YOUR NAME: Jefferson Lin

YOUR NAME: Jefferson Lin

LESSON: MENTAL HEALTHCARELAW & POLICY

SOURCE:Washington Law Help, TeamChild, NY Times, Civil Conversation Reading Guide

TIME AND DAY TAUGHT: ____, _____ (50 min)

Number of students:Lesson designed for class of 30 students

Materials required:Editorial Articles, Handouts

I.GOALS: Studying Mental Healthcare Law & Policy helps students:

A.Understand how to act if faced with a mental healthcare situation in WA state.

B.Learn about the different policy and legal issues related to mental health and the gun violence debate

II.OBJECTIVES:

A.Knowledge Objectives - As a result of this class, students will be better able to:

1.define "mental healthcare".

2.define “civil commitment”or “involuntary treatment”.

3. understand the basic federal and state mental health laws, eg. the basics of WA’s Involuntary Treatment Act (ITA)

4.identifythe main arguments surrounding the debate about mental healthcare and gun violence

5. understand the role of legislative advocacy and interest groups

B.Behavioral/Skills Objectives - As a result of this class, students will be better able to:

1.access public mental healthcare services. know how to navigate the available resources.

2.read, summarize and analyze an argument.

3.orallyadvocate an opinion or point of view.

C.Attitude Objectives - Students will be better able to feel:

1.that the law is positive and protective.

2.thatmental healthcare is important in the law.

3. that the law is created and developed through advocacy and civil debate.

III.CLASSROOM METHODS

A.Introduction: Brainstorm definition of mental healthcare. Mental healthcare services could include counseling, family therapy, group therapy, medication management, or other services that would help you.

B.Ask students:what does mental healthcare have to do with the law? Brainstorm a few ideas: mental healthcare and criminal law (eg. insanity defense, mental health courts (alternatives to incarceration), juvenile justice),education law (eg. IEPs), access to services (eg. minor consent to mental health services), Americans with Disabilities Act (protects people w/ mental disabilities/illnesses from discrimination in employment or in government), mental health parity (providing equal health insurance coverage for mental health treatment), Social Security Disability Insurance (provides cash assistance & health care coverage for individuals with serious mental illnesses), responsibilities of therapists/psychiatrists (confidentiality, reporting requirements).

C.Inform students that mental health plays an important role in many areas of the legal system. Note: In WA, if you are 13 or older, you get to make the decisions about what kind of mental health treatment you need or want with your doctor or counselor. See attached “TeamChild Tips for Youth Handout”Explain that today we will explore one aspect of the mental healthcare system that has been a hot current events topic.

D.Congressional Hearing Activity: Explain to students that they will be representing different advocacy or interest groups in a hearing before the U.S. Congress. In the wake of recent violent shootings (eg. AZ Rep. Giffords, Newtown school shooting), Congress has convened a hearing to explore potential policy and legislative reforms to address the role of mental health in reducing violence. The question before Congress is: Can changes in the American mental health system reduce gun violence without creating more problems?

1. Divide students into 8 different groups.

2. Each group will be assigned to one of the NY Times editorial articles.

3. Students should individually read through the article and fill out the questions on the worksheet.

4. After reading through the article, students should engage in a Civil Conversationto discuss the article’s main points, agreements/disagreements with author, and critical/clarifying questions.

5. After discussing the article as a group, choose 1 or 2 students to prepare a brief 1-2 minute Congressional testimony, which persuasively argues the perspective of the author/interest group. Encourage students to really get into their role.

6. Presenters from each group will take turns. Other students who are not presenting will become legislators. The legislators should take notes of the arguments presented and think of questions to ask the presenters.

E.Debrief:

1. Take a poll of the students to find out which viewpoint they found most persuasive.

2. Ask students:Which argument did you agree with most? And why? What did you find persuasive (the evidence, reasoning, presentation)?

3. Briefly explain what “civil commitment” or “involuntary treatment” means. Involuntary commitmentorcivil commitmentis a legal process through which an individual with symptoms of severe mental illness is court-ordered into treatment in a hospital (inpatient) or in the community (outpatient). Laws vary from state to state. See attached “Family Guide to Involuntary Treatment”

IV.EVALUATION

1. Student’s answers of worksheets, quality of presentations,and class answers/questions in debriefing of activity.

Congressional Hearing Activity Worksheet

Article Title: ______

Read through the entire selection without stopping to think about any particular section. Pay attention to your first impression as to what the reading is about. Look for the main points, and then go back and re-read it. Briefly answer the following questions.

1)This article is about: ______

2)The main points are:

1. ______
2. ______
3. ______

3)In the article, I agree with: ______

4)I disagree with ______

5)What evidence is presented? ______

6)What are 2 questions about this article that you think need to be discussed? ______

Rules for Civil Conversation

1)Read text as if it were written by someone you really respect.

