Counseling Policy

TRICARE: Will Soldiers and Veterans be Supported?

2005-05-25T10:32:00.000-04:00

You've seen this issue come up several times here at CPB, and now the rubber is hitting the road as the House and Senate Armed Services Committees sit down with TRICARE legislation to consider "a provision to allow licensed professional counselors to practice independently under TRICARE, the military healthcare system, and in Defense facilities. Unfortunately, TRICARE currently does not allow soldiers to see licensed professional counselors without physician referral and supervision. Counselors are also prevented from practicing independently in military treatment facilities and other Department of Defense (DOD) programs. As a result, soldiers have to jump through numerous hoops before they can access mental health services from a counselor.

Representatives Robin Hayes (R-NC) and Walter Jones (R-NC) have sponsored the "TRICARE Mental Health Services Enhancement Act (H.R. 1358)," which would grant independent practice authority to counselors in TRICARE and other DOD programs. Equivalent legislation has not yet been introduced in the Senate, but may be introduced as an amendment to the Defense bill. Because the House and Senate Armed Services Committees are going to be considering the Defense Authorization bill this week, it is essential to contact your members of Congress NOW to ask for their support for recognition of counselors in DOD programs." - ACA Action Alert

Read more background on this legislation here and here. Use your seven minutes today to contact your legislator. Ask them to advocate for soldiers, veterans, and their families through TRICARE.

This Is the Future Unless We Change It

2005-05-16T00:22:00.000-04:00

The Missouri legislature, looking at budget deficits and rising health care costs, voted to cut 90,000 people from their Medicaid rolls. 90,000 individuals have had the social safety net pulled from under them. When the changes take effect in August, elderly and disabled people with incomes that exceed the new cutoff - $579 a month - could lose their Medicaid coverage and be forced to move to nursing homes.

STL Today: "Gov. Matt Blunt signed legislation Tuesday that will scale back Medicaid, the government's $5 billion health care program for the poor.

The changes are expected to eliminate taxpayer-financed insurance coverage for about 100,000 parents, people with disabilities and elderly people. Thousands more will have to pay some of their medical bills.
[...]
Blunt said Medicaid was growing faster than Missouri taxpayers' ability to finance it."

KFVS: "Medicaid patients say they will no longer be able to afford things they need like medications, at home caregivers, and repairs to their wheelchairs. It’s not just Medicaid recipients who are feeling the brunt of these cuts though. These cuts have a trickle down effect, hitting doctors’ offices that rely heavily on Medicaid recipients. One Heartland medical center will probably have to cut certain services for its Medicaid patients soon."

NPR: "For disabled Missourians like 44-year old Irene Schivers, the situation is no less serious. Schivers spends her days in a mobile home she shares with two dogs, a computer and a collection of dolls. Cerebral palsy and lupus have made her unable to work. She says that the new guidelines, with would require her to take in less than $500 a month before Medicaid kicks in, will make her ration food and give her dogs away.

"They want us to die," says Schivers. "We are a burden on society, so they don't care. We don't work, so why should we get anything? Just go ahead and die."

Governor Blunt explained to Missouri citizens that it is morally wrong to raise taxes to pay for the Medicaid program, and he would therefore be forced to sign the budget into law. This question will face every state in the nation because health care costs are rising everywhere. Every state will have to choose between raising taxes, enacting meaningful health care reform, or sentencing America's most vulnerable people to abject poverty without government aid.

Counseling Policy Blog advocates that we stand up for the voiceless, and insist that lawmakers either shore up Medicaid, Medicare, Social Security Disability, Veterans' Benefits and the other vital health care programs protecting the poorest and sickest among us or create and follow through with meaningful health care reform that ensures quality health care for Americans who can't afford it.

The choice is stark: Either care for the poor and sick, or cut them off from government aid and leave them to fend for themselves. For those of you who don't work with Medicaid populations, know that these are families just like yours but with the twin yokes of poverty and health problems. Counselors will advocate for caring, for acting compassionately, for prioritizing the dignity of the sick and disabled.

When these people are forced into nursing home care or into the Emergency Rooms of Missouri hospitals, it is the citizens of Missouri who will pay higher hospital bills and higher nursing home prices. When jails become homeless shelters for the disabled poor, it is Missouri citizens who will subsidize building new jails or new residential care facilities. When families grow desperate, it is Missouri citizens who will bear the brunt. For Governor Blunt to claim that raising taxes is immoral while ensuring that every Missourian will pay more for their own health care is disingenuous at best. Governor Blunt is putting wealthy special interests above the needs of the disabled and above the reality of those citizens who will end up footing the bill.

If you live in Missouri, know that the fight isn't over. Next year's budget will be a new battle, and you can start now to ensure that these bad decisions are publicized and then reversed. For the rest of us, know that our statehouses are also looking at reduced federal money, shrinking industrial tax bases, and skyrocketing health care costs. It's only a matter of time before your state legislature is deciding whether to care for the sick, give tax breaks to the very rich, or create a health care system that is viable for every American.

Let your representatives know where you want them to stand when decision time comes.

CPB will post regularly about the proposed federal budget cuts, and we will do our best to monitor statehouses' moves regarding health care. It's up to you, however, to get involved and initiate change for the better. Make a call...Write a letter...run for office, it's your country and your responsibility. Go get 'em!

Why Are We Advocates?

2005-05-12T11:48:00.000-04:00

Reports by the U.S. Surgeon General and President Bush’s New Freedom Commission on Mental Health have stated some need to know facts regarding mental health in children and adolescents. Remember as you read these facts that, while the government asked for this study in order to know how best to support Americans with mental health, the FY 2006 budget is slashing the programs necessary to provide the services.

