Archive for » July 7th, 2012«

Florida not checking national mental health records for gun carry permits

Another gap has surfaced in how Florida screens applicants for gun carry permits: The state agency responsible can’t access a federal database containing 1.6 million records of people nationwide with mental illness, the Sun Sentinel found.

Because it is not a law enforcement agency, the Department of Agriculture and Consumer Services cannot obtain information from the FBI’s National Instant Criminal Background Check System, known as “NICS”, when considering whether to grant a concealed weapon license.

In addition to certain mental health records, the index has other potentially disqualifying information gathered nationwide, such as data on illegal immigrants, drug addicts, military personnel who have been dishonorably discharged, and people who have renounced U.S. citizenship.

Last month, the Sun Sentinel reported that Florida wasn’t completing background checks for gun carry permits on those applicants whose fingerprint card submissions repeatedly were illegible.

The latest development raises additional concerns about the thoroughness and reliability of the state’s concealed weapon screening process.

Efforts have intensified nationwide to pool information about potentially unstable firearm holders since the 2007 Virginia Tech massacre, when 32 people were gunned down bySeung-Hui Cho,who had been ordered by a court two years earlier to undergo mental health treatment.

Since then, states and the federal government have been working to share information through the NICS system to prevent anyone from obtaining firearms if they have been ruled mentally incompetent or committed to a mental hospital.

Florida law enforcement does check the NICS system, and its nearly 8 million records in total, when screening gun purchases made through licensed firearm dealers. But Florida can’t use the NICS system for concealed carry permits because a criminal justice agency doesn’t administer the licensing program.

As a result, gun control advocates say, Florida could be missing potentially vital pieces of information for weeding out individuals with a history of mental illness.

“It seems incredibly silly and dangerous to public safety to let this information rest on the shelf,” said Josh Horwitz, executive director of the Washington-based Coalition to Stop Gun Violence. “People with dangerous mental health histories should not be allowed to carry firearms in Florida.”

Most states do check the NICS system when considering whether to grant a gun permit, the Sun Sentinel found.

But Florida can’t because concealed weapon permits here are handled by the Agriculture Department.

Since the department is not a law enforcement agency, by federal regulation, it is prohibited from receiving information from NICS.

The Florida Department of Law Enforcement is involved in the permitting process, as the performer of background checks, but is barred by federal regulations from passing along NICS-acquired data to a non-criminal justice agency. So FDLE doesn’t consult the database.

“We are complying with all of the laws as they are,” said FDLE bureau chief Martha Wright, who oversees the screening process. “I’m not sure there is anything else we can do within the current regulatory structure.”

Horwitz, however, says there is no excuse for Florida not to make the administrative changes necessary to be able to view the data, particularly given that they can be retrieved instantly.

“I think the bottom line is that someone needs to check this information,” he said. “There should be an easy solution to this problem.”

Agriculture Department spokesman Sterling Ivey said Friday that the department is working with FDLE to determine what can be done.

“Unfortunately, there are restrictions in place on who can use and access the NICS data and until the results of a NICS check is allowed to be received by the department, the department has no other alternative but to continue to follow current law,” Ivey said.

The background screening gap is particularly significant because Florida is a go-to place nationwide for gun carry permits that then are valid in other states through so-called reciprocity agreements.

Florida has 952,000 active concealed weapon licenses. Nearly 12 percent are held by out-of-state residents, according to the Agriculture Department.

Applicants to the state for carry permits must submit their fingerprints, which are used for a background check.

FDLE runs applicants’ names through four databases. One contains Florida criminal histories. Another state database has information on Floridians with outstanding arrest warrants or domestic violence restraining orders.

Florida also cross checks applicants with the FBI’s index of nationwide criminal histories, and with another federal database of people that police officers should be on the lookout for, like fugitives, sexual offenders, convicts on probation and others.

Clerks of courts throughout the state also provide FDLE with cases in which people in Florida have been found mentally incompetent or


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As Blood Donations Decline, US Ban On Gay Donors Is Examined


(CNN) — The American Red Cross says power outages created by recent storms in the East and Midwest cut blood donations, which were already low this summer. In June there was a nationwide shortfall, with donations down more than 10% across the country.

“We are asking people to please call 1-800-RED-CROSS or visit us at redcrossblood.org to find a way to donate if they can,” said Stephanie Millian, Red Cross director of biomedical communications. “We need people’s help.”

