WASHINGTON — Increasing access to hospital beds and treatment for people with mental illness — whether they want it or not, in some cases — is an important step to reforming the country’s broken mental health system, said administration officials and others at a White House Mental Health Summit on Thursday.
“There is no question, sadly, that the way we support and treat Americans with serious mental illness is broken,” said HHS Secretary Alex Azar.
“There is nothing compassionate about letting individuals with serious mental illness suffer from lack of food or housing because their illness prevents them from making rational decisions,” he said, and nothing compassionate about letting them “suffer from symptoms that can cause them to be arrested, and often incarcerated, where they will not get the care and services they really need.”
Eleven million Americans had a serious mental illness in 2018, and one-third received no treatment, Azar said, citing data from the Substance Abuse and Mental Health Services Administration (SAMHSA).
Azar said the 2020 appropriations bill boosts SAMHSA’s funding for assisted outpatient treatment (AOT), also known as court-ordered treatment. A SAMHSA spokesperson said funding amounts to $19 million, an increase of $4 million from fiscal 2019.
The secretary also highlighted other actions geared towards increasing access to mental health services, including approving waivers to the Institutions for Medical Diseases (IMD) exclusion — the decades-old restriction that prevents Medicaid reimbursement for inpatient treatment in hospitals with more than 16 beds — in order to increase access to care.
Two such waivers have been approved in Vermont and the District of Columbia for mental health, and 27 have been approved for substance use disorders, Azar said.
“Inpatient beds are not the solution to everything, but having inpatient beds available is an important part of our armamentarium in dealing with serious mental illness,” Azar said.
He urged states that have not yet submitted an IMD waiver to apply.
“We’re open for business,” he said.
Azar also plugged a new child-centered Medicaid model, the Integrated Care for Kids (InCK) model, which aims to help children access “crisis services” more quickly (program awardees were announced Thursday); and called attention to an advisory meant to help states leverage Medicaid funding to support school-based mental health services.
Finally, he shared that HHS is still looking for ways to modify the Health Insurance Portability and Accountability Act and Family Educational Rights and Privacy Act to improve care coordination broadly, including for people with serious mental illness.
President Trump put in an appearance at the event, offering his perspective on the country’s mental health challenges. He lamented the closure of psychiatric hospitals that began in the 1960s, saying “we must give major consideration to building new institutions.”
In the 1950s, he said, there were hundreds of thousands of psychiatric beds, and by 2016 there were about 37,000.
Other speakers at the summit included Drew Pinsky, MD, the celebrity doctor and addiction specialist, who was tasked with explaining the history of psychiatry in America. Pinsky spoke of the problem of anosognosia — lack of self-awareness about a condition — which can be particularly challenging in the context of mental health and argued for strengthening access to involuntary treatment.
In California, patients who would ordinarily be given a 72-hour hold because they are determined to be a danger to themselves or others, can, within four hours of this decision change their minds, he said.
If within that 4-hour window a person says, “You know what, I’ve thought better of it,” and can confirm that he or she has access to food and a place to live, “that’s it. No treatment. No assessment … you can just go,” Pinsky said.
“Our civil rights have outweighed the self-evident need for treatment,” he said.
DJ Jaffe, executive director of Mental Illness Policy Org. and the author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill, also called for making it easier to access civil commitment.
He argued that mental health advocates have “misled” the police and mental health officials and that any real reform would have to be developed without mental health advocates in the room.
“In order to solve the issues of civil commitment and assisted outpatient treatment, we have to stand up to the [American Civil Liberties Union] to Bazelon, to Disability Rights … to many mental health groups who now believe that being psychotic and delusional is a right to be protected rather than an illness to be treated,” Jaffe said.
Jennifer Mathis, JD, director of policy and legal advocacy for the Bazelon Center for Mental Health Law, told MedPage Today in an email that Jaffe’s views reflect “an extreme fringe of thinking in mental health.”
She decried Jaffe’s “instruction” to “‘leave mental health people out of the room’ when talking to criminal justice systems about people with psychiatric disabilities,” saying “nothing good would come of that.”
Mathis also said that Trump’s comment about expanding psychiatric inpatient hospitals “flies in the face of good practice and all that we have learned over the course of several decades. It is also contrary to federal law, including the requirements of the Americans with Disabilities Act and the Supreme Court’s Olmstead decision,” referring to Olmstead v. L.C., a 1999 Supreme Court ruling against “unjustified segregation” of disabled people.
“It says a lot about the administration’s approach to mental health that the lead speaker at the White House Mental Health summit urged the audience to ‘stand up against’ mental health advocates,” Mathis said.
Last Updated December 20, 2019