This list represents brainstorming ideas of advocates from across the country. They individuals, families, journalists, and professionals who are living/working with SMI. They have in-the-trenches experience. The list presents a partial picture of the depth and breadth of SMI issues in 2019. If you’d like a copy of this list and the 5-part plan posted yesterday, send me an email and I’ll send the documents to you. dede@soonerthantomorrow.com Thanks for your help.
1. RECLASSIFY SERIOUS MENTAL ILLNESS (SMI) FROM A BEHAVIORAL CONDITION TO WHAT IT IS, A NEUROLOGICAL MEDICAL CONDITION
2. REFORM THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
Present patients and families with a social worker to support the family unit throughout the care process, including medication and psychiatric treatment.
Require mandatory HIPAA training for everyone in the medical profession and mandate a test on proven knowledge.
Develop a federal program for the administration of an advance directive (PAD) which includes a universal release of information and designates an agent if a patient’s capacity is lost.
3. REPEAL MEDICAID’S INSTITUTES FOR MENTAL DISEASE EXCLUSION (IMD)
4. PROVIDE A FULL CONTINUUM OF CARE
Provide inpatient care (IMD waivers), outpatient care (i.e., AOT, Clubhouses), and housing ( a full array from locked stabilization to unlocked intensive, medium intensive, peer run, PSH, asylum).
Require a psychiatric standard of care for various SMI diagnoses like other medical specialties.
Require prescriptions based on need not ROI for the insurance industry
Remove ER’s as entry for mental illness hospitalization. The ER process and its chaotic environment aren’t conducive to the well-being of SMI patients.
5.DECRIMINALIZE SERIOUS MENTAL ILLNESS
Eliminate solitary confinement in jails and prisons.
Support nationwide civil mental health courts and expand criminal ones that are already established to keep SMI out of jails and prisons.
Establish mental health courts on a federal level, and coordinate federal courts and state-run mental illness facilities.
Move crimes that SMI commit in the federal system into state courts.
Mandate a way for families to provide medical history to jail/prison doctors to inform treatment.
Fund a digitized system for medical records in counties/hospitals to jails so information can be transferred immediately upon arrest and incarceration.
Provide uniform psychiatric screening of the incarcerated.
Use standardized protocols for medication of SMI prisoners.
Require strict limits on waiting for trial time.
6. PAY ATTENTION TO SUPPORTIVE HOUSING
Provide 24/7 supervised housing for those who cannot live independently.
Provide defined levels of support built around a person’s needs, especially long-term care.
Clarify Olmstead for SMI. Lease restrictive care isn’t always least expensive or best.
Examine, don’t ignore, a person’s ability to handle and benefit from a less restrictive setting.
7. REVAMP INVOLUNTARY TREATMENT
Use lack of insight (anosognosia) and grave disability as criteria for determining involuntary treatment.
Establish a federal standardized “need for treatment” involuntary commitment law.
Base restrictive settings on actual abilities, not wishful thinking or one-track plans.
8. INCLUDE EDUCATION
Require mandatory, institutionalized education about SMI for judges, sheriffs, attorneys, district attorneys, law enforcement, and first responders.
Require units of SMI education for educators — preschool through university.
Revamp Crisis Intervention Training and expand training to all counties.
Provide a health proxy form for college students to allow them to release medical information and name who can take care of them in a crisis.
Hold universities accountable and required to connect students to crisis intervention, especially during medical leave.
9. GIVE INCENTIVES
Incentivize the expansion of medical schools to graduate more psychiatrists, child psychiatrists, internists with psychiatry specialties, psychiatric nurse practitioners and physician assistants.
Allow loan forgiveness for providers treating SMI.
Give incentives for rural psychiatrists.
Incentivize more long-term treatment/stabilization of SMI.
Give incentives to psychiatrists to accept health insurance, especially Medicaid.
10. EXPAND ASSISTED OUT-PATIENT TREATMENT (AOT)
Federally clarify AOT and create a federal model for AOT law.
Offer AOT immediately to everyone upon diagnosis.
11. IMPROVE HOSPITALS
Build regional federal hospital for patients who cannot be treated in their home state’s hospitals because of lack of beds.
Improve reimbursements to hospitals which lose revenue on SMI patients.
End hospital discrimination against SMI “violent” patients and those “difficult to discharge.”
12. INCREASE RESEARCH AND EPIDEMIOLOGY
Fund NIMH research specifically for SMI.
Establish a Disability Advocacy Program for legal services for SMI when counties/states fail to provide long-term support services or when insurance/managed care and Medicaid fail to cover/pay for long-term supported services and treatment.
Pursue better national epidemiology studies for people with SMI.
Establish a federal law that requires states to track each SMI diagnosis with bad outcomes like death, homelessness, and incarceration.
13. REVISIT PARITY
Clarify parity for SMI and include Medicaid and Medicare in parity law.
Enforce violations against parity law.
14. ADDRESS SOCIAL SECURITY AND DISABILITY INCOME ISSUES
Change the way social security income for the disabled is taken by states when a patient is admitted to state operated mental health institutions, residential care facilities, and hospitals.
Increase disability income to a level where a person can survive and maintain reasonable housing.
16. CREATE PSYCHIATRIC CAMPUSES
Build psychiatric campuses with multiple levels of care, supportive housing from most restrictive to least restrictive, and separate independent living apartments.
Provide on-campus coffee shops, gyms, recreational facilities, and gardens where people with SMI could work with support as needed.
Provide substance abuse treatment services, AA or NA meetings.