Monday, February 27, 2012

Kudos to Scott Peters of South Dakota - We need his voice in Tennessee!

My Voice: The Argus Leader

The World Health Organization has long recognized that mental health forms the basis for all health. Indeed, mental health disorders account for four of the top 10 causes of disability in the U.S., and they are significant contributors to other leading causes of disability, such as cardiovascular disease. The cost of mental health disabilities in the U.S. exceeds $100 billion annually.

It is significant that the S.D. Health & Human Services Committee, on behalf of the Department of Social Services, introduced SB15 to reduce barriers to mental health treatment and to promote recovery from disabling mental and physical conditions. SB15 was a product of a lieutenant governor’s Behavioral Health Workgroup, consisting of mental health, chemical dependency, medical and legal professionals, consumer advocacy groups, legislative and state agency representatives.

Broadly, the primary outcome of SB15 is that mental health disorders can now be identified and treated earlier — as quickly and effectively as are other serious medical conditions. Upon recognizing the symptoms of a stroke or a heart attack, our loved ones and physicians would never knowingly postpone or fail to administer proven, effective treatment. Yet, in mental health care, for a brain disorder every bit as serious as a stroke, current law imposes roadblocks to effective care and treatment.

Here are a few examples of how SB15 aligns mental health care with other medical care:

A court-appointed guardian of an incapacitated person can generally seek medical treatment for that person’s physical illness, by “substitute informed consent.” In current mental health law, however, the guardian must have specific court authority to admit the person for treatment and the incapacitated person must also agree to that admission. This makes no sense, and SB15 removes those barriers to obtaining mental health care.

An agent, appointed by a person’s durable power of attorney, now will be able to admit that person for mental health care, under the terms of the power of attorney, just as any other medical care. If a person is committed for involuntary treatment, because the person has a severe mental illness and is a danger to self or others or chronically disabled by the illness, the mental illness board may now also assess whether the person is incapacitated for the purposes of making treatment decisions, and it may order effective treatment at the commitment hearing, instead of waiting for a separate court proceeding.

Under SB15, the Board might consider treatment for a co-occurring substance use disorder. Current research shows that a majority of people who have a severe mental illness also have a substance use disorder (perhaps over 65 percent). The two disorders together are often so intertwined that these patients cannot recover — unless both conditions are effectively treated together. SB15 now aligns the best practices for treatment and recovery from both mental illness and CD disorders in one process.

Finally, it is historically clear that severely mentally ill persons often fail to continue effective treatment after an inpatient stay.

SB15 allows the board to consider an outpatient commitment and a treatment order as a lesser restrictive alternative to continued inpatient treatment. It also allows treating physicians and outpatient program directors to seek assistance from law enforcement and the board to attempt voluntary compliance with a prescribed course of treatment. These provisions are designed to help with “revolving door” issues, to promote a continuum of care after inpatient treatment, and to avoid having to wait for intervention until the person is in such poor mental health that it takes an extended time for the person to again recover.

We now know, from functional MRIs and current research studies, that the sooner a person is effectively treated for a severe mental illness, the better chance that person has for a long-term recovery and the lesser chance for a long-term disability. This legislation helps individuals, communities, and treatment providers improve the overall, foundational health of South Dakota citizens. I commend the lieutenant governor for his focus on mainstreaming mental illness treatment, the Workgroup for developing this legislation, and the Department of Social Services for supporting it.

Written by
Scott Peters, co-chairman of the Minnehaha-Lincoln County Board of Mental Illness.

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