One group that would like to help, but legally can’t, may be moving one step closer to eligibility. Since the 1980s, when the AIDS epidemic decimated their community, gay men — or MSMs (men who have sex with men) as they are called by federal agencies — have not been allowed to donate blood. In June, a group of 64 U.S. legislators led by Rep. Mike Quigley, D-Illinois, and Sen. John Kerry, D-Massachusetts, sent a letter to the Department of Health and Human Services encouraging it to move forward with a study that may lead to the end of the decades-old ban.

“We remain concerned that a blanket deferral of MSM for any length of time both perpetuates the unwarranted discrimination against the bisexual and gay community and prevents healthy men from donating blood without a definitive finding of added benefit to the safety of the blood supply,” the letter said.

“This is a matter of life and death and we are turning away over 50,000 healthy men who want to donate blood,” Quigley told CNN. “A straight person who has unsafe sex with multiple partners can give blood, and that creates a greater risk than a gay person in a monogamous relationship.”

The policy started at a time when people didn’t know how the deadly virus that causes AIDS spread. At the time, there wasn’t a good test to detect whether HIV was present in donated blood, and HIV was getting into the nation’s blood supply. They knew this because hemophiliacs who were getting blood transfusions started showing symptoms of AIDS. What scientists also knew was that a disproportionate number of gay men were affected by the virus.

To eliminate risk, the Food and Drug Administration added a screening question to the federal guidelines. Blood banks were instructed to ask male donors if they had had sex with a man, even once, since 1977. The FDA regards 1977 as the beginning of the AIDS epidemic in the United States. If the potential donor responded “yes,” he would automatically be removed from the donor pool for life.

No similar questions were asked to screen out donors who engaged in other potentially risky sexual behavior. Donors weren’t asked about the number of partners they had, nor were they asked if their sexual partners had engaged in unprotected sex with other HIV positive partners.

“While the Red Cross is obligated by law to follow the FDA guidelines, we continue to work with the AABB (formerly known as the American Association of Blood Banks) to push through policies that would be much more fair and consistent among donors who engage in similar risk activities,” Millian said.

Scientists can now screen for most instances of HIV within days of infection, and the nation’s blood banks have called a lifetime ban “medically and scientifically unwarranted.”

Men who have sex with men still are disproportionately affected by the virus and account for nearly half the approximately 1.2 million people living with HIV in the United States, according to the Centers for Disease Control and Prevention. But it is a person’s behavior, not their sexual orientation, that puts them at risk say health experts.

While he is a gay man, Adam Denney thinks he would be the perfect candidate to donate blood. He doesn’t use IV drugs. He practices safer sex. He even educates people on how to prevent new HIV infections as a regular volunteer educator with AIDS Volunteers Inc. in Lexington, Kentucky. He thinks his exclusion is unfair.

“Yes, gay men are still a high-risk community, but so are minority women, and there are no standards prohibiting them from donating. There would be rightful outrage against that kind of blanket population ban,” Denney said. “I am banned based on one reason only, my sexual orientation. It’s totally discriminatory.”

When Denney went to donate at a blood drive on the Eastern Kentucky University Campus a few years ago, he said he knew what likely would happen when the nurses asked the sexual history question. “I did know what I was getting into, but I was shocked by how it felt to be rejected,” he said. “It was almost like they thought I wasn’t important enough to give blood, like because I was gay I didn’t count. It was a horrible feeling.”

Nathan Schaefer with GMHC, an AIDS service organization, said Denney normally would be the type of donor blood banks are hungry for. Studies show those who give blood when they are young become regular lifetime donors, something most blood banks are struggling to find these days. GMHC has been fighting to change the ban for years.

In 2010 GMHC joined a coalition of other nonprofits to encourage Congress to send a letter to HHS to end the ban, which some members of congress did. In June of that year, HHS brought together an independent panel of experts. The Advisory Committee on Blood Safety and Availability reviewed the policy and decided to keep it and concluded the ban was “suboptimal,” because it allows high-risk individuals to donate while keeping low-risk donors out. However, the expert committee also concluded “available scientific data are inadequate to support change to a specific alternate policy.” The panel suggested the policy not be changed and recommended further evaluation.

HHS then promised to conduct feasibility studies to determine if there was a subset of the gay male population that would pose little or no threat to the blood supply. “We finally got them to stop defending the policy at the very least, which was pretty significant,” Schaefer said.

