mental health reform legislation – The Mental Health Reform Blog

Shortage of Child Psychiatrists

Several weeks ago I was incredibly saddened by the news from a colleague and dear friend of mine, also a Duke child psychiatrist, that one of our mentors had passed away in his mid-80’s. He meant so much to me, I wish to mention and memorialize his name in my own little way in this humble esoteric blog. He was Dr. Marc (Marcelino) Amaya (with ‘Amaya y Rosas’ being his full last name).

He was one of the original child psychiatrists in a group that came down to Durham NC from Northeastern training centers to help start the department and to staff it. The other faculty was as were in all major medical centers of the last 50 years, superb instructors and fantastic clinicians that often left us rookies with our veritable mouths open at their insights.

Dr. Amaya started a complete children’s psychiatric hospital I think in the early or mid-1960’s to house what Duke could not offer on its grounds because it was private and not state affiliated and for funding issues. The Children’s Psychiatric Institute (CPI) was a fabulous training center on the level of such other state hospital affiliated and also lesser known than the more celebrated upper crust programs, but every bit as good as any of the Ivy League (Boston, NYC, Philly, etc.) centers such as the late and venerated Dr. Ralph Rabinovich of the University of Michigan at Ann Arbor. CPI has a short term and long term outpatient clinic, a family therapy program that was expanded by this writer and one of the veteran incredibly skilled social workers at CPI, Anne K. Parrish ACSW, LCSW, into a training program for child mental health trainees from Duke and UNC-Chapel Hill medical and graduate schools. Dr. Amaya was a superb supervisor and I always learned untold concepts, techniques, and gems at his feet so to speak. I also accompanied him to the testify in the Golden Days of Psychiatry and Psychology in this country to testify annually before the NC General Assembly (state legislature) as we would advocate for our state funded programs, but also for the private inpatient and outpatient programs at Duke and UNC! So there we would be harassing clinically and statistically the legislators (who in those days seemed to listen better..no matter their party affiliation). It was quite ironic but demonstrated the dedication that Dr. Amaya had to the delivery of mental health services to ALL children of the state and to any agency, institution, training program that was trying to provide such. His program was not his first concern in the statewide scheme of things, it was just another important part of the overall system of resources he foresaw for the state decades before some of them came into existence. He was a short man with a lyrical Hispanic accent that I as a Southwesterner could listen all day long and always feel like, when I was with him, I was a little bit ‘back home’ in the Southwest.”

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Colorado To Cease Using Jails for Mental Health ‘Holds’

Colorado has had the practice of holding patients needing psychiatric evaluation in jail for many years. There are a number of states who utilize the local, county or municipal jails for such purposes around the country. Some observers of the long term history mental health services’ delivery, have chalked up this practice to the lack of hospitals and therefore emergency rooms, in large areas of states that have no psychiatric services. This practice has largely been dropped by most states. It seems to persist especially in western states where communities are far from such facilities and have to rely on the local jails to ‘hold’ prospective mental health patients who need emergency evaluations and there are no suitable mental health resources available locally.

The term mental health ‘hold’ is essentially another term for an “involuntary civil detention” of a person who has not committed a crime but is a danger to themselves or others. Usually, these kinds of orders in Colorado and other states such as Kansas, to permit holding persons against their will for up to 72 hours. Kansas, for the curious reader, is struggling at present with the issue of how to structure their involuntary holding process altogether.

Colorado now is moving legislatively to force the abandonment of this practice for once and all. In an article entitled, “Colorado would outlaw using jails for mental health holds, increase services under $9,5 million proposal,” written by reporter Jennifer Brown and published in the newspaper, the Denver Post yesterday, this attempt at modernizing and providing mental health intervention and referral services before persons in need have to parked in jails is detailed.

The main thrust and corrective action of this bill would be to establish “two-person teams” that would perform evaluations locally and refer persons felt to be having more mental health problems than legal ones, on to suitable treatment resources before they would be placed in a local jail. This bill would ban the use of jails as holding areas for such persons based on an initial judgment of their being a danger to themselves or others, such as persons who made suicidal threats and about whom an emergency phone call has been issued by families or spouses to the first responders who usually are the police.

