Public Policy and Legislative Agenda

1. PSYCHIATRIC ADVANCE DIRECTIVES

Background

Mental Health America supports and promotes the use of psychiatric advance directives as a tool that offers several key benefits including:

promoting individual autonomy and empowerment in the recovery from mental illness
protecting individuals from being subjected to ineffective, unwanted, or possibly harmful treatments or actions
helping to prevent crises and the resulting use of involuntary treatment or safety interventions such as restraint or seclusion
enhancing communication between individuals and their friends, families , healthcare providers, advocates and other professionals

Although psychiatric advance directives cannot solve the basic problems of mental health systems that are under-funded, fragmented, and often coercive, they do offer an opportunity for consumers of mental health services to express their preferences for treatment and services during psychiatric crises.

Proposals

The enactment of legislation creating specialized psychiatric advance directives. Legislation designed to enable individuals to freely choose the most important elements of the directive for them including: what types of treatment will be covered, what events or determinations will trigger implementation, whether or not and under what circumstances the directive will be revocable.
Legislation based upon the recognition that, while the treatments authorized can be highly beneficial, even life-saving for the individual, many treatments have serious side effects. Therefore, the decision to agree or not to agree in advance to such treatments or to authorize someone else to do so on one's behalf is a serious one which should be accompanied by appropriate safeguards to insure that the decision is fully informed and free from coercion.
Mental health providers must comply with a valid psychiatric advance directive unless to do so would result in serious and imminent physical harm to the individual or others.
Individuals should have the right to release HIPAA protected information to their designated health care proxies and in their psychiatric advance directives.
The DMHMRSAS be required to promote education, training and research towards the successful creation and implementation of psychiatric advance directive programs. Further, the DMHMRSAS be required to promote the development of community dialogues of consumers, family members, friends, advocates, healthcare providers and other professionals to work together in promoting psychiatric advanced directives.

2. ACCESS TO CARE

Background

The underfunded and fragmented nature of Virginia's mental health system continues to adversely impact access to care as follows:

lack of a continuum of services including those in the least restrictive environment
insufficient access to providers from the full range of mental health disciples, including peer providers
lack of real choice of individual providers
lack of full access to culturally competent services
services that are predicated on where someone lives rather than on assessed need
lack of provider accountability for the implementation of clear published standards for access and wait times for emergency care, urgent, and routine appointments
need for the development of integrated policies within and between key Virginia Departments to work on issues of social inclusion
need for the development of an action plan in specific incremental steps with clear timetables to work on stigma, discrimination and prejudice.
absence of a public health approach and population-based interventions

Proposals

In the absence of the full range of mental health services, there should be no further reduction to the beds available to keep people safe.
Growth of trauma-informed services and crisis management supports including in-home crisis stabilization in addition to crisis stabilization units.
Growth of workforce development and training to ensure a full range of providers from all the mental health disciplines.
The development of a range of services for older people experiencing mental illness.
A rapid development of evidence based services for Veterans.
Continued development of strategies and services to divert mentally ill people from jail.
Access to high quality, affordable and personalized preventative, early identification and treatment services in both rural and urban settings
Develop a public health approach and population based interventions.
Encourage the development of pilot programs that seek to bring together primary health care and mental health services in delivering integrated care.

3. CHILD ADOLESCENT SERVICES

Background

The serious shortcomings of child and adolescent mental health services are well documented and include:

a fragmented system that focuses on periods when things have gone wrong rather than on early support and the promotion of preventive programs
a shortage of child and adolescent psychiatrists, psychologists and specialist counselors leading to very limited access to care
limited community based services coupled to a shortage of locally available crisis stabilization and in-patient beds results in children with serious disorders being denied appropriate wraparound, crisis or inpatient treatments. Only 1 in 5 children with serious emotional disorders receive care.
default to other systems being left inappropriately to provide mental health care, notably the juvenile justice system.
an absence of programs to both prevent poor mental health and to promote the mental well being of families

Proposals

Increase funding and evidence based service capacity including wraparound services, crisis stabilization and inpatient beds.
Increase efforts to improve the availability of mental health training for all people working with children and young people and further efforts to increase the number of specialist clinicians for children and adolescents.
Develop an action plan to create accessible information for children, young people and their families about what mental health is and about what services are available.
Utilize the "experts by experiences" in promoting the message that recovery is for everyone.
Encourage mental health screening as part of routine health care.

4. MEDICAID

Background

Virginia is ranked 48th in in the nation for per capita Medicaid spending and 50th for federal grants received for programs such as Medicaid
The low rates of Medicaid reimbursements are limiting the numbers of clinicians who will accept Medicaid.
Medicaid is not used to enable capacity building of mental health services.

Proposals

Enhance eligibility standards for Medicaid to at least 100% of poverty guidance to both increase the Medicaid federal dollars spent in Virginia and ensure that low income citizens begin to qualify for coverage.
Continue access to appropriate and timely medications based on individual need and focus on practice that improve consumer health and contain costs.
Increased provider accessibility to the Medicaid system, including timely and reasonable reimbursement rates.
Develop Medicaid incentive programs that enable providers to work collaboratively to improve the physical health of the many consumers with serious mental illness whose mortality rate is 25 years ahead of the average citizen
Extend Medicaid coverage to former foster care children until the age out of the system.