The HHS is still determining the criteria for which part of the population to study.

GMHC suggested the population to consider should include gay men who have had only one sex partner in the past six months. Spain and Italy, two countries with more progressive donor policies, hold everyone to that standard regardless of sexual orientation.

Schaefer takes the point one step further. “A straight person could donate today after having unprotected sex with hundreds of partners, and in the United States they won’t ask about that behavior,” he said. He added that four out of five gay men are HIV negative, which he estimated means 2 million additional people could be blood donors.

A 2010 study by the Williams Institute at the University of California-Los Angeles estimated that if gay men who had not had sexual contact for the past 12 months were allowed to donate blood, more than 53,000 additional men would likely make more than 89,000 blood donations. That number may seem small, but blood banks say it could help enormously, especially now, when blood supply shortages are common.

After Denney was denied the chance to donate, he asked some of his friends to help him demonstrate outside the blood drive. They produced signs to raise awareness about the ban and distributed educational material. They also escorted people to the drive, because they wanted people to continue to donate. “A lot of people in the Bible Belt assume you have AIDS if you are a gay man,” he said. “We wanted them to understand that is not the case. We are banned based on an outdated policy. When people questioned us, I told them about how I always heard that people who donate blood are heroes. Gay men want to be heroes, too.”


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Economist Andrew Dilnot recommended a raft of changes to social care …

Charities and health organisations reacted with fury to the breakdown of cross-party talks on the future of social care for the elderly as ministers said key decisions on how to fund reform would be postponed until next year’s spending review.

A long-delayed white paper on the future of social care will be published on Wednesday along with a draft social care bill. But most attention will focus on a separate progress report – not endorsed by the Labour party – that will make clear that funding for the changes has yet to be agreed.

The Treasury denied claims, circulating within the coalition, that chancellor George Osborne had blocked changes that would cost at least £1.7bn a year.

In 2011 a review chaired by economist Andrew Dilnot recommended a number of changes to adult social care funding in England. These included placing a cap of £35,000 on what people should pay towards home visits or care home costs before they get help from the state.

In England, council-funded home help and care home places for the elderly and adults with disabilities are currently offered only to those with assets of less than £23,250. The Dilnot report said the threshold for assets should rise to £100,000 and a £35,000 cap would be fair.

It is estimated that the reforms would cost an additional £1.7bn a year, rising to £3bn as numbers of elderly grow. Currently £14bn a year is spent by councils on social care.

Health secretary Andrew Lansley and the Liberal Democrats are understood to have been keen to agree the Dilnot plans, but had to accept that the Treasury’s hands would not be tied ahead of the 2013 spending review.

A Treasury spokesman said: “It is completely untrue that we have blocked anything. We have not even been in the talks.”

Michelle Mitchell of Age UK said: “If the government accepts the Dilnot recommendations in principle, that is definitely a step forward and welcome, but with care in crisis now it is not nearly enough. The government must set out the process by which it will make the all-important decisions about funding social care, including timescales and milestones. That is the very least older people and their families will be looking for next week.”

Andrew Chidgey, director of external affairs at the Alzheimers Society, said: “If there is no solution to the funding problem on Wednesday, it will be a catastrophic failure of leadership across the spectrum. It will be a betrayal of older people in this country”.

Mark Ellerby, managing director of Bupa Care Services, said: “There have been four green and white papers over the last 15 years, none of which have led to any substantial reform – this week’s white paper must break that pattern.”

In response to reports that the government has agreed in principle to cap social care costs, Andy Burnham MP, Labour’s shadow health secretary, said: “The government’s talk of agreeing to a cap on costs is meaningless without a plan to deliver it.”

Richard Humphries, senior fellow at the Kings Fund, said: “I think the key point is the simple arithmetic that there are more people living longer and therefore more people needing care and support. Costs are going to soar and the level of care will be haphazard. There will be a running down of standards.”


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Mental health team 'too free with drugs'

An audit of Orygen Youth Health medical records found 75 per cent of those diagnosed with depression were given the drugs too early.

An audit of Orygen Youth Health medical records found 75 per cent of those diagnosed with depression were given the drugs too early.

AUSTRALIA’S largest youth mental health service prescribed medication to a majority of depressed 15 to 25-year-olds before they had received adequate counselling, despite international guidelines advising against the practice.

An audit of Orygen Youth Health medical records found 75 per cent of those diagnosed with depression were given the drugs too early.

