11 Points for Mental Health Care Reform

Due to greater understanding of how many Americans live with mental illnesses and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges Mental health organizations across the U.S. are determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental health and substance use disorders are properly addressed and integrated into healthcare reform.

In anticipation of parity and mental healthcare reform legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform. .

MENTAL HEALTH SERVICE DELIVERY

1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.

2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.

3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.

4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of course, part of this initiative includes helping mental illness patients find a mental health clinic nearby.

MENTAL HEALTH SYSTEM MANAGEMENT

5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges. 

6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.

7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.

MENTAL HEALTHCARE INFRASTRUCTURE

8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental health and substance use performance measures that will be used to improve delivery of mental health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.

9. Health Information Technology: Federal and state HIT initiatives need to reflect the importance of mental health and substance use services and include mental health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.

10. Healthcare Payment Reform: Payers and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.

11. Workforce Development: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors. Provider organizations will need to participate in these efforts and be ready to ramp up their workforce to meet unfolding demand.

http://www.thenationalcouncil.org/cs/mission_and_vision

Social Media is Helping Reduce the Stigma of Mental Illness

"Social media can help deal with the stigma surrounding mental illness by allowing people anonymity and also offering a forum and a place to connect both for those who want to remain anonymous and those who would speak openly about their experiences." — Jackson Wightman,PR Daily

What Would Jefferson Say?

Jacob Payne, a high-profile political blogger from Kentucky recently filed a lawsuit against an anonymous blogger asking a local judge to order this individual to come forward to identify himself/herself and to cease and desist the publishing of critical comments that Payne considers "defamatory".

This is just one of many similar legal challenges making their way through the judiciary system in recent years.  Every one of these cases questions the basic rights granted by the First Amendment as they may apply to Social Media and the Internet.

Each side attempts to argue whether or not anonymous blogging is protected under our Freedom of Speech.   Supreme Court justices struggle trying to reconcile twenty-first century Social Media technology with our eighteenth century Constitution.  What are the relevant contexts and the original intent within components of debate separated by more than two centuries of cultural change?  This is an especially difficult task since the Web is something that Thomas Jefferson and John Adams could never have even imagined.  Having never conceived of such a technology, could they ever have been expected to grant rights and protections about Social Media?   And, then there is the issue of anonymity?  This they may have given some thought to back in 1776.  In fact, a pretty crafty patriot by the name of Francis Marion often went by the name "Swamp Fox," and no one but the redcoats seem to complain.  By the way, Marion was the character loosely portrayed by Mel Gibson in the "The Patriot."

One Person's Challenge is another Person's Opportunity

Perhaps, the most important Supreme Court case to date is McIntyre v. Ohio Elections Comm.  In that case, The Supreme Court has repeatedly upheld the First Amendment right to speak anonymously: "author is generally free to decide whether or not to disclose his or her true identity."

McIntyre v. Ohio Elections Commission is actually a very critical ruling as it indirectly relates to the use of Social Media as a therapeutic tool to aid in the socialization of those with mental illness.  The protection of anonymity is key in facilitating critical interactions in Social Media.  These positive interactions help to break down many of the stigmas associated with mental illness.  It is their anonymity that allows the mentally ill to explore the Web, interact with others and openly express themselves in a manner that offers them protection from a variety of internal (psychological) and external threats (stigma).

According to Web Rights Guru, Ethan Zuckerman: " Social Media gives people an anonymous forum to talk about the fact they are having difficulties, maybe think out loud, and reflect. Because the Internet has become such an interactive forum they can hear from others and they realize, ‘Wow, I am not the only one.'

While the ability to cloak ones identity from the masses when sharing personal experiences on the Web is most desirable for some, regardless of their mental health.  But, not everyone with mental illness prefers to remain anonymous in Social Media.

Steven Schwartz, struggles with BiPolar disorder and Borderline Personality Disorder.  A former Canadian journalist, Steven authors a popular blog called "the bipolar badger."  In his posts he openly shares his personal experiences dealing with mental illness…and he is brutally honest about it all.  That is not to say that he is unable to laugh at himself and share entertaining anecdotes in his writings from time to time.  Steven seems to believe that revealing himself and being who he really is equates to his own well being; the enlightenment of himself and countless others; and the general good.

