Current Law Impedes Mental Health Care, Experts Say

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Thomas InselMental health treatment in the United States is inadequate and new legislation is needed for it to improve, a panel of mental health experts testified before a Congressional subcommittee Tuesday, continuing a conversation on mental health renewed after the terrible mass shooting at a Connecticut school last December.

“We have 15 million children and teenagers -- people under the age of 24 -- who have a psychiatric disorder or a serious learning disorder in the United States,” said Dr. Harold Koplewicz, president of the Child Mind Institute, told the House Energy and Commerce Committee’s Oversight and Investigations Subcommittee.

“Less than half get any help,” he continued. “And the ones that do get help? It’s questionable how effective the help is.”

Koplewicz said there is a tendency for physicians to treat physical ailments “below the neck” differently from how they treat mental illnesses “above the neck.” When people experience physical illnesses, such as chest pains, people routinely call emergency physicians. However, when individuals begin displaying symptoms of mental illness the most common response is for others to notify police, he said.

Considering the large numbers of individuals in the nation with mental illnesses, Koplewicz simply does not believe there are enough active mental health professionals or enough meaningful research being conducted.

“Big Pharma has stopped investigating new drugs for the central nervous system, and frankly, the National Institute of Mental Health need more funds to really look at child mental illness or pediatric neuroscience,” he said. “The fact that 75 percent of all serious psychiatric illness occurs before the age of 24, and 50 percent before the age of 14, means that the biggest bang for the buck, the biggest return on your investment, is to try and identify these kids early.”

Dr. Thomas Insel, director of the National Institute of Mental Health, said a new “generation of interventions” are sorely needed to meet the nation’s mental health needs. “What we have is good,” he said. “But it’s not good enough.”

Currently, Insel does not believe there is a system in place in the United States to adequately address the mental illness needs of parents and young people. “There are not the community resources, there are not the hospital beds, there are not the crisis centers,” he said. “So we’re often forced to respond in an acute way for what is often a chronic disorder.”

In the United States, about 4 percent of all people suffer from severe mental illness. Insel described the population as “truly disabled” and in need of “very aggressive treatment.”

“What makes these disorders so vexing,” he said, “is that at the very core for many people with these illnesses, there is a loss of insight. They do not realize they are ill, or if they do, at the moment when they are psychotic, they reject the notion that they need help.”

As a result, illnesses of the like routinely result in family problems, and occasionally, criminal justice issues, he said.

Subcommittee ranking member Diana DeGette, D-Colo., said that, in many instances, severe mental illnesses manifest themselves when young people, especially males, are in their late teens and early 20s. As a result, many parents are legally powerless to seek assistance for their own children.

Dr. Michael Welner, founder and chairman of The Forensic Panel, said most state commitment laws severely hinder parents seeking mental health care for their sons and daughters. More often than not, mental health specialists--and not the parents of mentally ill children--are the sole determiners of whether a young person poses a danger.

“The most relevant symptom to Newtown is paranoia,” he said. “So let’s say you’re interviewing a paranoid patient. What kind of history are you going to get?”

The family, he said, is essential for providing information. “But the HIPAA (Health Insurance Portability and Accountability Act) law,” he added, “says you can’t talk.”

But legislators have the ability to change such laws overnight, Welner said.

“Why is it that parents are not empowered to impact decisions about dangerousness?” he asked. “Why is it that there isn’t a natural, open line of communication where people can get clinical history passed off to them?”

“We’ve heard a lot about gun control (and) guns are certainly a large part of the problem,” said Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center. “Untreated severe mental illness is certainly at least as big, and probably a bigger part of the problem.”

Of those suffering from severe mental illness about half do not recognize they are ill because of significant brain impairments. It’s one of the greatest challenges in working with them, Torrey said.

“Seventeen out of 20 studies that have looked at this show that the brain is different,” he said. “Yet the laws do not reflect that.”

Unless those brain differences are addressed in the law and in treatments, Torrey doesn’t believe mental health care national standards can improve.

“The HIPAA laws are legal barriers that really prevent families from having access to the information they need,” said Michael Fitzpatrick, director of the National Alliance on Mental Illness (NAMI). “We need a better, tighter and more diligent mental health system.”

Fitzpatrick said the nation lacks a “coordinated system,” with NAMI data showing in some states significant variability in mental health practices from county to county. He was also critical of  the Family Educational Privacy Rights Act (FERPA), which he believes--much like HIPAA protocols--bars parents from gaining valuable insight into the medical histories of their children.

“Many families and individuals experience severe mental illness for the first time when their family members are 17, 18, 19 and 20,” he stated. “Current law blocks families from having access to conversations they may be having with the university health system.”

Over the course of a year, he said NAMI receives thousands of calls from individuals attempting to commit a loved one for mental health treatment. “What we need to do is extend the commitment standards beyond imminent dangerousness,” he stated. “We need to simplify the process to allow people to get into the hospital, to get diagnosed and get the treatment they need.”