Clinical guidelines recommend that in most cases antidepressants should only be given to young people after they fail to respond to four to six sessions of psychotherapy, which usually takes about six weeks. However, the audit, carried out by Orygen’s own researchers, found on average patients received the drugs after just 27 days.

It also showed that fewer than half were followed up to see whether their symptoms had improved or to check for side effects, which can include an increased risk of suicide.

”Our results show monitoring was undertaken far less frequently than recommended and was not done in a systematic or precise way,” the study, published last month in the journal BMC Health Services Research, stated.

The audit, based on 150 patients who were treated in 2007, has raised fresh concerns about the potential for young people to be overmedicated in early intervention programs.

Former Australian of the Year Pat McGorry, executive director of Orygen, has long maintained that drugs are not the first-line treatment in any but the most serious cases.

The study acknowledged that all Orygen patients are offered psychotherapy and some may have been given antidepressants at an early stage because they were seriously ill or had declined therapy. But it did not fully account for the numbers of young people being given the drugs earlier than clinically recommended.

”There is room for improvement with regard to ensuring an adequate trial of psychological therapy before medication is initiated,” the researchers wrote.

Professor McGorry was unavailable for comment but Associate Professor Andrew Chanen, Orygen’s acting clinical director, told The Sunday Age there were no Australian guidelines for treating depression in young people when the study was conducted. The audit was designed to improve clinical practice, and measured Orygen’s treatment approach against British guidelines, which many doctors would have been unfamiliar with at the time.

He said if the audit was carried out today the results would be greatly improved because in 2010 the National Health and Medical Research Council and beyondblue developed Australian guidelines similar to those in Britain. Professor Chanen was on the committee that helped develop the guidelines.

The study’s lead author, Sarah Hetrick, who works at Orygen’s Centre of Excellence in Youth Mental Health, said their patients were different from those seen in general practice and tended to have severe and complex depression. ”Although results of the audit revealed some gaps between [the guidelines] and clinical practice, this is consistent with international research of this type across health fields.”

She said since the study was conducted, Orygen had piloted several strategies to resolve the issues it raised, including an online tool to monitor patients’ depression symptoms and suicidal thoughts. A cognitive behavioural therapy manual for treating young people with severe and complex depression is also being trialled.

George Patton, director of adolescent research at the Centre for Adolescent Health at the Royal Children’s Hospital, said it was positive that Orygen was reviewing its own clinical practice but the audit highlighted the need to evaluate the effectiveness of mental health services receiving federal government funding.

In last year’s budget, $222 million was invested in expanding the Early Psychosis Prevention and Intervention Centre model, a specialist clinical program run by Orygen Youth Health.

”This paper illustrates how much we need to be looking at these new services to determine the extent to which we’re following best clinical practice and to ask the questions, are we getting value for money out of these investments, and are we actually seeing better clinical outcomes?” Professor Patton said.

jstark@theage.com.au


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Mental Health contract a concern to employees

Click photo to enlarge

Ukiah Daily Journal

Editor’s note: This is the third in a series of articles about the county’s mental health system, and the county’s intention to contract out those services. See Sunday’s Ukiah Daily Journal for more.

The question of what will happen to the 46 county employees who work in the Mendocino County Health and Human Services Agency’s Mental Health Division is very much on the minds of their employer and union as the county works to privatize the county’s mental health services.

The county is working to develop a request for proposals, to be released in a month’s time, according to HHSA Director Stacey Cryer. The county hopes to sign over the remainder of its mental health services that aren’t already contracted out to 78 organizations, and possibly administration of those contracts.

“A third of those employees will likely continue in the county, monitoring the contracts, continuing quality assurance and quality improvement,” said HHSA Assistant Director Tom Pinizzotto, who also oversees the Mental Health and Public Health divisions.

Another third of the county’s Mental Health employees could potentially take other county jobs that are vacant but in the county’s budget, according to Pinizzotto, and the other third could be offered jobs by the contractor who steps up to take over mental health services.

One of the county’s difficulties in providing services is the cost of those employees, according to county administrators. Wages have been cut

recently across the board to help balance the county’s budget, including a 10-percent pay cut for the roughly 750 county employees represented by Service Employees International Union, Local 1021.

“When you reduce employees’ wages the way the county has, it makes it harder for people to stay to provide services,” SEIU Local 1021 field representative Paul Kaplan said.