2)Everyone in the conversation group should participate in the conversation.

3)Listen carefully to what others are saying.

4)Ask clarifying questions if you do not understand a point raised.

5)Be respectful of what others are saying.

What did you learn from the civil conversation?

______

______

What common ground did you find with other members of the group?

______

______

After listening to the arguments of the other groups,

With whom do you most agree? ______

______

Who makes the best argument?

______

______

Enforce the Laws, Don’t Add to Them

Sally Satelis a psychiatrist and resident scholar at the American Enterprise Institute.

JANUARY 17, 2013

Yes, we need to revamp our mental health laws and state policies, but the relationship between gun violence and severe mental illness is a tenuous one: the vast majority of people with schizophrenia, bipolar illness and other psychotic disorders are not violent and most violence is not committed by people who are mentally ill. Though shocking and horrifying, shooting sprees are rare.

It is true that severely ill people whose symptoms are unmedicated (and/or who abuse stimulants or alcohol) are at higher risk for committing violence than treated individuals; but even so, they account for only3 to 5 percentof violent crimes in the general population. What's more, from a public health standpoint, guns pose a greater risk to those who want to kill themselves, not harm others. According to the Centers for Disease Control, about6 deaths per 100,000 population— or more than half of all suicide deaths — involved self-inflicted gun shot wounds. The homicide rate by firearm was under4 per 100,000.

Still, mental health policies are in dire need of revision. For one thing, they need teeth: enforce good laws when they are on the books. In the case ofJared Lee Loughner, who shotRepresentative Gabrielle Giffordslast year, it turned out that Arizona had admirably progressive mental health statutes that permit involuntary evaluation and treatment of someone who desperately needs it. Loughner's delusions of mind control, agitated outbursts, bizarre preoccupations and paranoia were highly compatible with a diagnosis of schizophrenia.
In fact, under Arizona law, any concerned party can petition the court for an Order for Treatment. If Loughner had been found"persistently and acutely disabled"by severe mental illness and"likely to benefit from treatment"— regardless of whether he had a weapon or was suicidal — an evaluation and subsequent care could have been court mandated.

Of course, hindsight is clear-eyed. As incidents unfold in real time, most people are rightly uneasy about infringing on a person's liberty. But given Loughner's worrisome track record — the number of times the campus police were called to intervene; the pressing concerns of his teacher and of other students; and the very fact that the college would not re-admit him after his suspension without psychiatric clearance — it seems that a court petition could have been justified.

Second, many states have so-called outpatient civil commitment on the books — a practice whereby a patient who is demonstrably helped by medication is required to take it. In 2005, the New York State Office of Mental Health released anassessment of its so-called Kendra's Law, showing marked improvement in a wide range of measurements, including frequency of arrests, hospitalizations, assaults, threats of violence, incarceration, and homelessness. More than twice as many patients took their medication when under court order as before. A raft of studies from states like North Carolina, Arizona, Iowa, Ohio and the District of Columbia have demonstrated similar benefits. Outpatient commitment needs to be applied rigorously and more extensively.
So I applaud efforts to improve the way we care and monitor the mentally ill, but it's not the cure for gun violence.

Reform Commitment Laws, Add Psychiatric Beds

Dr. E. Fuller Torreyis the founder of theTreatment Advocacy Center. He is also the executive director of theStanley Medical Research Institute, the largest nongovernmental source of funds for research on schizophrenia and bipolar disorder in the United States.

UPDATEDJANUARY 17, 2013, 11:36 PM

In an effort to curb gun violence,President Obama promisedto make “access to mental health care as easy as access to a gun.” His recommendations for improving mental health services are largely disappointing. While it is critical to improve the reporting system to keep guns out of the hands of people who are mentally ill and to encourage the reporting of threats, he neglected to address the two most important issues for reforming mental health care and treating people with severe mental illness.

First, he did not address the need to fix the civil commitment statutes in many states. Approximately half of severely mentally ill persons, most of whom have schizophrenia or bipolar disorder, are unaware of their own illness and therefore will not voluntarily seek help. The commitment statutes in states like Connecticut make it virtually impossible to evaluate and treat people like Adam Lanza until they have already demonstrated dangerous behavior. If Lanza’s mother did inquire about getting her son evaluated involuntarily (on his part), she would have been told that it would be very difficult. Connecticut is also one of only six states that does not have a provision for assisted outpatient treatment, which has been shown to decrease rehospitalizations and episodes of violence and save money. Despite being the most proven solution, assisted outpatient treatment is not even mentioned in the recommendations.

