Act: the problem of definition

This study will critically examine the Mental Health Act 1986 (Vic), including the significant changes introduced through the Mental Health (Amendments) Act 1995 (Vic). It will be argued that the Victorian legislation presents some practical difficulties in application as it adopts too broad a definition of mental illness to be used reliably in assessing a person's need for treatment and/or criminal responsibility within a court of law. This lack of precision is potentially problematic for social workers and lawyers alike with respect to key decisions regarding assessment for mental health services and assigning criminal responsibility before the law. Implications for social work practice will be briefly discussed.     

DEA allows buprenorphine inductions based on telephone only

Last week, the Drug Enforcement Administration (DEA) said opioid treatment programs (OTPs) and Drug Addiction Treatment Act (DATA)–waived prescribers can treat new patients with buprenorphine based on a telephone call only. The Controlled Substances Act (CSA), enforced by the DEA, requires all new patients being treated with controlled substances to have an in‐person — or, for now, telemedicine — physical exam. Now, however, because of the coexisting COVID‐19 pandemic and opioid overdose crisis, the DEA has dropped this requirement. This follows the decision of the Substance Abuse and Mental Health Services Administration (SAMHSA) to allow exemptions from the OTP take‐home regulations allowing stable patients to be given 14 or 28 days of methadone doses, instead of coming in more frequently (see DEA, SAMHSA relax OTP/OBOT regulations due to COVID‐19, ADAW March 23, https://onlinelibrary.wiley.com/doi/10.1002/adaw.32664 ).     

Mental Health Workforce Change Through Social Work Education: A California Case Study

The 2004 CaliforniaMental Health Services Act requires large-scale system change in the public mental health system through a shift to recovery-oriented services for diverse populations. This article describes an innovative strategy for workforce recruitment and retention to create and sustain these systemic changes. The California Social Work Education Center Mental Health Program provides stipends to master's of social work students at 17 California universities. In return, students must work for 1 year postgraduation in community mental health practice. Results of a 5-year study show that stipend recipients closely mirror the diverse demographics of the state, and 94% have remained in community mental health practice. The article also discusses lessons learned and implications for social work education in California and other states.     

Alcohol reinforces both positively and negatively,complicating treatment

The Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act of 2010 require insurance companies to provide parity for mental health and substance use disorders, but these laws, on the books for a decade, aren't being enforced. And insurance companies are taking advantage of this, leaving treatment centers one choice, according to attorney Matthew Lavin: to appeal until they win, and if they don't win, to sue.     

Approved Social Work Training in Northern Ireland: Using Research to Examine Competence‐based Learning and Influence Policy Change

This article reports on how research activity helped describe and analyse ASW (Approved Social Worker) learning experience as well as acting as a catalyst for change and development in policy and practice in Northern Ireland. The paper contextualizes the study by outlining the legislation, the main features of the ASW role and the approach to ASW training in Northern Ireland, and by reviewing the literature on the efficacy and value of competence‐based learning. While the findings do not provide conclusive evidence that a competence‐based approach is inherently more effective than previous courses, they do indicate that candidates who were trained in this way were moderately more satisfied than those who had participated in non‐competence based programmes. The research also highlights the importance of the interrelationship between training, practice experience and support in developing and sustaining competence. The paper concludes with a review of the recommendations arising from the study and an analysis of the developments in training and regulations relating to practice experience and re‐approval of ASWs since publication of the research. The study is of contemporary interest given the proposed changes to the role of ASWs/Mental Health Officers in the context of the reviews of UK mental health law.     

Initial moves with school-family conflict: Entering,engaging and contracting

When beginning with a situation involving the dysfunction of a child, the clinical social worker should take care to enter and engage the relevant family and school systems in a manner that gives the best chance for effective treatment. Using an ecological-systems perspective, the authors discuss problem development as a process, and present a model that searches for accessible variables and establishes an early narrow contract. These moves earn the clinician a place in the system, credibility, and the leverage to work for change.The model of practice presented here is partially based upon work done in 1977–1983 with students of the Columbia University School of Social Work in a student unit based at the Kings County Hospital Center, Brooklyn, New York. The unit was funded by the National Institute of Mental Health Community Mental Health M.S. Program (Grant#5T01-1389505).     