Pinizzotto said he’s aware of the problem, and it isn’t a new one for the county of Mendocino as an employer.

“We’ve been a stepping stone for many of the private-sector folks,” he said, “people right out of college or grad school.”

Those people use their time employed with the county of Mendocino to get the required licenses for their professions, perform an internship and “move on to other jobs that pay better.”

Kaplan gave the example of a Mental Health employee who recently left to take the same job in a neighboring county that paid almost double the employee’s wage in Mendocino County.

Ben Anderson, executive director of Tapestry Family Services, one of the county’s contractors for children’s mental health services, said one of the advantages a contractor offers is less expense for employees. Tapestry offers a competitive wage, but doesn’t offer the same pension benefit that the county offers, he said.

But jobs and how much they pay isn’t the union’s primary concern, according to Kaplan.

“The concern with privatization is the arm’s-distance control you have over the services,” Kaplan said. “As public employees, our members have direct control over the services because they provide them. When you contract out to a private organization, the public loses a degree of control and oversight of those services.”

One concern, he said, is that there would be less accountability for the time a mental health client might have to wait to be assessed for routine, outpatient services.

“Who is looking at that, and where are the red flags being raised?” Kaplan said.

In addition to the question of how the county’s continued oversight of mental health services would play out, members have expressed concerns about not being able to see the RFP (request for proposals), and the accountability and cost for some of the county’s current contracts.

“What happens is contractors bid on providing certain services, and they have clauses in their contracts to allow for costs to increase because of things that happen that aren’t anticipated,” Kaplan said. “Those kinds of contracts end up costing more than they appear.”

Tiffany Revelle can be reached at udjtr@pacific.net, on Twitter @TiffanyRevelle or at 468-3523.


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School supply donations begin Friday to ‘Stuff’ backpacks

Helping children have a proper start for the upcoming school year can be as simple as donating much needed school supplies for the Schuylkill County United Way’s Stuff the Bus campaign.

This is the 10th year for the effort that started Friday with the arrival of the vehicles at the three drop-off points, inside the Cressona Mall, the Fairlane Village, Pottsville, and the Schuylkill Mall, Frackville. Donations can be made at any of the vehicles until July 26.

Donation boxes will also be available at Susquehanna Bank offices.

“It’s a hardship of some of these families,” Kelly Malone, executive director of Schuylkill United Way, said Friday of the cost for school supplies.

The items will then be distributed in August, she said.

Last year, more than 950 backpacks were stuffed and given out to those in need.

This year, 1,035 backpacks are needed, she said.

“Our agencies are seeing an increase in the consumers they are serving,” Malone said.

Stepping up to fill the need is the Wal-Mart Distribution Center at the Highridge Business Park.

They donated 312 backpacks, Malone said. This isn’t the first time the center has donated to the cause, she said, having given money in prior years.

Cynthia Tilinski, compliance manager at Evans Delivery, Schuylkill Haven, said workers at the site collect items that are later given for the campaign. The president of the company also donates to the cause, she said.

“We like to help the children so they are able to go to school that first day. It is hard for some families,” she said.

The Schuylkill Mall also has gotten involved and is offering an incentive for donations. For example, those who donate school supplies will have a chance to win prizes during the Schuylkill Idol events, according to the mall’s website.

With the donation of certain school supplies, those who go to the movies July 13 or 14 can get a buy one, get one free deal, the website says.

By being given the bags filled with such supplies as pens, pencils and other items, families then can spend their finances on other items, Malone said.


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Debate for Guernsey’s charity lottery rules

The States are to debate whether profit from the Channel Islands Summer Lottery can be given to charities in Guernsey.

The law currently dictates that profit from the Christmas lottery does go to charity, but the summer profit goes to the States.

In Jersey profit from both of the £1m prize funds go to local charities.

Guernsey’s Culture and Leisure Minister, Mike O’Hara, said he was “sure” the regulation would be overturned.

He said: “We’re going to go back to the States, it might be October-November time, to ask.

‘Magic million’

“I’m sure at the end of the day the States all want the proceeds to go to charity but there are things we have to discuss before that.”

The new summer lottery was launched on 28 June with the sale of one million £2 tickets in Jersey and Guernsey. The draw is due to take place on 9 August.

If all of the tickets are sold, an estimated £350,000-450,000 is expected to be raised, with the remaining £250,000-350,000 going on costs and agents’ fees.