Prevalence of Child and Adolescent Mental Disorders
- Four million children and adolescents in this country suffer from a serious mental disorder that causes significant functional impairments at home, at school, and with peers. Twenty-one percent of our nation’s children ages 9 to 17 have a diagnosable mental or addictive disorder that causes at least minimal impairment.[3]

- In any given year, only 20% of children with mental disorders are identified and receive mental health services.[4]

Consequences of Untreated Mental Disorders in Children and Adolescents
Suicide
- Suicide is the third leading cause of death in youth aged 15 to 24. More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.[5]

- Over 90% of children and adolescents who commit suicide have a mental disorder.[6]

- In 2002, almost 4,300 young people ages 10 to 24 died in this country by suicide.[7]

- States spend nearly $1 billion annually on medical costs associated with completed suicides and suicide attempts by youth up to 20 years of age.[8]

School Failure- Approximately 50% of students with a mental disorder age 14 and older drop out of high school; this is the highest dropout rate of any disability group.[9]

Juvenile and Criminal Justice Involvement
- Youth with unidentified and untreated mental disorders also tragically end up in jails and prisons. According to an NIMH funded study – the largest ever undertaken –an alarming 65% of boys and 75% of girls in juvenile detention have at least one mental disorder.[10] We are incarcerating youth with mental disorders, some as young as 8 years old, rather than identifying their disorders early and intervening with appropriate treatment.

Higher Health Care Utilization
- When children with untreated mental disorders become adults, they use more health care services and incur higher health care costs than other adults. Left untreated, childhood disorders are likely to persist and lead to a downward spiral of school failure, limited or non-existent employment opportunities, and poverty in adulthood. No other illnesses harm so many children so seriously.[11]

Early Identification, Evaluation, and Treatment are Essential to Recovery and Resiliency
- Research shows that early identification and intervention can minimize the long-term disability of mental disorders.[12]

- Mental disorders in children and adolescents are real and can be effectively treated, especially when identified and treated early.

- Research has yielded important advances in the development of effective treatment for children and adolescents living with mental disorders. Early identification and treatment prevents the loss of critical developmental years that cannot be recovered and helps youth avoid years of unnecessary suffering.[13]

- Early and effective mental health treatment can prevent a significant proportion of delinquent and violent youth from future violence and crime.[14] It also enables children and adolescents to succeed in school, to develop socially, and to fully experience the developmental opportunities of childhood.

When advocating for the programs and policies necessary to aid our nation's most vulnerable citizens, it's helpful to structure your advocacy around the facts. These facts, having been produced by and for a Republican administration, allow us to contact our Republican lawmakers with confidence. Spend your seven minutes today educating a lawmaker on the needs of our young people, and the short-sightedness of slashing Medicaid.

Seven Minutes a Day

2005-05-10T09:13:00.000-04:00

I've been living through mental health reform for 4 years now in the state of North Carolina. The old public mental health system's been converted into a public/private hybrid that walks like a state bureaucracy and quacks like a state bureaucracy. The reform's stated intentions were to lower costs, increase competition and client choice, and improve quality through a business mentality. Instead we've seen big public agencies go private and subsume other public agencies. We've seen red tape grow thicker and longer. We've seen the entity that administers state dollars struggle through poor management, broken systems, and outright denial. It's been a mess.

I got tired of wringing my hands over the whole situation and got on board with the one private agency that's successfully negotiated the mental health reform tsunami. Through sheer boldness and tenacity, the leaders in this agency have worked tirelessly to get paid for the work we've performed. The state continues down a path that leads right back where they started...but with less money than when they started there.

Rather than sit back and simply watch and groan as bureaucracy after bureaucracy ate away at the funds necessary to meet the needs of western North Carolina's citizens, I decided to channel that energy into something productive. I started writing about political topics on another blog, attending informational meetings and learning what I could about the mechanics of the systems that continue to repeat the same mistakes. I began advocating for legislation that might move our profession and our mental health systems in the right direction. Here's what I've learned so far:

1. It feels great to call a Congressperson's office to advocate for or against a piece of legislation. They work for me. I am the public they serve, and they're obligated to hear me out.

2. One phone call, no matter how impassioned, will not turn the tide of events. A lone opinion won't sway a legislator one way or the other. This rule changes if the one call is from a big donor to the legislator's campaign or is a valued friend.

3. Several phone calls from different people can change the vote of a legislator.

4. Letters and emails are effective if (a) they're not form letters; (b) they're all addressed from within the legislators constituency; and (c)they're in sufficient numbers.

5. Staffers at your legislators office will get to know you if you give them the chance. Even if they don't agree with you, they will still like you if you are polite, consistent, and genuine.

6. It only takes about seven minutes a day to advocate for yourself, your profession, and your clients.

Seven minutes a day. Whether it's making a phone call, writing a letter, sending an email, educating an influential person in your local coffee shop, your seven minutes can add another voice to the growing chorus of those who believe that it is our job as a nation to care for the most vulnerable among us.

If you're a manager, urge your employees to use seven minutes a day to advocate for continued Medicaid benefits for the needy. If you're a therapist, take seven minutes to advocate for mental health parity in insurance claims. If you're a person who uses mental health services, use your seven minutes to call your representative to tell him what you used the mental health system for today. There's no one who can't be a part of this growing movement to advocacy for the mental health professions.

Use Counseling Policy Blog's sidebar to find an organization you'd like to receive legislative alerts from. Use the Congress.org link to find contact info for your representatives. Let me know, by comment or email, how it's going and how I might help.

Seven Minutes A Day.

May is National Mental Health Month

2005-05-09T09:36:00.000-04:00

Most Americans aren't going to know that this is National Mental Health Month just like they didn't know that last month was National Poetry Month. The reason? Too few voices reaching too few ears. As part of our advocacy work, educating the public about mental health issues can have far-reaching effects.

