Behavioral health issue brief: state budget actions that affect public mental health services and systems: year end report-2003

With ongoing declines in the economy, states have readjusted their FY 2003 budgets throughout the fiscal year, while at the same time negotiating their upcoming FY 2004 and FY 2005 budgets. Because of the current fluidity of state budgets, this issue brief contains snapshots of actions taken at various times throughout FY 2003. It is intended to provide the reader with a general overview of the effects on public mental health systems, of the decline in state economies. The Health Policy Tracking Service (HPTS) will continue to track this issue, and will update this brief at quarterly intervals.

Behavioral health issue brief: parity and other insurance mandates for the treatment of mental illness and substance abuse: year end report-2003

Parity and other insurance mandates for the treatment of mental illness and substance abuse continue to be on the agenda of many state legislatures. A broad spectrum of opinions surround what mandates for mental health and substance abuse could and should be. The debate over mandated benefit legislation typically centers around consumer protection versus cost. There are strong opponents, for example, that advocate for nothing less than full parity for mental health and substance abuse treatment. Equally strong are the groups that oppose parity because they believe it will lead to a health care cost increase and, therefore, an increase in the number of uninsured. Both sides continue to make progress as the victories and the defeats unfold on the floors of state legislatures.

The psychiatric protection order for the "battered mental patient"

Psychiatric patients are routinely treated against their will. Legally enforceable psychiatric protection orders would protect patients from coercive psychiatric interventions

Dangerous and severe personality disorders: a new personality concept from the United Kingdom

In 1998, we in England were shocked by the apparently motiveless murders of a mother and two of her children when they were traveling home from school in a rural area. Subsequently a patient with personality disorder, being monitored by the forensic psychiatric services, was convicted of their murders. The government was determined to prevent this type of offense from recurring and in 1999 introduced a new concept, dangerous and severe personality disorder (DSPD). This subsequently became a treatment and assessment program for individuals who satisfy three requirements: (1) have a severe disorder of personality, (2) present a significant risk of causing serious physical or psychological harm from which the victim would find it difficult or impossible to recover, and (3) the risk of offending should be functionally linked to the personality disorder. The implications of this program are discussed with regard to international systems of classification and service provision. We also attempt to place DSPD in the wider context of psychiatric participation in the management of personality disordered offenders.

Public policy and evidence-based practice

The time has come to add to the body of EBP implementation knowledge at multiple levels, including knowledge about policy, program priorities, clinician practice, consumer adherence, and family member support. Implementation at the policy level, however, is primary and paramount. The national initiative supporting EBP implementation is one of the most important innovations on the mental health horizon. It will serve as the testing ground for what can be learned about bridging the gap between science and service. This important initiative will not go far if it is not supported by mental health policies--at state and federal levels--that create the organizational and financial incentives to implement EBPs. In addition, it will be a time-limited activity if it also does not yield lessons about how to adapt to new evidence and on-going systemic changes. Organizations must be flexible and able to learn and adapt. The promise of decades of research must be realized in practice. There is an opportunity to combine quality improvement with accountability through performance measurement and the implementation of effective new services and treatments. The Surgeon General simultaneously identified this research's promise and documented its shortcomings. His report outlines courses of action for policymakers that should guide clinicians away from service disparities and toward the implementation of EBP.

[Psychiatric and neuropsychological legal assessment of traumatic brain damage and Law 30/95]

Medico-legal assessment of people who have suffered injuries in road traffic accidents must use Law 30/95 as a reference frame. Psychiatric and neuropsychological syndromes secondary to traumatic brain injury (TBI) are no exception and pose demanding challenges to physicians and psychologists. This paper analyzes descriptive and nosological difficulties face by psychiatrists and psychologists; their expert contribution includes translation of official diagnostic entities into categories published in the annex of Law 30/95. Our psychopathological repertoire was created in the 19th century and has hardly been revised since. The wide and varied types of neuropsychological impairments encountered in TBI have to be diagnosed within a very narrow range of DSM-IV and ICD-10 categories. The most common conflicts encountered in the medicolegal arena are revised: the differential diagnosis between dementia and combinations of organic personality disorder with cognitive impairment; differential diagnosis between spontaneous psychiatric illness (bipolar disorder, schizophrenia) and psychiatric syndromes secondary to brain injury (posttraumatic psychosis, organic bipolar disorder); differential diagnosis between concussional syndrome and organic personality disorder, cognitive impairment or organic affective disorder. Specific diagnostic guidelines are suggested for each of these clinical situations. Actas Esp Psiquiatr 2003;31(6):353-360 <FONT face="Courier New" size=2></FONT>

The aggressive child

Acute assessment and management of the aggressive or violent child or adolescent are a challenge for clinicians. Early recognition of signs of impending violence and a clear understanding of the progression of violent behavior are essential to ensure safety of patients and staff. The management of violent and aggressive patients using behavioral interventions tailored to the stage of violence or aggression is critical to reducing the likelihood that the child or adolescent will attack staff or injure self or others. The indications and risks of chemical and physical restraints and hospital standards and guidelines that govern the use of behavioral and experience regarding the prevalence, presentation, and differential diagnosis of psychotic disorders in juveniles. The clinician must rapidly disentangle which elements of the clinical presentation indicate true psychotic thought processes versus elements that represent misunderstood developmentally appropriate phenomena, symptoms of nonpsychotic illnesses, or harbingers of an underlying primary medical illness. A thorough assessment is required before appropriate treatment can begin.

Charitable Choice regulations applicable to states receiving Substance Abuse Prevention and Treatment Block Grants, Projects for Assistance in Transition from Homelessness formula grants, and to public and private providers receiving discretionary grant funding from SAMHSA for the provision of substance abuse services providing for equal treatment of SAMHSA program participants. Final rule

On December 17, 2002, the Department of Health and Human Services (HHS) published a Notice of Proposed Rulemaking (NPRM) to implement the Charitable Choice statutory provisions of the Public Health Service Act, applicable to the Substance Abuse Prevention and Treatment (SAPT) Block Grant program, the Projects for Assistance in Transition from Homelessness (PATH) formula grant program, insofar as recipients provide substance abuse services, and to SAMHSA discretionary grants for substance abuse treatment or prevention services, which are all administered by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services. The Secretary requested comments on the NPRM and gave 60 days for individuals to submit their written comments to the Department. The Secretary has considered the comments received during the open comment period and is issuing the final regulation in light of those comments.

The self-exclusion program: legal and clinical considerations

In recent years, attention focused on compulsive gambling(1), and its causes and cures, has increased at a notable rate. Among the measures taken to help the compulsive gambler is the voluntary(2) self-exclusion program which is either in place or being considered in various states.(3) Although the programs differ from jurisdiction to jurisdiction, the basic premise is that the gambler requests that he be banned from the gaming establishment and/or removed from its mailing list. This article examines this new concept primarily from a legal perspective. The self-exclusion program represents a state-created legal entity constructed upon a clinical foundation. It prominently includes several clinical references to mental health principles. Of necessity, there appear some analogies to the field of substance abuse; these have provided at least a starting point for more particularized study and research in the fledgling field of compulsive gambling treatment.