AN EXTENDED LIST OF SMI ISSUES THAT NEEDS TO BE ADDRESSED by Dede Ranahan

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.

OUR 2020 GRASSROOTS FIVE-PART PLAN TO ADDRESS SMI UPDATED by Dede Ranahan

This plan was developed by dozens of SMI individuals, families, professionals, and journalists from across the country. The five issues included in the plan were voted on from a long list of priorities as top priorities. If you’d like a copy of this plan, a cover letter, and an extended list of SMI needs, email me: dede@soonerthantomorrow.com. I’ll send you the documents so you can forward them to those within your sphere of influence — local, state, and national.

As the number of candidates in the 2020 presidential election cycle continues to decline, it’s important to thank those who’ve dropped out but developed good plans that include SMI — Steve Bullock, Kamala Harris — and to refocus our efforts on the remaining candidates - Republican and Democrat. Right now Buttigieg and Klobuchar have good plans. Warren and Booker are working on plans. The White House will be hosting a summit on Transforming Mental Health Treatment to Combat Homelessness, Violence and Substance Abuse on December 19. Thank you for your help.

2020 GRASSROOTS FIVE-PART PLAN
TO ADDRESS SERIOUS MENTAL ILLNESS (SMI)
(Updated December 3, 2019)

FOR ALL 2020 PRESIDENTIAL CANDIDATES
PLEASE ADDRESS THESE TOPICS IN YOUR CAMPAIGN
 APPEARANCES  AND DEBATES


1. RECLASSIFY SERIOUS MENTAL ILLNESS (SMI) FROM A BEHAVIORAL CONDITION TO WHAT IT IS, A NEUROLOGICAL MEDICAL CONDITION.

WHY RECLASSIFICATION IS IMPORTANT
Reclassification will unlock more research funding and help eliminate discrimination in treatment, insurance reimbursement, and the perception of SMI as “behavioral” condition. SMI is a human rights issue. NIMH ranks SMI among the top 15 causes of disability worldwide with an average lifespan reduction of 28 years.

PRESIDENTIAL ACTION
* Create a cabinet position exclusively focused on SMI.
* Push for Congressional appropriations to include schizophrenia in a CDC program that collects data on the prevalence and risk factors of neurological conditions in the US population.

2. REFORM THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

WHY HIPAA REFORM IS IMPORTANT
Overly strict HIPAA laws make it extremely difficult for families and caregivers to partner in the treatment of their loved ones, resulting in important life-saving medical information gaps. By eliminating this barrier, family support will be strengthened, reducing the chance of relapse, homelessness, imprisonment, and death.

PRESIDENTIAL ACTION
* Work with legislators to change HIPAA law to ensure mental health professionals are legally permitted to share and receive critical diagnostic criteria and treatment information with/from parents or caregivers of SMI.

3. REPEAL MEDICAID’S INSTITUTES FOR MENTAL DISEASE EXCLUSION (IMD)

WHY IMD REPEAL IS IMPORTANT
IMD repeal will increase the availability of psychiatric inpatient beds. The IMD exclusion is not only discriminatory to those suffering from neurological brain disorders, it is a leading cause of our national psychiatric hospital bed shortage. It prohibits Medicaid payments to states for those receiving psychiatric care in a facility with more than 16 beds who are 21-65, the age group with the most SMI.

PRESIDENTIAL ACTION
* Work with legislators to repeal the IMD exclusion.

4. PROVIDE A FULL CONTINUUM OF CARE

WHY A FULL CONTINUUM OF CARE IS IMPORTANT
A continuum of care insures that SMI patients receive early intervention at all stages of their illnesses, long-term care when needed, and follow-up treatment (medications and therapies) when they’re released. It reduces visits to jails, ER’s and hospitals, homelessness, and morgues. A continuum of care provides life-time management.

PRESIDENTIAL ACTION
* Create federal incentives to states which are addressing a full array of inpatient, outpatient, and supportive housing care.


5. DECRIMINALIZE SERIOUS MENTAL ILLNESS (SMI)

WHY DECRIMINALIZATION OF SMI IS IMPORTANT
People suffering with other neurological conditions like Alzheimer’s and dementia can get treatment promptly without being kicked out of their homes to wander the streets until they are arrested and put in jail or prison rather than a hospital. Serious mental illness is the only disease where the doors to treatment are shut unless a crime is committed. This is pure and simple discrimination with the disastrous results we see in our country today — homelessness, incarceration, the disintegration of families, and death.

PRESIDENTIAL ACTION
* Work with legislators and others to change “must be a danger to self or others” criteria.
* Work with legislators and others to change involuntary commitment criteria and redefine it in objective terms based on scientific medical need for treatment. Psychosis, like a stroke, is a traumatic brain injury and needs immediate treatment for the best outcome.

Note: Tomorrow I’ll post the extended list of recommendations.