Counseling Policy Blog suggests a twin track approach:

1. Use your professional connections to set up educational forums for local leaders - Sherriff's Department, Police Department, School Principals, Churches, Social Services, and the local press. There's oodles of information all over the web for you to distribute or present. Here's a site you might try for starters:

* The National Mental Health Association is going big guns into this month, and they are dripping with information.

2. Maintain and increase connection to your state and federal representatives who are making top-down policy decisions that will affect us all.

Media and Publicity Guide

One of every two Americans who need mental health treatment do not receive it, and the rate is even lower —and the quality of care poorer— for ethnic and racial minorities.

It's time to grow advocacy, friends. Your efforts and your willingness to incite advocacy in others can bring about a shift in the thinking of policymakers at local, state, and federal levels. But they're not going to come around without our help. Seven minutes of advocacy every day, to your representatives or to other professionals who aren't yet advocating for themselves and their clients, can raise awareness of mental health issues and move mental health towards parity with physical health issues.

Go get 'em, advocates!

If You Live in the D.C. Area

2005-05-06T14:19:00.000-04:00

Consider attending the May 11 Congressional Briefings on Children's Mental Health by the Campaign for Mental Health Reform:

Promoting Resilience and Mental Health:
The Need for Early Intervention for Children and Adolescents
A Congressional Briefing sponsored by the Campaign for Mental Health Reform

In coordination with:
Representatives Tim Murphy and Grace Napolitano, Co-Chairs
Congressional Mental Health Caucus

Wednesday, May 11, 2005
11:30 a.m. – 1:00 p.m.
345 Cannon House Office Building -- Caucus Room
(Lunch will be provided)

The key to enhancing resilience and the mental health of our nation’s children and adolescents is through the early identification and treatment of mental health problems. We invite you to hear from our panelists regarding the scientific basis for intervening early and the cost of failing to provide needed treatment. Several of the panelists will describe their personal experiences and how timely, effective mental health treatment helped them and their families.

Panelists:
Cynthia Wainscott, on behalf of the Campaign for Mental Health Reform and Chair, National Mental Health Association Board of Directors

Kenneth Duckworth, M.D., Medical Director, National Alliance for the Mentally Ill, and Assistant Professor, Harvard University Medical School

Larke Nahme Huang, Ph.D., Commissioner, President’s New Freedom Commission on Mental Health, and Managing Research Scientist, American Institutes for Research

Rosa Maria Gil, D.S.W., Founder & President, Comunilife, Inc; past-President of the Association of Hispanic Mental Health Professionals

Marley Prunty-Lara, student, Augustana College, Sioux Falls, SD and University of Minnesota-Twin Cities, Minneapolis, MN

Morton Sherman, Ed.D., Superintendent, Cherry Hill School District, New Jersey

AND/OR the Senate version:

A Congressional Briefing

Sponsored by the Campaign for Mental Health Reform

In coordination with:
Senators Gordon Smith, Christopher Dodd, Mike DeWine
Jack Reed, Arlen Specter, and Tom Harkin

Wednesday, May 11, 2005
8:30 a.m. - 10:00 a.m.
902 Hart Senate Office building
(breakfast will be provided)

Same Program as above with the same panelists.

Alert your representatives about these important briefings, and if one of your representatives is a co-sponsor, then call to let them know how much you appreciate their hard work advocating for those who depend on mental health services.

America's Most Vulnerable Need Your Help

2005-05-04T18:12:00.000-04:00

Medicaid is slated to be cut by $10,000,000,000. Children and Family services such as Supplemental Security Income (SSI), Temporary Assistance to Needy Families (TANF), child care, foster care and adoption assistance programs, and the Social Services Block Grant are slated to be cut by nearly $7,000,000,000.

That's $17,000,000,000 worth of cuts to Medicaid and other programs for needy families. That means that up to a million families in need of mental health and related services will not receive them. Without adequate mental health care, SSI, TANF, child care, and child welfare services this nation will experience a meteoric rise in unemployment, crime, and broken homes.

The budget's spending targets passed the House and Senate last week, though the House passage could have been stopped if six democrats hadn't failed to show up for the vote:

Representative Edolphus Towns (D-NY 10) (202) 225-5936
Representative Steve Rothman (D-NJ 9) (202) 225-5061
Representative William Jefferson (D-LA 2) (202) 225-6636
Representative Harold Ford (D-TN 9) (202) 225-3265
Representative Lloyd Doggett (D-TX 25) (202) 225-4865
Representative James Clyburn (D-SC 6) (202) 225-2313

If you live in one of these districts, your voice can be very loud in this debate. Time to call and let your representative know that hollowing out the nation's Medicaid, Social Security Disability, Foster Homes, and Social Services Block Grants while doling out over a hundred billion dollars of tax cuts isn't a position you can get behind.

Here are some other cuts in the budget:

Head Start funds would be reduced $3.3 billion over five years, with 118,000 fewer youngsters enrolled in 2010.

The budget cuts food stamps by $1 billion over 10 years, which means 200,000 to 300,000 fewer low-income working families with children will receive nutrition assistance.

The budget cuts $6,600,000,000 from the Pension Benefit Guaranty Corporation.

The budget cuts $4,700,000,000 from Student Loan Programs.

The budget calls for a sell-off of public parks to private interests for total revenue of $175,000,000 over 10 years by privatizing 40,000 individual federal forest properties.

This budget cuts funds for the most vulnerable people in our society.

This budget also offers $106,000,000,000 in tax cuts.

