Wednesday, March 26, 2008

Supporting Disabilities as a Cultural Competence

MassHealth under the Rosie D vs. Romney settlement calls for proposals/discussions to promote cultural competence and to reduce disparities for healthcare services for its citizens.

I am writing in this blog to advocate one component of cultural competence. I am aware that there are some organizations in the Boston area who are hired to train mental health professionals and social service workers on multicultural sensitivity training. I attended one such training last year and though the information and presentation was excellent by "Families First," it did not provide any information on how to work with individuals with disabilities.Mass Health can implement Disability sensitivity as one component of Cultural Competence. By coincidence, Blue Cross/Blue Shield of Massachusetts interviewed me two weeks ago about the need to include the above topic as a cultural competence for mental health professionals. It is also important that medical professionals also receive the same training in this area as well. Currently, Tufts University and I believe UMASS has patient-doctor trainings in which "hired" patients train doctors on how to interact with them and to understand their symptoms. I heard positive feedback from persons with disabilities who participate as patients in this training.Mass Health can recommend that clinics/facilities that staff receive trainings similar to the Patient/Doctor model that is currently being used. The question is how to pay staff to attend such trainings. That is always the tricky part of the equation. For mental health professionals, CEUs can be awarded to going a training during a staff meeting or a special meeting time. But again, mental health clinicians do not get paid for mandated staff meetings. This issue of payment or compensation has to worked between Mass Health and the provider.Why do medical and mental health professionals need to learn to be more culturally competent in this area?1) The is a new population of veterans coming home from Iraq and Afganhistan who are newly disabled and will need both medical and mental health services. The current health insurance benefit for vets is not adequate to cover all their healthcare needs.2) More and more persons with disabilities across the board are living in the community and not necessarily in institutions. Governor Patrick's plan for Long Term call for more funding to be used for community based services for individuals with psychiatric disabilities; developmental disabilities with physical disabilities to live in the community across the commonwealth.3) Professionally and personally speaking, I heard numerous complaints from consumers and advocates with disabilities vent their frustrations on how their medical or mental health professional treated them for their symptoms. An example is when an individual goes to a health facility with a personal care attendant, the medical professional tends to talk to the PCA and not to the client. Another example is when a colleague of mine who is a wheelchair user told me how her mental health clinician told her to go fight her "revolution" during the last session. The revolution is about the barriers in the environment that prevent persons with disabilities from enjoying the same freedoms as their able-bodied counterparts. We both wondered if she would tell a person from a multicultural background the same information. I think not..

Robbin Miller, LMHC
Advocate/Counselor
Moderator

Friday, March 21, 2008

Testimony to Health and Human Services

Dear Health and Human Services:

I support new reforms for the children's mental health in the Commonwealth. The system is broken on how mental health services are delivered and paid for. It was only a matter of time until a lawsuit was filed by parents to advocate for improved mental health services for their children known as the Rosie D vs Romney case. As an independent advocate and mental health professional, I was appalled how parents had to take their kids to the local emergency rooms to get evaluated for mental health services when in fact some of the services that did not involve immediate medical treatments ( for example, life threatening situations) and stablization could have been done at outpatient clinics. I support more intensive care management and family stabilization services to be conducted on the outpatient level and be in place from six months to a year for some families that are in danger of having their children taken away. Staff needs to be trained on how to interact and to counsel children who are dual diagnosed with psychiatric and physical disabilities.

I further advocate that parents be held accountable for some of their children's mental health issues. It is found after some investigations by the Department of Social Services that parents have their own mental health issues that need immediate attention. I don't understand why these parents are not pre-screened by their doctors before the leave the hospitals with their babies. The system is reactive, and after the fact, as damage is done to these children. Possibly a proactive measure would be to implement pre-screening tools for pregnant mothers and fathers to determine if they are capable of taking care of their children's phyiscal and mental health needs. If adoptive parents have to go through the same measures, then these parents need to go through the same thing as well.

