Questions to the Commissioners:
(Mental Health; Public Health; and Mass Health)
Here are two questions I have for the commissioners:
1) What can be done to decrease no-shows for children on Mass Health receiving mental health services? After speaking with providers across the domains, this population has the highest no-show rate for services. As a result, mental health clinics have challenges retaining mental health clinicians to work there. Will the commissions support paying for their no-shows?
2) What can be done to change the mindset that biology is destiny? Massachusetts is behind the times that any biological parent can parent their child without consequences. There are issues of high risk families leaving the hospitals with their infants when there are known facts that the parents may have mental health(untreated) or substance abuse problems. How come nothing is done to be prevent future damage these kids? I support prescreening these parents before they leavthe hospitals like they do for adoptive parents. Parenting comes from the heart and not from chromosomes.
Robbin Miller
Advocate/Private Practitioner
Monday, May 5, 2008
Friday, April 18, 2008
Children's Mental Health Coalition Introduces Bill of Rights for Families Living With Mental IllnessesWashington, D.C., April 15, 2008 -- The children's mental health coalition has created a Bill of Rights for Children with Mental Health Disorders and their Families. The coalition includes the American Academy of Child and Adolescent Psychiatry (AACAP), the Autism Society of America (ASA), the Child and Adolescent Bipolar Foundation (CABF), Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD), the Federation of Families for Children's Mental Health (FFCMH), Mental Health America (MHA), and the National Alliance on Mental Illness (NAMI)."This Bill of Rights represents the standard of what families living with mental illnesses should expect from treatment," said AACAP's President, Robert Hendren, D.O.
"Children do better when they receive consistent, tailored treatment. Few children receive any treatment and fewer still receive the sustained, quality care that they require.
"The Bill of Rights was created because of the inconsistency of accessible mental healthcare services throughout the country.The Bill of Rights:
1. Treatment must be family- driven and child-focused. Families and youth, (when appropriate), must have a primary decision-making role in their treatment.
2. Children should receive care in home and community-based settings as close to home as possible.
3. Mental health services are an integral part of a child's overall healthcare. Insurance companies must not discriminate against children with mental illnesses by imposing financial burdens and barriers to treatment, such as differential deductibles, co-pays, annual or lifetime caps, or arbitrary limits on access to medically necessary inpatient and/or outpatient services.
Comment: Bravo! 20-24 sessions a year is not enough.
4. Children should receive care from highly- qualified professionals who are acting in the best interest of the child and family, with appropriate informed consent.
Comment: We need hold some families accountable who try to commit SSI fraud for ther children when in reality, they are doing it to avoid working.
5. Parents and children are entitled to as much information as possible about the risks and benefits of all treatment options, including anticipated outcomes.
6. Children receiving medications for mental disorders should be monitored appropriately to optimize the benefit and reduce any risks or potential side effects which may be associated with such treatments.
7. Children and their families should have access to a comprehensive continuum of care, based on their needs, including a full range of psychosocial, behavioral, pharmacological, and educational services, regardless of the cost.
Comment: Yes, valid research on how medications work by the literature and not by "high pressure" tactics and gifts by drug companies to prescribers.
8. Children should receive treatment within a coordinated system of care where all agencies (e.g., health, mental health, child welfare, juvenile justice, and schools, etc.) delivering services work together to support recovery and optimize treatment outcome.
Comment: What do we do about those parents who abuse substances and/or have psychiatric isssues and are allowed to have their children back and/or those who walk out of the hospitals with their babies? What about parent pre-screening for these issues like adoptive parents have to go through?
9. Children and families are entitled to an increased investment in high-quality research on the origin, diagnosis, and treatment of childhood disorders.
10. Children and families need and deserve access to mental health professionals with appropriate training and experience. Primary care professionals providing mental health services must have access to consultation and referral resources from qualified mental health professionals.
Comment: Who will pay for these consultations?
Robbin MillerAdvocate/private practitioner
"Children do better when they receive consistent, tailored treatment. Few children receive any treatment and fewer still receive the sustained, quality care that they require.
"The Bill of Rights was created because of the inconsistency of accessible mental healthcare services throughout the country.The Bill of Rights:
1. Treatment must be family- driven and child-focused. Families and youth, (when appropriate), must have a primary decision-making role in their treatment.
2. Children should receive care in home and community-based settings as close to home as possible.
3. Mental health services are an integral part of a child's overall healthcare. Insurance companies must not discriminate against children with mental illnesses by imposing financial burdens and barriers to treatment, such as differential deductibles, co-pays, annual or lifetime caps, or arbitrary limits on access to medically necessary inpatient and/or outpatient services.
Comment: Bravo! 20-24 sessions a year is not enough.
4. Children should receive care from highly- qualified professionals who are acting in the best interest of the child and family, with appropriate informed consent.
Comment: We need hold some families accountable who try to commit SSI fraud for ther children when in reality, they are doing it to avoid working.
5. Parents and children are entitled to as much information as possible about the risks and benefits of all treatment options, including anticipated outcomes.
6. Children receiving medications for mental disorders should be monitored appropriately to optimize the benefit and reduce any risks or potential side effects which may be associated with such treatments.
7. Children and their families should have access to a comprehensive continuum of care, based on their needs, including a full range of psychosocial, behavioral, pharmacological, and educational services, regardless of the cost.
Comment: Yes, valid research on how medications work by the literature and not by "high pressure" tactics and gifts by drug companies to prescribers.
8. Children should receive treatment within a coordinated system of care where all agencies (e.g., health, mental health, child welfare, juvenile justice, and schools, etc.) delivering services work together to support recovery and optimize treatment outcome.
Comment: What do we do about those parents who abuse substances and/or have psychiatric isssues and are allowed to have their children back and/or those who walk out of the hospitals with their babies? What about parent pre-screening for these issues like adoptive parents have to go through?
9. Children and families are entitled to an increased investment in high-quality research on the origin, diagnosis, and treatment of childhood disorders.
10. Children and families need and deserve access to mental health professionals with appropriate training and experience. Primary care professionals providing mental health services must have access to consultation and referral resources from qualified mental health professionals.
Comment: Who will pay for these consultations?
Robbin MillerAdvocate/private practitioner
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
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
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
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
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