There's a lot a politicking to be done between now and the passage of the budget. Call your Representatives and Senators. Vent some spleen. Argue impassionedly. Or just call and let them know that you support retaining funds for the neediest Americans. No matter how you choose to do it, it's fun.

Medicaid Cuts Pass House and Senate Committees

2005-05-03T11:40:00.000-04:00

Bazelon Center for Mental Health Law: "April 29, 2005—Last night, the Congress approved its budget resolution, which sets spending guidelines for fiscal year 2006. Its approval clears the way for billions in cuts to the Medicaid program, the single most significant source of public financing for mental health services, and for freezing spending on other domestic discretionary programs, including mental health programs, for three years.

The budget resolution passed the House by a vote of 214 to 211 and the Senate by a vote of 52 to 47. It cuts $10 billion over five years from Medicaid, the first such cut to the program since 1997.

[Ed.- Ten House members did not show up to vote at all. Only four of these members could have altered the outcome. I don't have the names of all ten, but here are six of them: Representative Edolphus Towns (D-NY 10) (202) 225-5936; Representative Steve Rothman (D-NJ 12) (202) 225-5061; Representative William Jefferson (D-LA 2) (202) 225-6636; Representative Harold Ford (D-TN 9) (202) 225-3265; Representative Lloyd Doggett (D-TX 25) (202) 225-4865; Representative James Clyburn (D-SC 6) (202) 225-2313.]

Medicaid plays an increasingly crucial role in helping low-income children and their families, the elderly and Americans with mental and physical disabilities to access needed healthcare.

The resolution does not detail where these cuts should come from; instead lawmakers have picked a number based on a desire to cut federal entitlement programs. However, President Bush's proposed FY 2006 budget suggested specific cuts to Medicaid, and lawmakers will likely look to those changes first.

Among the cuts the President proposed were several that would hurt people with mental illnesses who rely on the public mental health system. In particular, significant cuts to targeted case management services were included. Targeted case management is an important community-based Medicaid service for children who require wraparound services to help them avoid school failure, contact with juvenile justice authorities and other adverse outcomes. For adults, it is equally vital in linking them to a range of critical support services, such as housing and employment.

Furthermore, reductions in the number of people eligible and in services covered by the federal government would almost certainly be needed to meet targets in the House and Senate budget resolutions.

Now that the budget resolution has been passed, Congressional committees will use the $10 billion target as a guideline for making specific policy changes to Medicaid and other programs, as well as for setting appropriation levels for other programs, such as those run by the Substance Abuse and Mental Health Services Administration."
[...]
"Although advocates’ efforts to stop Medicaid cuts were not entirely successful, the final budget resolution calls for roughly half of the $20 billion initially called for by the House."

The Time Is Now to Act on TRICARE

2005-05-02T11:08:00.000-04:00

Read Counseling Policy Blog's background on TRICARE legislation here.

ACA: Markup of the Defense Authorization bill is just a week away! Call members of the House and Senate Armed Services Committees today to support inclusion of a provision in the Defense Authorization bill granting independent practice authority for licensed mental health counselors in Department of Defense programs.

TARGETS: Your OWN members of Congress, especially members of the House Armed Services Committee and Senate Armed Services Committee. Click Here and enter your zip code to find contact information for your legislators.

Every phone call they receive is one more nudge towards giving soldiers and their families easier access to quality mental health services. If you've never made a call to your representative, go ahead and take the plunge. While you've got their staff on the phone, maybe you want to let them know about some other issues you have concerns about. Bend their ears, they work for you.

Act Now for Medicaid Families

2005-04-28T06:12:00.000-04:00

{info via Bazelon Center for Mental Health Law:}

Last night, as a result of a widespread effort by mental health professionals across the country, "lawmakers voted overwhelmingly to urge House negotiators to strike Medicaid cuts from the final budget resolution."

"The House voted 348-78 to approve Representative John Spratt’s (D-SC) motion to instruct the members charged with reconciling differences between the Senate and House budget resolutions (conferees) to reject indiscriminate Medicaid cuts. The motion also urges House conferees to accept the formation of a bipartisan Medicaid reform commission called for by the Senate’s budget resolution. House approval of the motion is a major victory against roughly $20 billion in indiscriminate cuts to the Medicaid program, the single most important source of financing for mental health services."

However, "House conferees may still ignore instructions in the Spratt motion and opt for cuts to the Medicaid program and other programs important to people with mental or psychiatric disabilities. Congress Daily reports that the final budget resolution now being hammered out by House and Senate negotiators contains $10 billion in Medicaid cuts and $7 billion in additional cuts to programs many people with disabilities depend on, such as the Supplemental Security Income (SSI) and Temporary Assistance to Needy Families (TANF), child care, foster care and adoption assistance programs, and the Social Services Block Grant."

That's $17,000,000,000 worth of cuts to Medicaid and other programs for needy families. That means that up to a million families in need of mental health and related services will be left behind. Without adequate mental health care, SSI, TANF, child care, and child welfare services this nation will experience a meteoric rise in unemployment, crime, and broken homes.

"The House may consider the final budget resolution as early as this morning. Please call the Capitol switchboard now at 202-224-3121 [or click here for other contact information] to be connected to your Representative and urge him or her to reject any budget resolution that would undermine opportunities for Americans with mental or psychiatric disabilities to lead independent and successful lives in the community. Once you’ve been connected with your Representative’s office ask to speak with the Legislative Assistant handling the budget resolution."

"- Medicaid cuts would be disastrous for people with mental illnesses. Medicaid is the single most important source of financing for mental health services in America.

- Reductions in SSI would have a disproportionately harmful effect on people with mental disabilities, many of whom rely on these programs to help make ends meet. People with mental illnesses make up more than a third of Americans who receive SSI.