Deputy Francis Quin, the chairman of the Guernsey Lottery Advisory Panel, previously said: “If the summer lottery is well supported and the magic million is reached, we can investigate a law change that could enable Guernsey charities to benefit.”

Mr O’Hara added that he also wanted clarification on what should happen to the money from unclaimed prizes.


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Youth mental health team too free with drugs: audit

An audit of Orygen Youth Health medical records found 75 per cent of those diagnosed with depression were given the drugs too early.

An audit of Orygen Youth Health medical records found 75 per cent of those diagnosed with depression were given the drugs too early.

AUSTRALIA’S largest youth mental health service prescribed medication to a majority of depressed 15 to 25-year-olds before they had received adequate counselling, despite international guidelines advising against the practice.

An audit of Orygen Youth Health medical records found 75 per cent of those diagnosed with depression were given the drugs too early.

Clinical guidelines recommend that in most cases antidepressants should only be given to young people after they fail to respond to four to six sessions of psychotherapy, which usually takes about six weeks. However, the audit, carried out by Orygen’s own researchers, found on average patients received the drugs after just 27 days.

It also showed that fewer than half were followed up to see whether their symptoms had improved or to check for side effects, which can include an increased risk of suicide.

”Our results show monitoring was undertaken far less frequently than recommended and was not done in a systematic or precise way,” the study, published last month in the journal BMC Health Services Research, stated.

The audit, based on 150 patients who were treated in 2007, has raised fresh concerns about the potential for young people to be overmedicated in early intervention programs.

Former Australian of the Year Pat McGorry, executive director of Orygen, has long maintained that drugs are not the first-line treatment in any but the most serious cases.

The study acknowledged that all Orygen patients are offered psychotherapy and some may have been given antidepressants at an early stage because they were seriously ill or had declined therapy. But it did not fully account for the numbers of young people being given the drugs earlier than clinically recommended.

”There is room for improvement with regard to ensuring an adequate trial of psychological therapy before medication is initiated,” the researchers wrote.

Professor McGorry was unavailable for comment but Associate Professor Andrew Chanen, Orygen’s acting clinical director, told The Sunday Age there were no Australian guidelines for treating depression in young people when the study was conducted. The audit was designed to improve clinical practice, and measured Orygen’s treatment approach against British guidelines, which many doctors would have been unfamiliar with at the time.

He said if the audit was carried out today the results would be greatly improved because in 2010 the National Health and Medical Research Council and beyondblue developed Australian guidelines similar to those in Britain. Professor Chanen was on the committee that helped develop the guidelines.

The study’s lead author, Sarah Hetrick, who works at Orygen’s Centre of Excellence in Youth Mental Health, said their patients were different from those seen in general practice and tended to have severe and complex depression. ”Although results of the audit revealed some gaps between [the guidelines] and clinical practice, this is consistent with international research of this type across health fields.”

She said since the study was conducted, Orygen had piloted several strategies to resolve the issues it raised, including an online tool to monitor patients’ depression symptoms and suicidal thoughts. A cognitive behavioural therapy manual for treating young people with severe and complex depression is also being trialled.

George Patton, director of adolescent research at the Centre for Adolescent Health at the Royal Children’s Hospital, said it was positive that Orygen was reviewing its own clinical practice but the audit highlighted the need to evaluate the effectiveness of mental health services receiving federal government funding.

In last year’s budget, $222 million was invested in expanding the Early Psychosis Prevention and Intervention Centre model, a specialist clinical program run by Orygen Youth Health.

”This paper illustrates how much we need to be looking at these new services to determine the extent to which we’re following best clinical practice and to ask the questions, are we getting value for money out of these investments, and are we actually seeing better clinical outcomes?” Professor Patton said.

jstark@theage.com.au


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Prop. 63, Mental Health Services Act, not as advertised

In 2004, voters approved Proposition 63, which levied a 1 percent tax on millionaires to expand mental health services, and created a state plan to ensure progress toward providing them. Before we passed the law, the official ballot pamphlet told us “how the money would be spent.” New tax revenue would:

– Expand existing county mental health Systems of Care for children, adults and older adults, based upon a proven model of service; and

– Create prevention and early intervention programs within the model systems to help prevent mental illnesses from becoming more severe and disabling.

As one of several co-authors of the Mental Health Services Act, the official name of Prop. 63, I thought the purpose and intent provisions spelled out a clear path to implementation. The Systems of Care model that would receive 75 percent of the Prop. 63 revenue was fully explained in legal codes; government couldn’t screw this up.

