Tag: Mental Illness

Red corded telephone handset on blue background, top view. Hotline concept

To Promote Health Equity, States Must Restrict Police Intervention in Mobile Crisis Response

The Petrie-Flom Center Staff Leave a comment

By April Shaw and Taleed El-Sabawi

The COVID-19 pandemic and recent increases in the incidence of televised violence against Black persons by law enforcement actors and others have contributed to the worsening mental health of these subordinated and marginalized communities. While the policy solutions needed to address this disparate impact are structural and multi-faceted, the introduction of 988, a national mental health crisis hotline, offers an opportunity to positively contribute to the overall goals of decreasing police interactions with Black and Brown communities.

The Federal Communications Commission (FCC) issued a Final Rule designating 988 as a national suicide prevention and mental health crisis hotline in September 2020. Congress later passed the National Suicide Hotline Designation Act of 2020 codifying 988 as the dialing code. Per the FCC Final Rule, states are required to implement 988 into their networks by July 2022.

States have wide latitude in how they implement 988, and though many will likely stop at the bare minimum of creating a suicide prevention hotline, 988 could be coupled with the creation of police alternative (or non-police) mobile responses that assist with de-escalation, stabilization, and connection to treatment. Non-police responses promise to decrease police interaction, excessive use of force, and criminalization of mental illness. Such non-police responses have gained in national popularity due in large part to organization and protests led by Black Lives Matters activists.

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Transformation of Behavioral Health Care Through Section 1115 Waivers

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By John Jacobi

As the Biden administration works to improve health access and transform health delivery, behavioral health reform should be at the front of the queue.

People with severe mental illness and opioid use disorder are dying young for lack of routine health care. Much of the work that needs to be done in behavioral health is developed or developing at the state level. But the Biden administration has a powerful tool for encouraging state-level innovation in the § 1115 Medicaid waiver process.

Reform through state waivers

Section 1115 waiver authority permits the Department of Health and Human Services to approve pilots and demonstrations if they are found likely to promote the objectives of the Medicaid program. Waivers, which do not require Congressional or formal regulatory enactments, permit relatively rapid cycling of innovation, in contrast to the lumbering pace of legislative or regulatory change.

While applications for waivers originate with the states, presidents have set the agenda by signaling what categories of waivers will be looked upon favorably, offering the administration the ability to put its stamp on the development of care for low-income and disabled people.

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The Case for Non-Police Response to Behavioral Health Crises

The Petrie-Flom Center Staff Leave a comment

By Jennifer J. Carroll and Taleed El-Sabawi

People who use drugs continue to die at staggering rates, due not only to overdose from contaminated drug supply, but also due to our persistent reliance on the carceral system to respond to behavioral health crises.

This approach stems from the state-sanctioned violence of the War on Drugs. It takes various forms, including the use of police officers as first responders to behavioral health crises (including welfare checks), the excessive police use of force, and the use of potentially lethal restraint methods to subdue agitated persons. It also manifests in police officers’ use of jail cells as tools for forced “detox” believing that coerced withdrawal while in custody will reduce overdose risk or help someone “go clean” (it very clearly does not).

Evidence-based alternatives to police response for behavioral health crises exist. However, despite being both feasible and effective, these alternatives to police intervention remain the exception, rather than the rule.

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The Health Service Ombudsman: NHS Failing Patients with Mental Health Problems

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By John Tingle

Failings in National Health Service (NHS) care for patients with mental health problems is a worryingly persistent story in the English media. Many reports show harrowing and dramatic failings in NHS care provision for the mentally ill some of which result in avoidable deaths.The Health Service Ombudsman  (HSO) represents the final stage in the NHS complaints procedure and is an independent  office reporting  directly  to Parliament.The HSO carry’s out investigations into complaints  and makes the final decisions on those that have not been resolved by the NHS in England.In a recently published report the HSO reveals reveals unjust, shocking and tragic failings  in NHS care provision for patients with mental health problems.Some mental health care complaints figures are given in the report.In 2016-2017 there were 14,106 complaints made to NHS mental health trusts (hospitals) with ,65% being upheld or partly upheld by the local organisation.Case work data between 2014-15 and 2017-18 was analysed and five key themes showing persistent failings that the HSO see in complaints being made emerged from this exercise:

  • Diagnosis and failure to treat.
  • Risk assessment and safety
  • Dignity and human rights.
  • Communication.
  •  Inappropriate discharge and provision of aftercare.