- TANF is a critical means of support for people with disabilities. Adults who receive TANF benefits are three times more likely to have at least one physical or mental health impairment than adults who do not receive benefits under the program."

For those of you who haven't yet acted, know that it's a lot easier than you've built it up in your mind to be. The people at the other end of the phone are not smarter than you, they're not savvier than you. They're just people, and their role is to listen to what you have to say and communicate it to your representative. So take the plunge. Contact your representative right now. It'll take you seven minutes, and you'll walk around with an attractive rosy afterglow for the rest of the day.

Go get 'em, advocates.

Keeping Families Together Act

2005-04-27T07:00:00.000-04:00

From Depression and Bipolar Support Alliance:

Should loving parents have to give up custody of their child because the child has a mental illness?

Absolutely not – yet, every year thousands of families must make the heart-wrenching decision to give up custody of their ill child in order to receive mental health services. This is a decision no parent should have to make. Latest figures show that parents placed more than 12,700 children into the child welfare or juvenile justice systems so they could receive treatment. It is a national tragedy that in 2005, families must undergo such drastic measures to get care for a seriously-ill child.

Far too often, in order to get essential mental health services for their child, caring parents must make the choice of custody relinquishment – giving their child up to the state – so the child can qualify for care, or living in poverty in order to keep custody of their child. This inexcusable practice has to end. Custody relinquishment is not a rational choice for society and it’s no choice for families.

Too many children with mental disorders and their families have suffered too long because the system has failed them. State agencies consistently hear from families that seek help for their children, but are offered none.

Staying Together

Hopefully, help may soon be available. A piece of legislation called Keeping Families Together Act (H.R. 823 and S. 380) has recently been introduced to Congress. The bill’s main components include:

- Allocation of $55M to improve access to state mental health and support services for families in danger of losing their children because they cannot afford mental health care.

- Creation of state interagency systems of care as an alternative to custody relinquishment.

- More efficient use of resources to care for children while allowing them to stay with their families.

- Increasing the availability of home and community-based services; improve collaboration among agencies that serve children with mental health needs, including education, child welfare and juvenile justice."

This measure has bipartisan support but has not yet cleared the House or the Senate. These Senators are cosponsoring the Senate version:
Sen Collins, Susan M. [ME]
Sen Bingaman, Jeff [NM] - 2/15/2005
Sen Clinton, Hillary Rodham [NY] - 2/28/2005
Sen Coleman, Norm [MN] - 2/15/2005
Sen DeWine, Mike [OH] - 2/15/2005
Sen Dodd, Christopher J. [CT] - 3/3/2005
Sen Durbin, Richard [IL] - 3/11/2005
Sen Harkin, Tom [IA] - 2/16/2005
Sen Kennedy, Edward M. [MA] - 3/2/2005
Sen Lieberman, Joseph I. [CT] - 2/15/2005
Sen Pryor, Mark L. [AR] - 2/15/2005
Sen Sessions, Jeff [AL] - 3/2/2005
Sen Smith, Gordon H. [OR] - 2/15/2005

These Representatives are cosponsoring the House version:
Rep Ramstad, Jim [MN-3]
Rep Castle, Michael N. [DE] - 2/15/2005
Rep Johnson, Nancy L. [CT-5] - 2/15/2005
Rep Kennedy, Patrick J. [RI-1] - 2/15/2005
Rep Stark, Fortney Pete [CA-13] - 2/15/2005

If you don't see your elected officials' name(s) on this list, then it's time once again to pick up a phone or a pen or a keyboard and let Congress know that this is an easy fix for American families if they'll only take the time to do it.

Iraq War Clinician Guide Available Online

2005-04-26T10:30:00.000-04:00

From the U.S. Department of Veterans Affairs: "The Iraq War Clinician Guide was developed by members of the National Center for PTSD and the Department of Defense. It was developed specifically for clinicians and addresses the unique needs of veterans of the Iraq war. For the complete PDF click Iraq War Clinician Guide, 2nd Edition. You can also download individual chapters".

While you're downloading this excellent resource from the VA, take the time to contact your representatives to encourage them to sign on to H.R. 1358, allowing Licensed Professional Counselors to be full-fledged TRICARE providers. Read more about the TRICARE issue here.

2005-04-25T21:01:00.000-04:00

Haloscan commenting and trackback have been added to this blog.

Support the Homeless

2005-04-25T09:14:00.000-04:00

NAMI: "This past week, a bipartisan coalition of Senators and House members introduced legislation to further the cause of ending chronic homelessness over the next decade. This legislation -- (S 709/HR 1471) known as the Services for Ending Long-Term Homelessness Act (SELHA) -- authorizes funding for a federal initiative to finance services in permanent supportive housing targeted to individuals exiting chronic homelessness."
[...]
"Advocates are strongly encouraged to contact their members of Congress and urge them to cosponsor S 709/HR 1471. Attached is a sample letter. When contacting members of Congress, remind them that:

- People with severe mental illness and co-occurring disorders are disproportionately represented in the chronic homeless population (those who stay homeless for a year or more),
- Permanent supportive housing works to end chronic homelessness by providing accessible, coordinated, and flexible services that lead to recovery and reintegration into community life.
- Funding for services in permanent housing is a critical link in supportive housing and is often the most difficult element for non-profit developers to pull together"

The NAMI page on this subject mentions President Bush's support of this legislation to help the homeless but fails to mention the multiple areas of his FY 2006 budget that will serve to increase homelessness.

The Campaign for Mental Health Reform:

"Radical Restructuring of Flagship Housing Program Threatens People with Disabilities
The Administration’s proposal to block grant the U.S. Department of Housing and Urban Development’s (HUD) Section 8 program, which provides housing to millions of individuals and families, threatens rental subsidies for people with disabilities and would increase overall affordability problems.