I was wrong. Incompetence and politics led the state Department of Mental Health to change the law for private reasons and required counties to follow a different path altogether.

In 2007, the director of the department explained to me that we now were prioritizing services to “those most in need.” To do so, the department tossed the proven model to begin anew, with startups, and a new costly and endless stakeholder, planning and training process. This generated a bonanza for the consulting and contracting industry.

Mental health care in California is provided through a partnership of the state with each county. The new state regulations directed counties to spend the majority of Prop. 63 revenues on new programs for new clients. Counties were told to ignore the existing mental health programs, which, while underfunded and understaffed, are the primary source of treatment for mental illness.

Twenty percent of Prop. 63 funds are to be spent for prevention and early intervention so as to keep mental illnesses from becoming “severe and disabling.” But few such programs exist because state regulations prohibit counties from spending this prevention money to serve those “diagnosed with a serious mental illness or serious emotional disturbance.”

Meanwhile, the tax revenue exceeded expectations – by June 30, $7 billion in Prop. 63 funds had been allocated to counties (despite a significant raid on the act’s trust fund during Gov. Jerry Brown’s first budget year) and the act is on track to generate $1.4 billion this fiscal year. In 2010-2011, the state spent $4.4 billion on mental health services. The percentage of revenue from each funding source for California mental health services was: 35 percent federal; 25 percent Prop. 63; 23 percent state realignment (a dedicated funding source created in 1991 and fed by sales taxes and vehicle license fees) funds; 17 percent state General Fund and other sources.

The Mental Health Services Act has funded 1,600 new programs throughout the state. The state Department of Mental Health has reported that 25,000 mental health services consumers were now “fully served.” The 600,000 other public mental health consumers remain in the old primary county systems. They are as poorly served after Prop. 63′s passage as before.

In every county, new Prop. 63 programs operate as an independent system alongside the old System of Care. Each is managed by the same county department, but with separate budgets and accountability.

When the state Department of Mental Health closed its doors this month under the governor’s realignment plan, the chief deputy director informed the Legislature’s health and budget committees that its oversight of Prop. 63 had ceased. Accountability is now gone.

Senate President Pro Tem Darrell Steinberg, a sponsor of Prop. 63, endorses the current results. To make certain county plans continue in the same direction, the senator inserted amendments to the Mental Health Services Act into a budget bill, thus sanctioning regulations that defy the original purpose and intent of the law.

Steinberg’s substantive amendments were not subjected to any stakeholder process or intensive public review; after one Senate policy hearing, the provisions were transferred into the budget bill and passed within 48 hours. The state will now transfer more than 25 percent of Prop. 63′s revenue to county slush funds, inviting local officials and special interests to fund virtually any venture, including research, that claims to promote healthy outcomes for any constituency.

The issue is close to home for me: The state’s fraudulent regulations deny two grandsons access to prevention services that would fulfill the Prop. 63 promise to help prevent serious mental illnesses from becoming more severe and disabling.

“We were robbed” is the prevailing view from volunteers like me, who collected signatures and donations, and now share the deep disappointment of betrayal by our state government and by special interests, who claim to be our advocates for change but instead support the status quo while collecting generous grants.

The state regulations and the Steinberg amendments both warrant legal challenges. The options to clean this up and fund treatment of serious mental illnesses are:

– Lobbying for Brown administration corrections as the federal Affordable Care Act is implemented;

– Finding a legal team to challenge these new provisions in court and prove that these violate the initiative approved by voters; and

– Waiting for another legislator to take up the cause in a few years.

In the meantime, families and consumers will continue to speak out at state and local hearings. They will experience blank stares and sometimes a polite nod, but never any answers from the politicians.

Where the money goes

San Francisco: Some $127 million in Prop. 63 funds has been allocated to San Francisco. The prevention money portion funds 12 programs, one intervention/recovery service for youths experiencing early psychosis, while others focus on education, Healthy Families and access to the core mental health system. But what happens if your family, friends or neighbors seek actual help?

The Mental Health Association of San Francisco recently was awarded grants totaling $5.9 million for stigma reduction, that is, strategies to reduce stigma toward persons with mental illness. That is more than the city’s total budget for prevention services.