The bill would further increase the availability of the on call assessment teams, increase local crisis response centers and transportation from rural areas to treatment centers. A “behavior health specialist” would work directly with police on such emergent service requests and in effect intervene to deflect the crisis-bound person in need to treatment rather than to a local jail.

Interestingly enough, the funding for this expansion of statewide largely rural emergency mental health services is envisioned to be funded by monies from the medical marijuana retail industry now legal and growing in Colorado.

Presently, Colorado law permits holding such a person deemed in mental health crisis in jails for up to 24 hours and then mandating disposition such as transportation to a distant behavioral health services center, such as a clinic or a large urban hospital ER, or the state hospital many miles away also. In practice, it appears that such persons in crisis were held for longer than the prescribed 24 hours and that counties found the volume of such patients to be higher than they were equipped to deal with. The article notes one example county had over one hundred persons in its jails in little over a year’s period of time. The article makes mention of the issues seen all over the country, that law enforcement agencies face day in, day out, namely the lack of resources to provide transportation for patients. It notes that counties would face the issue of removing a law enforcement officer from patrol service to the county when a patient would be driven to a far distant mental health service center. The article notes that this is a much bigger problem in the wide open spaces, sparsely populated of Colorado’s western counties. I lived in western Colorado for a few years as a young child in mountainous mining towns and my trips back later in life showed things and population densities had not changed. So I read the dilemmas that the agencies providing mental health or first responder services in the vast reaches of a western state and immediately sensed why.

The article notes that Colorado has the sixth highest suicide rate in the USA, yet is in the bottom half of the states in this country as far as providing adequate mental health/substance abuse services.

Observers of the mental health reform scene in this country may watch Colorado’s admirable restructuring of mental health service delivery efforts through the vehicle of this commendable legislation.

Virginia’s Mental Health Reform Legislative Progress

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What the New 21st Cure Mental Health Law Brings with It Locally

From the Christian Science Monitor newspaper, comes a good article, New reforms to alleviate pressure on local mental health system that lays out what the newly passed this week 21st Cures Act can bring with it at a local area and gives a hint of the tremendous expectations that will arise around this bill.

In the article, the author outlines some of the major features of the bill, but more importantly, shows how its provisions, especially in the legal arena may be expected to both furnish and require the provision of nonexistent services for the mentally ill in the justice system.

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Helping Families in Mental Health Crisis Act Passed the House of Representatives

I have long awaited this juncture, the partial passage of the most significant, and hopefully helpful federal mental health reform legislation in this country since President Kennedy’s 1963 Community Mental Health Center Act, the Helping Families in Mental Health Crisis Act,” or HR 2646. [I would encourage readers to actually follow the link to the text of the bill and give it a studied read]. Politics is ordinarily as an area I steer away from in my public blog writings as for the last 30 years it has been nothing more than a hopeless, dirty, pointless and non-productive quagmire that until recently has held no real relationship to the issues dear to this effort’s mental health professional’s heart.

But the time has come to start commenting upon, openly following in [I hope] responsible medical journalistic fashion, the life, future and fruits and/or unintended consequences of the slow legislative efforts and developments of years of failed political/legislative efforts to repair our long broken mental health care delivery system, both public and private. The Helping Families Crisis Act now appears to be the first piece of legislation with at least a reasonable potential to effect a vast amount of good effort in the right directions and quarters. One of the many recent news articles, printed over the last year or so to keep this bill alive in the public’s mind, prompted my entering into the national discussion regarding this legislation and its significance. I had held off doing so as for months it has appeared that it would be lost in the polarization of the political parties of the last four Presidential terms or buried/ignored because of lack of support since it concerned “mental health issues,” and all their complexities that at time legislators seems to avoid like the plague. But now it has recently “made it over the top,” as it were and appears destined for passage by the Senate in the near fall. In fact, it has seemed to gain a sort of hallowed status as one of those bills that the pols finally realize they had better jump on to the bandwagon rather than ignore any longer. And politically speaking, it has greatly helped that two brave Republican Congressman have fought hard for this legislation and made it politically acceptable to even most extremists to support.”

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