As HIPAA changes loom,patients demand continued confidentiality for SUD records

In last week's issue, we wrote about the plans by the federal Department of Health and Human Services (HHS) to weaken the Health Insurance Portability and Accountability Act (HIPAA), citing regulatory burdens and the need for information‐sharing (see ADAW, Jan. 21). The plans, detailed in a request for information (RFI) issued Dec. 12, throw a wrench into the plans by the “make 42 CFR Part 2 like HIPAA” movement, which would erase the federal confidentiality regulation protecting substance use disorder (SUD) treatment records by watering it down to HIPAA standards. Now, with even HIPAA seeming too burdensome, the need is even greater to protect the consent provision of 42 CFR Part 2 — which is basically all that's left after the Substance Abuse and Mental Health Services Administration (SAMHSA) allowed information‐sharing for the vague “health care operations” without consent last year (see ADAW, Jan. 8, 2018). Last week, H. Westley Clark, M.D., J.D., dean's executive professor at Santa Clara University and former director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration, made this abundantly clear in his comments to ADAW.     

Men of the Flesh: The Evaluation and Treatment of Sexually Abusing Priests

The Roman Catholic Church in the United States is experiencing a financial, psychological, public relations, theological, and spiritual crisis over priests who sexually abused minors or acted out sexually in a variety of ways and members of the church hierarchy who covered up their crimes in order to prevent scandal. In this chapter I discuss the problems of sexuality among errant clergy through my work at The Institute of Living, Hartford Hospital's Mental Health Network.

I argue that if change is to take place in the Roman Catholic Church, it must be systemic and Catholic moral theology needs to develop a more developmentally and scientifically sound narrative of human sexuality for parishioners and clergy.     

Devils and deep blue seas: the social worker in-between

This paper examines the role of the approved social worker, as defined by s.114 of the Mental Health Act 1983, with particular regard to ethical dilemmas in crisis intervention. Issues of management accountability, health and safety are set against the approved social worker's statutory responsibility to assess people experiencing mental health problems and, where necessary, admit to psychiatric hospital under compulsion. Consideration is given to the impact of this work upon the worker, on whom extreme and sometimes conflicting demands are made. An attempt is made to integrate these viewpoints within a fundamentally psychodynamic perspective.     

Custodianship and its implications for the Children Act

SUMMARY. Custodianship of children was introduced by the 1975 Children Act, but not implemented until 1985. It has now been overtaken by new concepts in the 1989 Children Act, but the experience thus far provides useful indications of how Residence Orders may be operated. Based on Department of Health funded research, this article shows how careers and birth families see such measures designed to give security to children while maintaining contact with their original parents. The article gives important information to all professionals who will have to work with the new principles of parental responsibility.     

From tragedy to triumph: a segue to community building for children and families

In 2000, more than 60 nonprofit agencies, health care providers, government officials, and community advocates in Tarrant County, Texas, came together to work for systemic change in the mental health care system. The coalition, known as the Mental Health Connection, began working toward a "No Wrong Door" approach to mental health services, which required aggressive coordination between federal, private, and nonprofit resources. The result is a five- to six-year plan for implementation of a new systems of care model for children with severe emotional disturbances and their families. The Mental Health Connection also focuses on legislative advocacy to bring about necessary policy changes at the local, state, and federal levels. Finally, the coalition focuses on developing sustainable revenue streams that will allow the new systems to remain in place once the group accomplishes the initial mission of the Mental Health Connection.     