Sacramento: Some $222 million in Prop. 63 funds has gone to Sacramento County. These prevention services link people to care, but the wait for a first appointment can be more than six weeks. A Strengthening Families group manages five prevention programs, none of which addresses mental illnesses, yet receives Prop. 63 funds.

Rose King is one of the co-authors of the California Mental Health Services Act, which voters approved in 2004 as Proposition 63. She has filed a whistle-blower complaint after challenging the Department of Mental Health (see mitruestories.wordpress.com). Send your feedback to us through an online form at sfgate.com/chronicle/submissions/#1


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Romney surges ahead in campaign donations from Kansans

Few states are more reliably Republican than Kansas when it comes to funneling money to campaigns. /ppAnd despite Mitt Romneys lackluster showing at the Kansas Republican caucuses in March where Republican voters gave Pennsylvania Sen. Rick Santorum a 51 percent to 21 percent win over Romney Romney is ahead in campaign donations from Kansans./ppRomney ended the last finance reporting period in late June with $648,631 in contributions from Kansans, compared with President Obamas $513,544./ppOverall, Romney has 36 percent of all the money Kansas individuals have spent on presidential campaigns, with 28 percent going to Obama and the rest to Republican candidates who have dropped out or to third-party candidates with almost no chance of winning./ppAnd the numbers are likely to get more lopsided now that the Supreme Court largely upheld the presidents landmark Affordable Care Act, often simply called Obamacare./ppI think thats going to activate the Republican base more than anything else,” said Ken Ciboski, a Wichita State University political science professor who tends to side with Republicans./ppAnd some Democrats are a bit disappointed that Obama seemed to let Republicans dominate the health care debate, said Mel Kahn, a WSU political science professor who tends to support Democrats. /ppI think (Republicans) have an incentive to whip him even though social conservatives arent that excited about Romney, Kahn said./ppCiboski noted that it may take time to see if that enthusiasm survives as Romney tries to capitalize on the health care decision while also remaining tied to the Massachusetts health care law that required most residents to get health insurance./ppWhatever cash flows out as a result of the Supreme Court decision may matter more to number crunchers and political observers than average voters, Kahn said./ppOnce candidates hit a certain threshold of name recognition and financing, extra chunks of money dont matter very much unless they pay for an incredibly effective political ad not just a typical attack, but a game changer that brands a candidate or his or her opponent./ppAnd the impact of individual contributions, which are limited, has been blunted by a 2010 Supreme Court decision that allows corporations, unions and advocacy groups to spend unlimited money to support or oppose a candidate through super PACs that have already spent more than $100million. /ppThe $1.8 million that Kansans have given to presidential candidates is less than 1 percent of the $523million collected by all presidential candidates during this election cycle, according to data from the Federal Election Commission./ppBut the balance of that spending makes Kansas stand out./ppThe state ranks fifth in terms of percentage given to Republican candidates, with 73 percent of its federal election spending of nearly $7.4million going to Republicans./ppIts outdone only by Tennessee, Mississippi, North Dakota and South Dakota, according to data provided by the Center for Responsive Politics, a nonpartisan organization that tracks political money./ppThe states modest giving to Democrats 24 percent of all political contributions on the federal level gives it enough to outdo 13 other states in terms of percentage given to Democrats./ppJane Schmidt, a retired nurse, said her husband Marcus, a retired prosthetics chief with the Veterans Administration, gave $2,000 to the Obama campaign last year and said they had given to his campaign in prior years./ppShe praised Obama for getting the Affordable Care Act approved, which will help people with pre-existing conditions and others without health insurance get the insurance and care they need./ppShe said that economic problems created by the housing crisis, European economic woes and a host of other political issues have created a huge set of challenges for Obama./pp”Its going to take more than four years to undo the mess created over past years,” she said./ppSchmidt said her husbands donation is a drop in the bucket, especially considering the Citizens United decision that allows corporations to donate unlimited amounts in support or opposition of candidates./pp”This really says the rich people will control who becomes president,” she said. “And it really messes with one person, one vote.”/ppJeff Johnson, president of Flint Hills National Golf Club and a partner in several restaurant operations, is one of the Republican contributors. During this cycle, he and his wife have given $5,000 to Mitt Romney the maximum allowed./ppHe acknowledges that its not much in the context of a huge presidential campaign machine. But he said it represents his enthusiasm for Romneys stance for smaller government and free-market ideals./ppI just feel so strongly,” he said. As a business person, Im so turned off by bigger government, entitlements and people expecting handouts.”


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