The HSO also points out in the report that the other common factor in the cases examined is too frequent substandard complaint handling by the NHS organisation. This adds insult to injury, compounding the impact of failings. Read More

Mental Health First Aid Training in Prisons, Police Departments, and the Presidential Election

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By Wendy S. Salkin

It has been widely reported and acknowledged that many incarcerated Americans live with mental illness. In 2014, the Treatment Advocacy Center and the National Sheriffs’ Association published The Treatment of Persons with Mental Illness in Prisons and Jails: A State Survey, a joint report that included the following findings:

  • In 2012, there were estimated to be 356,268 inmates with severe mental illness in prisons and jails. There were also approximately 35,000 patients with severe mental illness in state psychiatric hospitals. Thus, the number of mentally ill persons in prisons and jails was 10 times the number remaining in state hospitals.
  • In 44 of the 50 states and the District of Columbia, a prison or jail in that state holds more individuals with serious mental illness than the largest remaining state psychiatric hospital. For example, in Ohio, 10 state prisons and two county jails each hold more mentally ill inmates than does the largest remaining state hospital.

Similarly widely reported and acknowledged is that prisons often either cannot or simply do not serve the mental health treatment needs of those housed within their walls. As Ana Swanson of The Washington Post observed:

Unsurprisingly, many prisons are poorly equipped to properly deal with mental illness. Inmates with mental illnesses are more likely than other to be held in solitary confinement, and many are raped, commit suicide, or hurt themselves.

Solitary confinement is often used as a means of separating inmates living with mental illness from the rest of a prison population. As Jeffrey L. Metzner and Jamie Fellner reported in their March 2010 article, “Solitary Confinement and Mental Illness in U.S. Prisons: A Challenge for Medical Ethics”: Read More

Second Amendment Rights and Mental Illness

Temple University Center for Public Health Law Research Leave a comment

Editor’s Note: An updated of this post was published on March 6, 2017, entitled “The Balancing Act Between Mental Illness and Gun Rights.”

By Mariam Ahmed, JD/MSPP (2016)

In recent years, there have been a multitude of state- and federal-level discussions about how to use law to minimize gun violence as active shooter events increase. During these deliberations, one point that has repeatedly been debated is whether people with mental illness should have their gun possession rights limited.

Here’s how the legal landscape currently looks.

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Short-Term Emergency Commitment Laws Require Police to Assess Symptoms of Mental Illness

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By Leslie Allen, JD

On November 20, 2014, the Public Health Law Research program released a new 50-state dataset analyzing state law governing the short-term emergency commitment process. These laws give law enforcement officers and others the right to involuntarily admit someone into a mental health care facility if they are in danger of harming themselves or others because of a mental illness.

In 47 states, police may take a person into custody without a warrant, and may initiate an emergency psychiatric hold – essentially committing them to a mental health institution without their consent. Recently, the media has increasingly examined how the police interact with the mentally ill (for example, “Police Taught to Spot Signs of Psychiatric Crisis” from FoxNews, republishing from the  Associated Press, “Police Confront Rising Number of Mentally Ill Suspects” from The New YorkTimes, and see “Where the Police are Part of Mental-Health Care” from The Atlantic). Much of the police forces’ relationship with the mentally ill is established by the laws governing civil commitment.

Police officers serve as first responders for mental health crisis treatment by legislation in nearly every state. Read More

Good News and Bad News About Gun Laws, Mental Illness and Violence — Part 1

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This is Part 1 in a three-part series on gun laws, mental illness and violence in the United States.

by Jeffrey Swanson, PhD

Federal and state efforts to restrict firearms access to potentially dangerous people with mental illness have focused in recent years on extending the reach of states’ reporting to the National Instant Criminal Background Check System (NICS). In August, in response to the Colorado movie theater shooting, Mayors Against Illegal Guns released a report tallying the number of mental health records each state has submitted to the NICS and ranking each state’s reporting performance. Nearly five years after Congress enacted the NICS Improvement Act, only about half the states have submitted more than a negligible proportion of their mental health records.

The Mayors’ report mentions the “mentally unstable man” who shot President Reagan and his press secretary, Jim Brady, for whom the Brady Handgun Violence Prevention Act was named. It recalls the deadly rampages at Virginia Tech in 2007 and in Tucson in 2011. It includes an interactive map titled Fatal Gaps: Can dangerous people buy guns in your state?  The not-so-implicit message here is that states’ spotty reporting of mental health records to the background check database is partly to blame for the senseless deaths in mass shootings.

It is easy to say there’s a problem with our gun laws or their enforcement by pointing to isolated cases where mentally disturbed mass shooters were able legally to buy guns. That is probably true. Unfortunately, there is no evidence yet available to suggest that filling the NICS with more records of people with gun-disqualifying mental health histories would have any measurable impact in reducing firearm violence in the population.

A study underway at Duke University, funded by the National Science Foundation and the Robert Wood Johnson Foundation’s Public Health Law Research Program, may soon provide some answers to that question. Whatever the study finds, though, the results will hinge on whether two assumptions underlying our gun prohibitions turn out to be true:  that there is a strong causal relationship between serious mental illness and gun violence; and that our extant gun-disqualifying legal criteria can accurately identify the subgroup of mentally ill individuals at risk.

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