For putting his neck on the line, the mental health community owes Steven Schwartz many accolades and many thanks.  But this is just Steven's story.  For others, it is the anonymity that they crave allowing them to shield themselves from the insensitivities they may face from day to day. There is much hurt resulting from unfair stereotyping and the acceptance by others of inaccurate and improper assumptions made about those who struggle with mentally illness.There is little doubt that Schwartz undergoes healthy catharsis as he openly and honestly expresses his personal thoughts and emotions.  Admirable is Steven's stated goal (within his blog) to personally help make a difference in the ongoing campaign to reduce the stigma, shame and misconceptions associated with having mental illness.

Technically Protecting Your Anonymity

All people need to talk with and learn from others about themselves and about the world around them. This is regardless of whether they wish to reveal themselves or remain anonymous.  This is not just a need of the mentally ill; it is a basic human need.  And, as we have learned from the courts; all of those who appreciate democracy place a very high value of their Freedom of Speech along with their right to remain anonymous when sharing their views, publicly.  Those who are mentally ill and who are able to grasp these concepts are among them.

So what basic tips can be offered to protect one's anonymity over the Web these days:

1. Use pseudonyms tied to free, international webmail and blog hosting sites.  These are less easily traceable than the better known fee-based, domestic services
2. Use public computers, wherever possible.  Schools, libraries and Internet Cafes are among the places that offer Social Media access for free or at reasonable cost.
3. Use anonymous proxy servers like those found on a list of public proxy servers.  Chances are you may need help choosing and setting up a proxy server interface, but once this is done it is nearly impossible for your IP (computer /location/identity to be traced)
4. Use a stealth blogging site like "Invisiblog," which allows blog posting by specially created E-mails (Mixmaster) rather than by direct uploading of written material.   It really helps to cover one's personal trail.  There are also ways to further encrypt one's Web contributions with online services such as GPG.  It will take some effort or the need to ask for help setting some of these tools in motion, but it is worth the added attention.

 If Social Media continues proving to be an aid in the overall treatment of Mental Illness, it becomes increasingly important for everyone in the mental health community to advocate for the protection of anonymity on the Web.  This will be a tough battle as the courts must be consistent in their rulings and it will be nearly impossible to create a double standard here.  Can anyone really separate the malicious creep who posts attacks – anonymously – on the Web to avoid detection and prosecution from the mentally ill, who may also let loose from time to time –anonymously- to avoid identification and stigma?   This will be a real challenge.  At stake may be more than the gold standard of Freedom of Speech; it may be the platinum value of good mental health.

http://advancedbehavioral.com/

                                                                        

Easy Ways to Help Raise Self Esteem

For many people self-esteem is a problem that can be a lifelong issue and one that can seriously impact both personal and professional relationships. While many would seek to raise their self-esteem, they may find that this is easier said than done, as this is a tremendously sensitive and delicate issue. In order to raise one's self-esteem, it is critically important to understand the nature of self-esteem and how it develops as well as the important link between self-esteem and success.

Generally, self-esteem is relate to your view of yourself, how others view you, your abilities and your accomplishments. Low self-esteem develops when an individual feels that they will fail at tasks they attempt or when they think that others do not think highly of them and their accomplishments.

Self esteem touches every aspect of our lives; both public and private. Therefore it can impact how we interact with our families, our co-workers and those we are involved with on a social level. Even hobbies can be affected negatively or positively by self-esteem. Due to the fact that self-esteem is an integral part of developing a happy, successful life and career, the lack of self-esteem can result in very serious situations. Low self-esteem has been linked to depression and suicidal thoughts.

Fortunately, there are a number of ways that an individual can go about raising their self-esteem. In situations in which low self-esteem is resulting in thoughts of self-harm or harm to others, it is critically important to obtain counseling in order to address these issues. In milder situations, low self-esteem can be treated in a variety of manners that involve relative privacy.

One of the most successful ways to treat low self-esteem is by addressing and reviewing those issues in the past that may have resulted in a negative mindset. In many cases, the root issues may have involved either accomplishments that were attempted but not achieved or perhaps an individual from the past who caused hurt with belittling comments. Whatever the root issue may happens to be, the key to overcoming low self-esteem involves taking the time to recognize the impact the issue has had on your current life and then casting it away from you. Imagery techniques can be particularly useful in this context. Imagine tossing the source of your low self-esteem far away from you.

Other techniques that are frequently used to raise self-esteem involve detailed record keeping. You may be quite surprised to find that you are good at a number of things. Toward that end, make a point to keep a record of all your accomplishment; even if they may seem minor or insignificant. Review these regularly and eventually your low self-esteem will be replaced with high self-esteem.