Section 811 Housing Funds Cut in Half
The Administration would cut Section 811, which provides new housing units to people with disabilities who need support to live successfully in the community, in half from FY 2005 levels ($238 million to $120 million).

Fair Housing Enforcement Funds Cut
The budget would reduce funds to support fair housing enforcement by more than 20%, hampering enforcement efforts and allowing discrimination against people with disabilities to persist. Complaints of disability discrimination comprise the largest number of complaints filed with HUD and state and local fair housing enforcement agencies."

When you contact your lawmakers to support S.709/H.R.1471 (SEHLA), take the opportunity to let them know that cuts in housing programs will add to the problem that SEHLA is trying to solve. It's not helpful to throw water on a fire with one hand and gasoline on it with the other.

Oppose cuts in housing programs. Ask that the programs' budgets remain unchanged or that they be increased.
Support Mental Health treatment for the chronically homeless through SEHLA.

Take five minutes out of your day to contact your representatives and help the homeless.

Advocacy 101

2005-04-21T09:54:00.000-04:00

Last week, as the ill-considered Bankruptcy Bill passed through the Congress, a colleague sought me out to share her disgust with her representatives who voted for it. I asked her if she'd called her congressman and then gave her the phone number. She was intimidated, never having spoken to her elected officials before, but she said she'd do it.

Twenty minutes later, she found me again, this time all smiles. She laughingly told me how she'd argued the congressman's staffer into the ground on the topic. Her spirits lifted, and she looked forward to calling again.

A lot of people are intimidated by the thought of calling a congressman or senator's office, as though these people are somehow too powerful to be bothered with the opinions of their constituents. On the contrary, I've been informed by the ACA's Washington lobbyists that citizen phone calls, emails, and letters are the most effective way of getting an official's attention.

Here are some tips to help you get started down the path of being an advocate for your family, your town, your profession, and your nation.

1. Know How to Contact your Representatives:

Click Here to find the phone numbers, email addresses, and street addresses of your Federal Congressperson and Federal Senators. Save this info to your computer desktop for easy retrieval.

Click Here to find the contact information for your state and local elected officials. The site is project Vote Smart. You'll see a field on the left-hand sidebar. Enter your zip code and you'll get the information you need.

2. Know What you Want to Talk About When You Call:

Once you've identified an issue that you want to bring to your representatives' attention, learn a little more about it through internet searches or other reading. Ten minutes of preparation will build your confidence and hone your argument.

3. Know That You Won't Get to Speak Directly to Your Representative:

But the people who answer the phones and open the mail get paid to relay information to their bosses. Your concern will not disappear into the memory hole.

4. Be Direct and Concise:

Say what you need to say in a polite, brief, and genuine way. If writing a letter, be sure to include your mailing address in the body of the letter. Elected officials won't pay attention to you if they can't be sure you're a constituent.

5. Ask Questions:

If you ask a question that the staff can't answer, then ask when you should expect to hear back from them.

6. Be Persistent:

Call or Write as often as you'd like. Get to know the names of the staff at your officials' offices. Get them to learn yours.

7. Have Fun!

This is democracy at work. As a citizen you have the right and privilege to communicate in a persuasive way with your representatives. They work for you. Enjoy it! Tell your friends. In fifteen minutes you can go from being a frustrated spectator to a citizen activist.

Counseling Policy will continue to post information on how to improve your advocacy skills and how to vanquish the fears that keep you feeling politically powerless. Please email or comment with your ideas, resources, and tales of advocacy.

Your Own Advance Psychiatric Directive

2005-04-20T07:03:00.000-04:00

{From the Bazelon Center for Mental Health Law:}

"If you are concerned that you may be subject to involuntary psychiatric commitment or treatment at some future time, you can prepare a legal document in advance to express your choices about treatment. The document is called an advance directive for mental health decisionmaking.

Here we offer a set of templates you can use to prepare such a directive. You can use them to:

- tell a doctor, institution or judge what types of confinement and treatment you do or do not want; and/or
- appoint a friend or family member as "agent" to make mental health care decisions for you if you are incapable of making them yourself.

Forms for Creating an Advance Psychiatric Directive

A. Directions for using the forms.

Part I. A statement of your intent in creating an advance directive for mental health care decisionmaking. This emphasizes your strong desire that providers respect your right to influence all decisions about the your care.

Part II. This form lets you name another person to make decisions for you if you are determined to be legally incompetent to make your own choices. Also, your instructions about the circumstances under which you can change your agent and who should be appointed your guardian if a court decides to name one.

Part III. Your instructions about hospitalization and alternatives to hospitalization, medications, electroconvulsive therapy (ECT), emergency interventions (including seclusion, restraint and medication) and experimental studies or drug trials.

Part IV. Your instructions about who should be notified immediately if you are admitted to a psychiatric facility, who should be prohibited from visiting you and who should have temporary custody of your child(ren).

Part V. Here you may choose whether or not you will have the right to suspend or terminate your advance directive while you are incapacitated, if allowed by the law in your state. The section includes space for any other instructions about mental health care.

Part VI. Signature page, on which you and two witnesses sign the advance directive before a notary, after you have filled in the blanks and made any changes you wish.

"Can I change my mind?

You can revise your advance directive at any time unless you have been declared legally incompetent. However, state laws vary about whether you may revoke your advance directive or overrule your own agent after becoming incapacitated. Part V spells out some options describing when you want to be able to revoke, suspend or end this advance directive. A lawyer can explain your state's law in this regard. (Note that only a few states have any specific law on this. As of 1997, Alaska, Hawaii, Illinois, Maine, Minnesota, North Carolina, Oklahoma, Oregon, South Dakota, Utah and West Virginia do.)

