Massachusetts, like many states across the country, is struggling to survive a fiscal crisis, while attempting to maintain services for those with mental illnesses. For FY2010, the Commonwealth’s Committee on Mental Health and Substance Abuse (MHSA Committee) has been deliberating a number of bills. The Department of Mental Health (DMH) is closely following four of those bills likely to move through the coming legislative session, according to Anna Chinappi, DMH spokesperson.
An Act Relative to the Coordination of Children’s Mental Health Care (HB 3586/SB 757), if passed, would reimburse mental health clinicians for collateral contact, which is defined as the process by which a mental health clinician contacts a primary care physician, Department of Children and Families (DCF) social worker or teacher to coordinate and integrate the mental health care and other aspects of a child’s life. “This collaborative work is essential to the coordination of a child’s overall health care,” says Chinappi.
Additionally, the legislation would require commercial insurers to cover collateral services, i.e., face-to-face or telephone consultations of at least 15 minutes that are needed to make a diagnosis and develop and implement a treatment plan for children and adolescents under the age of 19.
The Massachusetts Psychological Association (MPA) has been part of the coalition that filed the first children’s mental health bill and remains supportive of this “second wave of benefits,” according to Elena Eisman, EdD, ABPP, MPA executive director/director of professional affairs. “Collateral services are very important and may serve to help keep people servicing children in the public and commercial sectors,” she says.
Chinappi cites An Act Regarding Rights of Persons Receiving Services from Programs or Facilities in the Department of Mental Health (originally HB 1945/SB 743; now SB 2280) as another priority. This bill would add a right to fresh air for individuals in a mental hospital to the current Five Fundamental Rights law. The other rights include the right to reasonable access to receive and make confidential calls; the right to send and receive sealed, unopened, uncensored mail; the right to receive visitors “of our own choosing” daily and in private at reasonable times; the right to a humane environment, including a private and secure living space and the right to access legal representation.
According to Jonathan Dosick, coordinator for CFAR (The Coalition for Fresh Air Rights), this legislation originally focused on a proposed method for fair appeal when any of the Five Fundamental Rights were violated. This language was stricken, but the fresh air component has been retained.
Approximately seven years ago, Dosick began lobbying to add access to fresh air to the fundamental rights law. “As a consumer, I saw a direct correlation with times being outside and overall wellness,” he says. “It used to be a test for readiness for discharge.”
When Dosick began his efforts, 13 hospitals denied patients access to the outdoors; now the number is closer to 30. “Hospital administrators and lobbyists are strongly against the bill citing cost and staffing as reasons,” he says.
Toby Fisher, MBA, MSW, policy director for the National Alliance on Mental Illness of Massachusetts (NAMI) says, “We support the spirit of the bill and feel that fresh air is a benefit and should be part of the treatment; however, we are unclear how to maintain safety with some of the inner city hospitals where there are no open areas safely removed from major streets.”
An Act Directing the Department of Mental Health to Study Peer Run Respite Services (HB 3584) would authorize DMH to conduct a feasibility study for this model. The study should include need and scope of services; associated costs and financing mechanisms; benefits and barriers to a peer-run respite program; review of such models in other states and consultation with other members of the mental health community, according to Chinappi.
Another key legislative concern is An Act Pertaining to People with Mental Illness in Hospital Emergency Rooms (HB 3585). This proposed bill would require the DMH and Department of Public Health (DPH) commissioners to provide a semiannual report on the progress of their joint working group on emergency room treatment of individuals with behavioral health disorders. “The bill also requires data analysis relating to the use of behavioral restraint in certified emergency care units of facilities as defined in section 70E of Chapter 111,” Chinappi says.
NAMI has thrown its support behind this bill. “We feel that the use of restraint and seclusion is always a treatment failure and should be used only as a last resort. The over-use of emergency rooms for psychiatric issues is often due to the lack of access to community based mental health services,” says Policy Director Fisher and adds that emergency rooms should be tracked to develop solid public policy to alleviate restraint and seclusion and wait times.
Chinappi reports that the MHSA Committee has conducted hearings and reported favorably on all the above bills. She emphasizes, “DMH is following these four bills, but doesn’t take any positions on the bills. We are monitoring their progress.”