Second, Obama’s recommendations ignore the fact that there are now95 percent less public psychiatric bedsbeing offered in this country than there were 50 years ago. The number of beds per population is the same as it was in 1850. Arizona, for example, ranks 49th among all states in bed availability. If the Pima Community College authorities had considered referring Jared Loughner (who shot Representative Gabrielle Giffords and others in Tucson in 2011) for evaluation, as they should have done, they almost certainly would have been told that no beds were available.

Thus, access to mental health care for the potentially most dangerous mentally ill individuals will not improve until we address commitment laws and psychiatric bed availability. President Obama does neither.

Require Therapists to Warn of Danger

D.J. Jaffe is executive director ofMental Illness Policy Org, a nonprofit research group.

UPDATEDJANUARY 17, 2013, 11:47 PM

Some in the mental health industry object to a provision of New York State gun law requiring them to inform county mental health directors when they conclude a seriously mentally ill patient is likely to cause “serious harm to self or others.” Those directors can notify law enforcement officers, who can take steps to restrict the patient's access to guns. Therapists claim disclosure will discourage future patients from coming in or being truthful.

Maybe. But the overriding concern must be keeping the patient they are currently seeing alive and those around them safe — not some hypothetical future client. The far greater risk is to know someone has a serious mental illness, believe they are dangerous — despite their being under your treatment — and do nothing about it. This approach has led tothree times as manypeople being incarcerated for mental illness as hospitalized and35,000 suicidesannually.

The mental health systemfavorsthe highest functioning over the most seriously ill. As Dr. E. Fuller Torrey said, “we treat mental health and jail mental illness.”

The reporting requirement could improve care. Once county mental health directors receive information that a seriously mentally ill individual is likely to become dangerous, they could and should prioritize this person for treatment not just fill out gun paperwork.

The last argument against reporting is that it causesstigma. Even if true, reducing stigma can’t trump preventing suicide and violence. Therapists who object to informing authorities about mentally ill individuals who threaten others would presumably have no problem if they themselves were the intended target.

The new reporting requirements can improve care, protect the patient and public and save money.

Care Less Likely if Therapists Are Cops

Paul S. Appelbaumis the Elizabeth K. Dollard professor of psychiatry, medicine and law, and the director of the Division of Law, Ethics and Psychiatry at Columbia University.Jeffrey A. Lieberman, president-elect of the American Psychiatric Association, is chairman of psychiatry at Columbia.

UPDATEDJANUARY 17, 2013, 11:42 PM

Not only could the recently adopted New York statute requiring mental health professionals to report patients “likely to engage in conduct” seriously harmful to themselves or others probably not work, it could make things worse.

If we are serious about addressing the problem of untreated mental illness, we should make sure that people who need quality mental health services have access to them.

But if, as seems to be the law’s intent, we want to reduce gun violence by keeping firearms away from people with mental illness, the law seems like a poor strategy, since the best available data indicates that only about 4 percent of violence in the United States is attributable to mental illness.Put somewhat differently, even if we could stop all violence by people with mental illness, we would still be left with 96 percent of the violence we suffer from today.

Even that 4 percent reduction in violence is based on the unlikely premise that mental health professionals can identify everyone likely to commit violence. As illustrated by Jared Loughner, the Tucson, Ariz., shooter, many people with serious mental illnesses do not seek or receive psychiatric treatment. That is particularly true early in their illnesses, when some data suggest the risk of violence is greatest. For those patients who make it into the office, clinic or hospital, our ability to discern which patients are likely to try to hurt themselves or other people is quite limited.

If questionable effectiveness was the only consequence of the new law, it might be worth trying anyway. But the statute actually could increase the likelihood of violence and suicide. People troubled by suicidal or homicidal thoughts might avoid treatment, or be inhibited from speaking frankly about their impulses, if they knew they could be reported to state authorities. Thus, the very people who should most be in treatment may be least likely to seek it. If rates of suicide and homicide rise as a result, we should hardly be surprised.

Targeting people with mental illness as a way to reduce violence is a strategy fraught with risk. To reduce the impact of untreated mental illness, our best hope is to improve the quality and availability of mental health services. If we are serious about reducing gun violence, we need to muster the political will to also do something more about the availability of guns.

Improve Care for Its Own Sake, Not for Safety

Jim Parsonsis the director of the Substance Use and Mental Health Program at the Vera Institute of Justice.

UPDATEDJANUARY 18, 2013, 11:23 AM

President Obama’s proposal to increase financing for mental health services for young people, as part of his plan to reduce gun violence, will be welcome.

In the small minority of cases where people with mental illness are prone to violence, providing access to mental health services may reduce that risk. When good community-based mental health treatment systems are not in place or fail to identify and effectively treat people with mental illness, we know that those people — most of whom are nonviolent — often end up in systems where they don't belong and where limited but often ineffective treatment services are available.