Should I see a mental health professional before signing an advance directive?

For your advance directive to be valid, you must be legally competent when you sign it. To protect yourself against any claim that you were not competent when you signed your advance directive, you can ask a mental health professional to conduct a mental status exam and note in your medical record file that you were of sound mind at the time. Ask for a signed copy of this note, and attach it to your advance directive. This is not absolutely necessary, but it can head off future challenges."

55 House Members Sign Letter in Support of School Counseling Program

2005-04-19T13:53:00.000-04:00

ACA: "In an effort to increase funding for the Elementary and Secondary School Counseling Program (ESSCP), 55 members of the U.S. House of Representatives (49 Democrats and 6 Republicans) signed a letter to members of the Appropriations Subcommittee on Labor, Health and Human Services, and Education. The letter, authored by Representatives James Langevin (D-RI), and Rob Simmons (R-CT), urges appropriators to provide sufficient funding for the Elementary and Secondary School Counseling Program (ESSCP) in fiscal year 2006. Last year (FY 2005), Congress provided $34.7 million for the program. President Bush's proposed FY 2006 budget would eliminate all funding for the ESSCP. The ESSCP is the only federal program that helps school districts hire more school counselors. Although the program is small, it plays a critical and fundamental role in expanding students' access to necessary counseling services.

The No Child Left Behind (NCLB) Act expanded the school counseling program to include secondary schools. However due to the statutory funding trigger in ESSCP, unless total program funding exceeds $40 million in a fiscal year, secondary schools are not eligible to apply for the program."

So this is your latest chance to get on the phone, pick up a pen, or type in a web address. Contact your lawmaker to ask if they support secondary school counseling. If not, then you might ask them how they propose to curb school violence, teen pregnancy, and the academic achievement gap. Let them know that secondary school counselors do the work of saving lives one child at a time. Let them know that cutting this vital source of funding from the FY 2006 budget will ensure that thousands of children will be left behind.

Support Medicare Coverage of Licensed Professional Counselors

2005-04-18T11:30:00.000-04:00

{via ACA}

Senators Craig Thomas (R-WY) and Blanche Lincoln (D-AR) have reintroduced the "Seniors Mental Health Access Improvement Act," which would reimburse Licensed Professional Counselors (LPCs) and marriage and family therapists under Medicare. Currently, only a Senate version of the bill exists.

The American Counseling Association (ACA) is continuing its initiative to urge the introduction of a House bill which would cover licensed professional counselors under Medicare. The provision passed the Senate in 2003 as part of the Medicare prescription drug bill, but was excluded from the final legislation enacted into law. ACA is therefore focused on gathering support in the House for Medicare reimbursement of LPCs.

We will be working closely with Senators Thomas and Lincoln's offices to explore options for passage of the provision. Our top priority is finding Congressmen willing to sponsor a House version of the bill. Congress can no longer afford to ignore the problem of mental illness among seniors and the disabled.

Click Here to contact your Congressperson. Ask them to sponsor legislation allowing Licensed Professional Counselors to be reimbursed under Medicare. Let them know that seniors deserve to be able to choose their own mental health care and that the government shouldn't restrict the professionals that citizens want to see. We need Republicans to sponsor this, so if you're a red-district reader, you're the one to get this job done.

Call their offices. You're going to enjoy it.

President's Fiscal Year 2006 Budget At A Glance

2005-04-17T17:05:00.000-04:00

From The Campaign for Mental Health Reform:

Below is a preliminary analysis of the Administration’s proposed funding for some key programs that are important to Americans with mental illnesses.

The Good
Millions in Spending Requested for Youth Suicide Prevention
The President's budget calls for $11.5 million in funding to implement the Garrett Lee Smith Act, legislation Congress adopted last year to reduce the number of young people who commit suicide. Suicide is the third leading cause of death among young Americans.

Administration Invests Significant Resources to End Chronic Homelessness
The Administration proposes to quadruple funding (to $200 million) for the Samaritan Housing Initiative above the FY 2005 request and increase total anti-homelessness assistance to $1.4 billion (a 16% increase).

Funds for State Incentive Grants (SIGs) Increased
The budget includes a $6 million increase in the State Incentive Grants for Transformation (SIGs) above what Congress approved last year for the grants. The budget request for SIGs, intended to help states shore up the tattered safety net for people with mental illnesses, is $18 million less than the President proposed last year.

Funds Maintained for Technical Assistance Centers Previously Selected for Elimination
The Administration’s budget maintains funding (roughly $2 million) for consumer technical assistance centers – which support self-help, peer-to-peer support, and promote the principles of community integration – after proposing eliminations of the centers in previous budget proposals.

Administration Earmarks Dollars for New Prisoner Reentry Initiatives
The President's budget earmarks $75 million for a new prisoner re-entry initiative, $15 million of which would go to the Department of Justice, with the remainder of which would going to the Department of Labor and the Department of Housing and Urban Development. It is unclear how much the initiative will be do to arrest the cycle of recidivism among ex-offenders with mental illnesses.

The Bad and the Ugly

Access to Services
Medicaid – Primary Source of Mental Health Funding – Faces Most Serious Threat
Medicaid is slated for $60 billion in cuts over 10 years and major structural changes that could drastically reduce access to critical services for Americans with mental illnesses who rely on the program. Medicaid is the largest public funder of mental health services.

Funding Inadequate to Patch Holes in the Community-Based Mental Health System
The proposed budget slashes the Center for Mental Health Services’ (CMHS) discretionary budget by $64 million, jeopardizing many programs for adults and children with mental disorders. The budget also freezes funding for many important community-based mental health services under CMHS. Programs affected include:

- The mental health block grant that provides mental health services and supports to children and adults with mental health disorders in their community;
- The children's comprehensive mental health program that supports the development of interagency systems of care for youth;
- PATH, which provides services to individuals with mental illnesses who are homeless or at risk of homelessness; and
- Protection and advocacy services to help people who have mental illnesses to better understand and assert their rights.