Regarding the infrastructure, the mechanisms to pay providers, particularly social workers and mental health counselors are unfair and inequitable. There are some counselors across the state who are making the same money as their clients on SSI with children. It is demoralizing to hear my colleagues vent about they are not paid for no-shows and how difficult it is to make a sustainable living with a masters degree and/or advanced degree in their field. It is utmost important that the commonwealth change the way they pay mental health clinicians for their work. It is agreed as a consensus that there is a shortage of qualified mental health clinicians, and changing the infrastructure and values on how clinicians are paid for their work will decrease the shortage and children with mental health needs will be served.

Robbin MillerAdvocate/Counselor

Saturday, March 1, 2008

Consumer awareness for prescription drugs

Have you ever noticed when you go to a mental health or family clinic, there are pens, paper, highlighters, and other free goodies from drug companies in the waiting rooms and in the providers' offices? Do you ever ask your prescribing physician, psychiatric nurse or psychiatrist about the safety of the drugs they are giving you for your health conditions? The community needs to be more aware that sometimes the prescriptions you are getting may not be really safe to take due to doctors falling for high pressure sale tactics from pharmaceutical salespeople. Read below about the movement to reform how drug cost are marketed to doctors:

Who We Are:
The Massachusetts Prescription Reform Coalition (MPRC) is a diverse group of non-profit national and local organizations, community organizations, healthcare advocates, private insurers, public payors, and healthcare providers. Members include:
AARP Massachusetts
Blue Cross Blue Shield of Massachusetts
Commonwealth Care Alliance
Commonwealth of Massachusetts Group Insurance Commission
Health Care For All
Massachusetts Senior Action Council
MASSPIRG
National Physicians Alliance
Neighborhood Health Plan
The Prescription Project
Why We Have Come Together

Massachusetts’ healthcare access expansion can only be maintained if healthcare costs are controlled. The cost of prescription drugs is among the fastest growing segments of health care spending. Between 2000 and 2007 the price of many of the most commonly prescribed brand name drugs rose by nearly 50%, far exceeding inflation. These rising costs threaten the stability of health care reform and the Commonwealth’s budget. The costs also threaten people's ability to access the medications that they need to maintain their health.

Our Priorities

The Coalition urges the Commonwealth to take action against industry marketing practices that inflate the cost of prescription drugs. Pharmaceutical companies spend more than $7 billion annually on marketing to physicians alone. These costs get passed along to consumers and the state through the high price of medications. The Coalitions top priorities are:
Pharmaceutical Industry Gifts to Prescribers: Studies show that gifts from pharmaceutical companies to prescribers inherently impact prescribing decisions.
Data-Mining: Pharmaceutical companies purchase prescription data to target their marketing efforts, magnifying their influence.
Evidence-Based Outreach: Much of the information that prescribers get about drugs comes directly from pharmaceutical salespersons and is, therefore, biased. An evidence-based physician education program (often referred to as “academic detailing”) would provide doctors with unbiased evidence to guide them in their prescribing decisions. Such programs have been shown to more than pay for themselves with savings to public programs in other states. Data
Pharmaceutical industry marketing expenditures directed at physicians doubled (from $3.5 billion to $7.2 billion) between 1996 and 2005.
Nationwide prescription drug spending rose 500% (from $40.3 billion to 200.7 billion) between 2000 and 2005.
Overall, the pharmaceutical industry spent $29 billion on promoting and marketing prescription drugs in 2005.
$7.2 billion spent on marketing directly to physicians, which is an average of about $8,800 per physician, per year.
The industry employs a sales force of over 90,000 representatives or “detailers,” which is about one for every nine physicians
Generics cost 30% to 80% less than brand name counterparts.
Spending would be reduced by $8.3 billion or 11% annually if adults substituted generics for brand names.
94% of physicians receive meals, medication samples, and other payments from pharmaceutical companies.

Contact Health Care for All for more information. Their website is:hcfama.org

Robbin Miller, LMHC
Moderator