Skip to comments.Five-Point Action Plan for President Obama to Reduce Violence by the Mentally Ill
Posted on 12/17/2012 12:19:31 PM PST by neverdem
President Obama said the federal government has to do something meaningful to prevent future shootings, like the recent massacre of 26 children and adults at a school in Newtown, Connecticut. Here is what the federal government can do to prevent violence related to mental illness:
1. Start demonstration projects of Assisted Outpatient Treatment (e.g. Kendra’s Law in New York, Laura’s Law in California) throughout the country. AOT allows courts to order individuals with mental illness to stay in treatment as a condition of living in the community. It is only applicable to the most seriously ill who have a history of violence, incarceration, or needless hospitalizations. AOT is proven to keep patients, the public, and police safer. The Department of Justice has certified AOT as an effective crime-prevention program. But mental-health departments are reluctant to implement AOT because it forces them to focus on the most seriously ill. Demonstration projects would help mental-health departments see the advantage of the program. (For why some people with serious mental illness refuse treatment, see this. See also how Assisted Outpatient Treatment laws (Kendra’s Law in NY and Laura’s Law in CA) keep patients, the pubic and police safer
2. Write exceptions into the Health Insurance Portability and Accountability Act (HIPAA) so parents of mentally ill children can get access to medical records and receive information from their children’s doctors on what is wrong and what the children need. Right now, for reasons of “confidentiality,’ doctors won’t tell parents what is wrong with their kids or what treatment they need, even as they require parents to provide the care. As a result, when a child goes off treatment, the parents’ hands are tied. They have all the responsibility to see the person is cared for, but none of the information or authority to see it happens. We have to change the patient confidentiality laws so parents can help prevent tragedies rather than become a punching bag for the public when something horrific happens.
3. End the Institutes for Mental Disease (IMD) exclusion in Medicaid law. This provision tells states: “If you kick someone out of the hospital, we will pay you 50% of the community care costs.” This causes states to lock the front door of hospitals and open the back door, regardless of whether the community is an appropriate setting. If you have a disease in any organ of your body, other than the brain, and need long-term hospital care, Medicaid pays. Failing to pay when the illness is in the brain is federal discrimination against persons with mental illness. I wrote on Medicaid discrimination for the mass market in the Washington Post, but John Edwards wrote a more scholarly paper on ending the IMD Exclusion. Relatedly, a proposal made by former vice-presidential candidate Ryan, under which Medicaid was block-granted could solve this problem.
4. Create a federal definition of serious mental illness, and require that the vast majority of mental-health funding go to it. Due to mission creep and the tendency to diagnose normal reactions of people as a mental “health” issue, government agencies now claim that 40 percent or more of Americans have a mental ‘health’ issue. Worst, most mental “health” funding currently goes to this group of the highest functioning. But only 5 to 9 percent of Americans have a serious mental illness. That’s where we should be spending our money — on the 5 to 9 percent who are most likely to become violent and need help, not the worried well. There is more than enough money in the mental-health system to prevent Newtown-type incidents, provided it is spent on people who are truly ill, not the worried-well. I wrote on this for a mass market on Huffington Post, but a much more scholarly paper was written by Howard H. Goldman and Gerald N. Grob. With the fiscal cliff approaching, prioritizing the most seriously mentally ill for services is more important than ever.
5. Eliminate the Substance Abuse and Mental Health Services Agency (SAMHSA). SAMHSA is the epicenter of what is wrong with the American mental-health system. SAMHSA actively encourages states to engage in mission creep and send the most seriously ill to the end of the line. They provide massive funding to organizations that want to prevent mentally ill individuals from receiving treatment. They have nothing positive to show for their efforts in spite of a massive bureaucracy that meets and meets and meets and never accomplishes anything. I wrote on this for a mass market in the Washington Times (PDF) and Huffington Post. But Amanda Peters wrote a terrific scholarly piece on SAMHSA(PDF)
for a law journal.
If Obama is serious about wanting to do something, the steps above would be the best first step. True, the mental-health industry may throw a fit as they find themselves obligated to serve the most seriously ill, but it’s the right thing to do. Anything else could be deadly.
Here is what states should do.
States should make greater use of Assisted Outpatient Treatment, especially for those with a history of violence or incarceration. AOT allows courts to order certain mentally ill people to stay in treatment as a condition of living in the community. AOT works. New Yorkers remember Larry Hogue, the “Wild Man of 96th Street,” who kept getting hospitalized, going off meds, terrorizing neighbors, and going back into the hospital. Connecticut does NOT have an AOT law on the books (see these facts about the Connecticut mental-health system), and we can’t say for sure if it would have helped in this case, but all states should have one to prevent similar incidents.
• States should make sure their civil-commitment laws include all the following, not just “danger to self or others: (A) Is “gravely disabled”, which means that the person is substantially unable, except for reasons of indigence, to provide for any of his or her basic needs, such as food, clothing, shelter, health or safety, or (B) is likely to “substantially deteriorate” if not provided with timely treatment, or (C) lacks capacity, which means that as a result of the brain disorder, the person is unable to fully understand or lacks judgment to make an informed decision regarding his or her need for treatment, care, or supervision.
