Mental health panel to endorse educator training, case management, not outpatient commitment

A bipartisan legislative panel crafting policy changes in response to the massacre at Sandy Hook Elementary School is expected to recommend that case management be available to people with serious mental illness and that educators receive “mental health first aid” training to recognize signs of problems.

The committee will also recommend creating a task force to look at ways to improve the mental health system for adolescents and young adults, including addressing gaps in private insurance coverage. And it’s likely to endorse a Massachusetts program that helps pediatricians intervene when children have psychiatric needs, the group’s co-chairwomen said Wednesday.

The details of the recommendations — like whether to encourage or mandate the teacher training — are still being finalized. But the panel is not expected to endorse changes to insurance coverage, or to recommend the use of court-ordered outpatient treatment for people with mental illnesses, a controversial concept that had gained some support in the wake of the Sandy Hook shooting.

“Instead of outpatient commitment, what we thought would work better would be programs that provide case management-slash-coordination for individuals who seem to be recycling in and out of [probate] courts,” said Sen. Toni Harp, a New Haven Democrat who co-chairs the panel.

Rep. Terrie Wood, a Darien Republican who co-chairs the panel, said court-ordered treatment wouldn’t likely receive bipartisan endorsement, since most of the support for it came from Republicans, the minority in the House and Senate.

Most of the panel’s recommendations will focus on adolescents and young adults, and that’s deliberate, Harp said.

“A lot of the gun violence is done by young people from 15 to about 25,” she said. “And a lot of the suicides [are] the same group. And it’s an area where we really have the fewest services.”

Other members of the subcommittee said they hope the recommendations will help eliminate the stigma surrounding mental illness.

“I think the key piece for our task force is we want to reduce the stigma of mental illness and raise awareness of what it is and what’s involved, and that with proper treatment, it can be managed quite well,” Wood said.

Falling through the cracks

The mental health panel is one of three subcommittees established by legislators to produce recommendations on mental health, gun violence and school safety. The mental health subcommittee is expected to meet again before forwarding its recommendations to legislative leaders, who will come up with a final bill. Harp said she expects lawmakers to act on it in the first two weeks of March.

A separate commission appointed by Gov. Dannel P. Malloy is also expected to make recommendations on mental health policy changes.

The task force on adolescent and young adult mental health would be charged with examining insurance changes, as well as the shortage of psychiatric professionals, improving early intervention and treatment, and alternate service delivery and payment models. It will also likely consider whether to move mental health services for young people out of the purview of the Department of Children and Families and into the Department of Mental Health and Addiction Services, Harp said.

“I think it’s time to review the mental health system in the state because clearly this young man in Newtown fell somewhere significantly between the cracks,” Wood said.

Mental health first aid, one topic with widespread support on the subcommittee, is a training course intended to reduce stigma of mental illness and teach people how to recognize mental health problems and intervene. Supporters liken it to CPR training that teaches bystanders how to help while professional help is on the way.

The recommendation about case management would endorse programs that serve a small portion of people with mental illness who need intensive supports, including assertive community treatment teams and Melissa’s Project, which coordinate clients’ care. Both models are in use in some parts of the state but not systemwide. It would also include a peer support program in which people in recovery from mental health issues offer assistance.

Harp said the programs are an alternative to court-ordered treatment. Wood said if they’re used properly, they could help avoid outpatient commitment.

Another panel member, Sen. Terry Gerratana, D-New Britain, said many states have outpatient commitment laws but don’t use them. In her research, Gerratana said, she hasn’t found anything saying the laws are necessary or successful.

“This is one of those areas where you say, ‘Should I be passing a feel-good legislation?'” Gerratana said.

The other recommendation likely to come from the committee is based on the Massachusetts Child Psychiatry Access Project, which provides consultation teams to help primary care providers help children with psychiatric problems. There are not enough child psychiatrists in the state, and pediatricians often struggle with what to do if they identify a patient as having mental health needs.

No consensus on gun permits, insurance

Lawmakers also discussed expanding access to school-based health centers, which provide physical and behavioral health services.

“When you seek care in a school-based health center … there really is not stigma and no one knows what you’re going in there for,” Gerratana said.

But Harp and Wood said the panel might not recommend more health centers because of concerns about the cost.

Harp said the panel discussed, but did not agree on, changes to insurance regulations that would specify that claims denials be made only by health care providers certified or licensed in mental health, and require the state insurance department to check whether plans comply with mental health parity laws. Other changes would have included standardizing the definition of medical necessity used to determine whether mental health services are covered by insurance, and requiring private insurance to cover evidence-based mental health services equal to those offered by the state.

“There was not agreement on that, but honestly, I think that’s one of the most important things that we can do to shore up the system,” Harp said. “We learned that people on Medicaid had better services that were more thorough and were more likely to lead to recovery than people who had commercial insurance. In our state, you either have to be very poor or very rich to get adequate care.”

The insurance changes are likely to be addressed in a bill by the Insurance and Real Estate Committee, Harp said.

The panel also discussed gun permitting issues, which Harp said would be relevant because the majority of gun deaths are suicide. But members did not reach consensus because some members thought they would be better addressed by the subcommittee focusing on gun violence.

Follow Arielle Levin Becker on Twitter @ariellelb.


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