The Efficacy of Involuntary Treatment in the Community

SUMMARY

Since the passing of the Mental Health Act (1986), Victoria, Australia, has implemented Community Treatment Orders (CTOs) as an alternative to involuntary inpatient admission for patients who are assessed as unable to be treated less restrictively but in an effort to avoid frequent hospital admissions. It is estimated that currently 3,000 people are annually placed on CTOs in this Australian state. The following article will review existing international and national literature on the subject of forms of involuntary treatment in the community before reporting on the findings of a research project that focused on gaining both consumer and service provider perspectives on the efficacy of CTOs. The research method was largely qualitative, involving three focus groups attended by 30 consumers, as well as 18 individual interviews with service providers. The aim of the project was to offer a voice to both consumers and service providers about their experiences and views of current practice and policy implementation in an area that can have a profound effect on the rights of consumers. Findings suggest that CTOs involve complex decision-making that tests professionals' ability to make judgements about legal and clinical processes. Consumers were generally dissatisfied with many aspects of the use of CTOs and both groups tended to view CTOs as stigmatising and disempowering. There were a variety of views expressed about the process of admission, discharge, and community supports. The article concludes by discussing the findings in the context of existing national and international literature and makes a number of recommendations about law reform, and service provision.     

Youth Advisors Driving Action: hearing the youth voice in mental health systems of care

The Children's Mental Health Initiative (CMHI) is funded by the Center for Mental Health Services within the Substance Abuse and Mental Health Services Administration. CMHI assists communities in developing comprehensive, coordinated services for children with serious emotional disturbances and their families. Broadly speaking, these systems are designed to be child centered, youth guided, family driven, community based, and culturally competent. To assure implementation of the "youth-guided" core value in the national evaluation, an advisory group of youth coordinator/youth teams representing communities across the country was developed. This group chose the name YADA-Youth Advisors Driving Action. YADA has made a substantive contribution to national evaluation efforts by bringing the youth perspective and voice to its audience at the community and national levels. This article describes YADA's founding and development, as well as related implications for psychosocial nurses.     

NAATP keeps focus on parity

We need to move beyond the principle of parity into the practice of parity.” These words from Mark Dunn, director of public policy for the National Association of Addiction Treatment Providers (NAATP), in an interview with ADAW last week are a sign of the frustration with how parity — the Mental Health Parity and Addiction Equity Act (MHPAEA), which guarantees that substance use disorders (SUDs) will be treated no differently from medical and surgical claims in the world of reimbursement — has been a real‐world disappointment to patients and providers alike.     

Two decades of serving children with autism in the People’s Republic of China: achievements and challenges of a state‐run mental health center

This article presents the results of research conducted at the first place where autism was diagnosed in China, the Nanjing Child Mental Health Research Center. The purpose was to examine the development of service provision for children with autism in this state‐run medical institution. Specifically, the specific intervention model for autism, factors influencing the development of this model and how structural and organizational features of the institution impact on the implementation of that model are examined. Results indicate: (1) the importance of family involvement in intervention due to limited services in China; (2) the challenges of providing educational services at a medical institution during the reform period. The implications of these services in contemporary China are significant to consider as an important way to address the rights of individuals with disabilities to have equal opportunities in society, beginning with early education.     

Table of Contents

New Treatment Money for West Virginia Providers under Justice Reinvestment Act OTPs Confront Price Challenges as They Diversify Drug Options Documentary Trailer Outrages W.Va. Town SUDs Mentioned at White House Meeting on Mental Health $26.9 Million Increase for SA Services in Texas Budget NIAAA Study Shows Varenicline Reduces Alcohol Consumption BFC and Hazelden Pursue Alliance State News Names in the News Resources Coming up     

Recovery Month will take place: Faces & Voices of Recovery will run it

Last week, we reported that the Substance Abuse and Mental Health Services Administration is walking away from its sponsorship of Recovery Month (see “After 30 years, SAMHSA walks away from Recovery Month,” ADAW, July 8, https://onlinelibrary.wiley.com/doi/full/10.1002/adaw.32770 ). This is correct. However, what needs clarification is this: Recovery Month will still take place, hosted by Faces & Voices of Recovery. Philip Rutherford, director of operations of Faces & Voices of Recovery, told ADAW in an email last week that the organization “is excited to host the Recovery Month website, previously found at recoverymonth.gov .” The new site “will contain a repository for the 2020 Recovery Month digital assets, like graphics and display banners for anyone to download and use, and more. Equally as important, organizations will be able to post information about their events on the Recovery Month calendar.” These materials have “been a staple of the event for years, and Faces & Voices is pleased to be able to keep it going.”