• When the “dangerousness standard” is used, it must be interpreted more broadly than “imminently” and/or “provably” dangerous.
State laws should also allow for consideration of a patient’s record in making determinations about court-ordered treatment, since history is often a reliable way to anticipate the future course of illness. (Currently, it is like criminal procedures: what you did in the past presumably has no bearing, so the court may not know past history when deciding whether to commit someone. In fact, there are ways to know which mentally ill individuals become or are likely to become violent.)
– D. J. Jaffe is executive director of Mental Illness Policy Org.
I don’t believe Lanza was severly mentally ill. I think he was just another a dylan klebold eric harris columbine wannabe just like the virgina tech massacre guy.
that’s what I think. probably tired of living and decided to take a bunch of people with him on the way out.
When someone starts by using condescending sarcasm, you can tell that the quality of the reasoning is going to be unimpressive.
I would point out that the fifth item on the list involves the abolition of SAMHSA, which is something that even a faux Constitutionalist like Ron Paul would endorse.
Issues relating to confidentiality, as represented in item 2, speak to an issue that is of very recent "Constitutional" vintage. You wrote:
Privacy restrictions are upon the government, not on other parties.
While that's not coherent English, I take it that you are arguing that there is some kind of absolute Constitutional "right to privacy." If there is, that "right" was unknown until it emanated from the penumbras of the Warren Court in the 1970s.
The second item quite reasonably argues that if someone is going to be legally liable for the health of their dependent child, they should be allowed to know what the health status of their child actually is.
The third item discusses reducing the ability of Medicaid to provide cash incentives for "treating and streeting" mental patients. If one wants to argue that Medicaid is unconstitutional, I'm not sure why reducing Medicaid's power and scope, is somehow even more unconstitutional than Medicaid itself.
The fourth item calls for the tightening up of the definition of mental illness to focus on those who are truly mentally compromised, instead of the very broad and open-ended federal standards we have now. This again calls for a narrowing of federal power and arbitrariness and a reining in of federal overreach. I'm not sure how this is unconstitutional but the existing very broad and formless federal mandate is somehow constitutional.
And the first item, calling for a federal law to ensure public safety is kind of the point of federal legislation in the first place.
let's continue the fiction that some vast intelligence is invested in Washington DC and that they'll come up with some solution
These 5 points are not calling for intellectual gymnastics, but common sense and the reduction of the power and discretion of federal entities.
He was on Fanapt, which is a powerful anti-psychotic.
You do not give something like that to an individual who is merely irritable and rebellious.
That is not surprising that he was on those meds. But I will wait for other evidence before I say anything further.
HIPPAA prevented Adam Lanza’s mother from receiving any information regarding her sons treatment once he turned 18.
The state in which he lived, CT, does not have laws allowing for court ordered outpatient treatment and very stringent commitment standards the prevent hospitalization until harm has occurred.
Perhaps if the system didn’t make it so hard to get help, help would have been more likely to be sought and gotten.
These proposals won’t prevent future incidents 100%, but leaving things the way they are now guarantees it will happen again.
I have seen this before with a relative with schizophrenia (a VA out-patient yet) and his mother ended up having to call the police on him, fortunately no guns around the house.
When they go off their meds they become more and more delusional until they think that they are God and Satan and that the world is ending and they are a key part of it. In fact I have seen it with more than one person.
Believe me, you do not want to have to deal with that.
Jail all the Democrats in Washington?
Obama bombs 60+ children in Afganistan with a missile and no one blinks. How is this less devastating than Conn?
This story is pretty good for explaining how serotonin syndrome can happen in people taking SSRIs. I'm sorry if you don't like the NY Times, but its health & science sections were very good as long as they kept away from politics.
Complicating matters is that someone can get into almost the same trouble when they stop taking SSRIs. It's called SSRI withdrawal syndrome. It's also called SSRI discontinuation syndrome.
There should be an FR award for reasoned and logical responses to the knee-jerk posts of people who likely didn't read the original article anyway. Well-said. You deserve the award for today.
Jaffe's arguments are sound, but I think you have pointed out their Achille's Heel. "Reduction of the power and discretion of federal entities" is not easily achieved. It is my opinion that the government has reached that point where it exists only for self-perpetuation, regardless of how well it disguises that motivation via language touting the common good.
And as long as those on the right and the left continue to seek the redefinition of mental illness as "the mindset of my ideological adversary," very little progress in reining in the state is likely to occur.
I’ve had some experience with friends and extended family regarding #2. You have an adult child, a kid away at college perhaps, showing signs that would concern anyone, and you want to help. But no one will talk to you about them or share information because of HIPAA privacy.
What about the suggestion by leftist Harry Bellafonte to remove the GOP conservatives? Give Obama dictatorial power to incarcerate them?
As NYers know, AOT doesn’t go far enough—there are still too many crazy people running through Manhattan with machetes or tossing people onto subway tracks or simply pouncing on people in the streets.
Post signs prohibiting aggressive behavior by mentally unstable people. 30.06
State Sen. Trotters Gun Not Registered, Prosecutors Say(IL)
Ill take Dems seriously on gun control when they have to hang for the same crimes we do.
He should lose his job ,have a criminal record and be barred from public service
Anything can be abused. But these are excellent ideas.
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