Children & Families
Special Education Funding Shortchanges Kids with Disabilities
The budget proposes $11.1 billion for the Individuals with Disabilities Education (IDEA) Act Part B Grants to states, well-short of what has been authorized to help schools and states implement the special education services required by the IDEA .

Veterans
Veterans Services May Deteriorate
Proposed increases for Veterans Administration (VA) medical services are illusory, at best. Funding increases are based on speculative revenue sources, including deceptive "management efficiencies" of $430 million, payments from veterans ($424 million) based on legislation Congress is likely to reject, and vastly inflated projections of third-party collections. The budget also proposes cutting VA's health care staffing – by more than 3,700 employees – at a time of war and mounting casualties. With what amounts to flat-funding (in the face of rising medical care inflation), the VA's FY 06 budget is a recipe for a deterioration in timeliness, access, and even quality of care – especially for veterans with mental health problems.

Employment
Workplace Supports Cut or Flat-Lined
The Administration’s budget would eliminate important assistance to individuals with mental illness in the workplace that has, until now, been offered through the federal supported employment program (previously funded at $37.4 million via the Department of Education) and provide no funding for several other important programs. Funding has also been reduced for services and supports available through the Department of Labor that assist individuals with disabilities in rehabilitation. The Work Incentives Grants to help individuals with disabilities gain employment is level funded at $19.7 million.

Housing
Radical Restructuring of Flagship Housing Program Threatens People with Disabilities
The Administration’s proposal to block grant the U.S. Department of Housing and Urban Development’s (HUD) Section 8 program, which provides housing to millions of individuals and families, threatens rental subsidies for people with disabilities and would increase overall affordability problems.

Section 811 Housing Funds Cut in Half
The Administration would cut Section 811, which provides new housing units to people with disabilities who need support to live successfully in the community, in half from FY 2005 levels ($238 million to $120 million).

Fair Housing Enforcement Funds Cut
The budget would reduce funds to support fair housing enforcement by more than 20%, hampering enforcement efforts and allowing discrimination against people with disabilities to persist. Complaints of disability discrimination comprise the largest number of complaints filed with HUD and state and local fair housing enforcement agencies.

Criminal and Juvenile Justice Programs
New Program to Address Criminal Justice Crisis Lacks Funds
The recently enacted Mentally Ill Offender Treatment and Crime Reduction Act, bipartisan legislation to address the high numbers of people with mental illnesses who are flooding the criminal and juvenile justice systems, receives no funds under the President’s budget. This law authorizes funding for states and communities to use for jail diversion, community re-entry, correctional mental health treatment, and cross training of law enforcement, corrections and mental health personnel.

Jail Diversion and Community Re-entry Initiatives Lose Funding
The Administration proposes eliminating Byrne Discretionary Grants, an important source of funding to help states finance a number of jail diversion and community re-entry initiatives, crisis intervention programs and mental health courts targeted for youth and adults with mental or emotional disorders.

Deep Cuts for Juvenile Justice Programs
The Administration proposes deep cuts in funding for several juvenile justice programs. Total funding for these programs would be reduced by 46% from FY 2005. The Juvenile Accountability Block Grant would be eliminated and funding for the Juvenile Justice and Delinquency Prevention Act would be reduced.

If you'd like to help your Congressperson or Senator to know where you stand on these budget areas - CLICK HERE - and tell them.

TRICARE

2005-04-16T12:04:00.000-04:00

As former VA Secretary Anthony Principi has said, the Iraq war's guerilla fighting and prolonged tours are having a profound effect on the mental health of the vets coming home. "This type of war – insurgency warfare – where you don't know whether you're going to be the next victim of a car bomb or roadside bomb or (rocket-propelled grenade)... it's like fighting in Vietnam." According to the New England Journal of Medicine, 15 to 17% of Iraq veterans suffer from major depression, generalized anxiety, or Post Traumatic Stress Disorder. {via Operation Truth}

Meeting the mental health needs of U.S. veterans and their families are at the heart of H.R. 1358, sponsored by Rep. Robin Hayes (R-NC). Rep. Hayes, a member of the House Armed Services Committee, has introduced legislation granting counselors independent practice authority under TRICARE, the military healthcare program, and in other Department of Defense programs. Rep. Walter Jones (R-NC) has signed on as an original cosponsor of the legislation. A Senate version of the legislation has not yet been introduced, but similar provisions are being considered for inclusion in the Defense Authorization Act.

Rep. Hayes chose to introduce the legislation because of his concern for the ability of soldiers and their families to access mental health services. Access to TRICARE-covered providers is especially worrisome in rural areas of Rep. Hayes’ district, where Guardsmen and Reservists may not live close to military treatment facilities or VA hospitals.

Currently, TRICARE and the Department of Defense do not recognize Licensed Professional Counselors. While Social Workers, Psychologists, and Marriage and Family Therapists are well-equipped to deal with the problems of our veteran populations, they are too few to handle the increasing numbers.

Veterans and their families will have easier access to mental health care if H.R. 1358 is included as part of the FY2006 Defense Authorization Act. You can help.

Click here, type in your zip code, and send a message to your Senators and Representative (especially if they're Republicans). Urge your lawmakers to include Licensed Professional Counselors in TRICARE, so veterans and their families can have better access to the mental health services so many of them need.

Counseling Policy Blog

2005-04-10T20:50:00.000-04:00

This blog will function as a forum to advocate, spur, chide, support, and inform.