It's been a year since the tragedy in Newtown, CT took so many lives, including that of the gunman, who some believe was battling serious mental illness but may not have gotten all the treatment he needed.
We’ve heard lots, since then, about the need for more mental health resources, and lots about the rollercoaster ride of federal and state funding for those resources. Here’s a round up of some of the year’s most significant developments for mental health patients and advocates:
- $100 million more in funding for community and rural mental health services: VP Joe Biden announced this week new funding for these centers to hire more providers and offer more services. A press release from Sen. Sheldon Whitehouse’s office said that could help 172,000 Rhode Islanders, but I am waiting for a response from his office on how this group would be helped exactly, and who they are (people with or without insurance, people already in the system or estimated to need services?).
- We finally got the final rule - the specifics - on The Mental Health Parity and Addiction Equity Act of 2008.This means insurers have their marching orders in terms of how and what they have to cover when it comes to mental health and substance abuse treatment. Also, new health insurance plans under Obamacare must cover mental health, and next year you can’t be denied coverage based on a pre-existing illness, including a mental illness.
- The Associated Press Stylebook added an entry on mental illness, which is significant because it helps codify for reporters how to cover and talk about mental illness. After a mass shooting, it seems, there’s always speculation and inaccuracy about who the shooter is and what might be or have been wrong with him. Getting that right, and avoiding drawing unsupported conclusions, is not only good journalism, it’s what helps fight unfair stereotypes and stigma surrounding mental illness.
- Access to mental health services is still an issue. A recent JAMA Psychiatry study found that only about 55% of psychiatrists accept private insurance, and even fewer accept Medicare and Medicaid, and the numbers are going down. That means psychiatric help is out of reach for many who might need it but can't afford it.
- Connecticut has made some progress, it seems, on empowering law enforcement, school officials, and health care providers to recognize and deal with serious mental health issues and trauma in children, including getting hundreds trained to screen kids for stress and trauma.
- There's now several hours of training for police academy recruits in dealing with mental illness on the job, and the Warwick Police Dept. even has a full-time captain responsible for mental health crisis response. That's because not everyone who seems crazy or even threatening needs to be locked up; sometimes they need a health professional's evaluation and the right treatment.
- Rhode Island lawmakers are trying to figure out how to collect and report mental health records in order to comply with the requirements of the National Instant Criminal Background Check System (NICS), which is part of the background checks for buying a firearm. But as Projo reporter Phil Marcelo pointed out, they've got their work cut out for them, first just in terms of the language on the books: lots of old laws using antiquated language for mental illness ("habitual drunkard," "mental defective," "adjudicated mentally incompetent?"). The terms are not only inconsistent within state law and between state and federal law; they confuse instead of clarify what we mean when we talk about mental illness and substance abuse. In other words, how can you collect and report records intended to bar someone from buying a gun when there's no consistent target?
- Accidental death by prescription drug overdose surpassed car accidents as the leading cause of accidental death in the US. In Rhode Island, drug overdose is practically an epidemic - and that's not hyperbolic, it's how public health officials and epidemiologists describe the problem here - and the numbers show no sign of abating. Addiction and substance abuse are huge mental health problems here. And there are more steps we could be taking to tackle them, but progress on some (like getting more prescribers to use the state's online prescription drug monitoring program) has been slow. It seems that every week I see piles of "consent orders" citing Rhode Island physicians for overprescribing controlled substances like Oxycodone, known to be incredibly addictive as well as incredibly lucrative when resold on the street.
- When it comes to the availability of mental health treatment, the number of community mental health facilities has gone up by nearly 50%, but the number of residential treatment beds in state psychiatric hospitals has gone down significantly, according to SAMHSA (see tables on mental health treatment availability). The "Behavioral Health, United States" report also found that only about 38% of adolescents with mood disorders - such as bipolar disorder - get the treatment they need. Part of that might be a lack of insurance coverage, because kids on state health insurance programs were likelier to get treatment. Getting the treatment you need at the level and duration you need it may still be a challenge; have you had any frustrating experiences trying to get treatment for yourself or a loved one, only to be told you have to exhaust the lower levels of treatment first?
- The American Psychiatric Association released the fifth iteration of its diagnostic manual, the DSM-5. This is the sometimes controversial guide to psychiatric disorders which not only helps clinicians standardize diagnoses but is also used by insurance companies to determine what gets covered. There were some significant changes from the previous edition, including stricter guidelines for diagnosing autism, reclassifying bereavement as more of a temporary, natural state and not a disordered one, and newly added disorders such as "body dysmorphic disorder," hair pulling, skin picking, and hoarding disorders. The National Institutes of Mental Health announced it would not fund research that relies only on a single DSM criteria, because the definitions are based on "clusters of clinical symptoms, not any objective laboratory measure." Instead, they'll be funding projects that cross categories, and especially those devoted to finding underlying neurological causes. Just another example this year of the battle not only over funding for mental illness but over who gets to define it.