Ethics and Mental Health Policy

Synonyms

Accessing mental health services; Ethics; Mental health equity; Mental Health Parity and Addiction Equity Act; Mental health policy; Patient Protection and Affordable Care Act

Definition

Ethics and Mental Health Policy: Duties, principles, and obligations directing the actions or guidelines of government or public entities pertaining to and prescribing how a person, organization, or other official party should respond to an individual based on that individual’s cognitive, behavioral, and emotional condition or well-being.

Introduction

Safeguarding the rights and ensuring privacy and protection for individuals experiencing mental illness are responsibilities that public officials and governing entities encounter routinely. Public officials are challenged to establish procedures and processes for responding to those with mental health disorders because the decisions they make are complicated by the need to weigh the interests of competing groups and constituencies, the reality...

Resource Sites

• Federal and State Roles in Protecting Those with Mental Illness (http://www.mentalhealthamerica.net/issues/federal-and-state-role-mental-health)

• This website provides a summary of federal legislation and regulations, federal protections, federal role in funding services, federal role in research, and states’ roles in mental health.

• Guide to VA Mental Health Services for Veterans & Families (https://www.mentalhealth.va.gov/docs/MHG_English.pdf)

• This guide is from the Department of Veterans Affairs. It is a comprehensive guide for military veterans and their families on how to access mental health services.

• Olmstead Act (http://www.mentalhealthamerica.net/positions/community-inclusion-after-olmstead)

• This site reviews content related to the Olmstead Act and efforts to protect and expand community inclusion for those with mental disorders.

• Mental Health Disparities

• The National Institute of Mental Health (NIMH) has a minority health and mental health disparities program. Also, for more information about the topic, see the 2012 National Disparities Health Care Report (https://archive.ahrq.gov/research/findings/nhqrdr/nhdr12/index.html). See the National Partnership for Action (http://www.npa-rhec.org/home) for a review of federal data sources pertaining to health-care disparities.

• Mental Health Parity and Addiction Equity Act (MHPAEA) (https://www.cms.gov/cciio/programs-and-initiatives/other-insurance-protections/mhpaea_factsheet.html)

• The Centers for Medicare and Medicaid Services through its Center for Consumer Information and Insurance Oversight provides a summary of the regulations, protections, and exceptions resulting from the Mental Health Parity law.

• Mental Health Resource Guide for Individuals and Families (http://www.mentalhealthministries.net/resources/resource_guides/Hope_Resource_Guide.pdf)

• The report provides a description of common mental illnesses and how to utilize mental health services.

• Navigating a Mental Health Crisis: A NAMI Resource Guide for Those Experiencing a Mental Health Emergency (https://www.nami.org/About-NAMI/Publications-Reports/Guides/Navigating-a-Mental-Health-Crisis)

• Produced by the National Alliance on Mental Illness, the report discusses how to assist oneself and others who are experiencing a mental health emergency.

• Regulations.gov (https://www.regulations.gov/)

• Public-facing website that enables tracking of federal regulations and laws

• 21st Century Cures Act (https://docs.house.gov/billsthisweek/20161128/CPRT-114-HPRT-RU00-SAHR34.pdf)

• This law (signed on December 15, 2016, by President Obama) was expedited by bipartisan support. The law ushers in major changes related to mental health, biomedical research, brain research, and regulation of drugs and medical devices.

Glossary

Adequacy

Adequacy refers to the quality of care people are receiving to treat their mental health disorder. Of people who accessed treatment, 20% reported that not all of their mental health needs were met or that treatment did not adequately address all their needs (Mental Health America 2018). Barriers to receiving adequate care include lack of insurance, not enough mental health-care providers – especially in rural areas – and gaps in care such as not receiving comprehensive outpatient services (Mental Health America 2018).

Anxiety disorder

Anxiety disorder symptoms are characterized by intense distress and prolonged feelings of being overwhelmed, worried, or fearful of a non-threatening situation (NAMI 2017a). “Anxiety disorders exist when anxiety symptoms reach the point of frequency and intensity that they cause significant impairment” (USDHHS 2005, p. 26).

Assisted outpatient treatment

“Assisted outpatient treatment (AOT) is the practice of delivering outpatient treatment under court order to adults with severe mental illness who are found by a judge, in consideration of prior history, to be unlikely to adhere to prescribed treatment on a voluntary basis. AOT is a form of civil commitment intended for those who suffer from anosognosia (lack of insight) in addition to severe mental illness, and have been repeatedly hospitalized or arrested as a consequence of treatment nonadherence” (SAMHSA National Registry of Evidenced Based Programs and Practices 2015, p. 1). Most often, it is the frequent users of services who are targeted to receive AOT. Studies have shown that individuals experience positive outcomes including improvements in treatment engagement and reduction in hospital stays (Munetz et al. 2014; Van Dorn et al. 2010).

Attention deficit hyperactivity disorder (ADHD)

This is the most common diagnosed mental illness among adolescents (Kaiser Family Foundation 2017). ADHD is defined as “A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (DSM-V 2013, p. 1). Individuals with ADHD often exhibit behavior characterized by the inability to focus on one task, trouble listening, and difficulty following directions (DSM-V 2013). People with ADHD are often easily distracted and may avoid engaging in mentally challenging tasks (DSM-V 2013).

Bioethics

A field of study and a set of activities intersecting medicine, policy, science, politics, and law concerning questions and challenges addressing how we act, view, recognize, or respond to a host of human health issues. In the Encyclopedia of Ethics, bioethics is framed as the “broad terrain of the moral problems of the life sciences, ordinarily taken to encompass medicine, biology, and some important aspects of the environmental, population, and social sciences. The traditional domain of medical ethics would be included within this array, accompanied now by many other topics and problems” (Reich 1995, p. 250).

Bipolar disorder

“A person with bipolar disorder cycles between episodes of mania and depression. These [manic] episodes are characterized by a distinct period of abnormally elevated, expansive, or irritable mood” (USDHHS 2005, p. 26). Symptoms of bipolar disorder include racing thoughts, not sleeping for prolonged periods of time, engaging in risky behaviors, and excessive drinking (USDHHS 2005).

Co-occurring disorder

A co-occurring disorder is diagnosed when a person has a mental health disorder and a substance use disorder (SAMHSA 2016b). Persons with a mental illness are at an increased risk of misusing substances (SAMHSA 2016b). Treating individuals with a co-occurring disorder is challenging as individuals experience multiple symptoms and differences in severity of each disorder (SAMHSA 2016b). Homeless individuals, people who have been incarcerated, and veterans are at an increased risk of developing a co-occurring disorder (SAMHSA 2016b).

Disparate

Referring to differences in care or treatment. “Mental health care disparities, defined as unfair differences in access to or quality of care according to race and ethnicity, are quite common in mental health” (McGuire and Miranda 2008, p. 1). Ethnic minorities are more likely to receive poor or inadequate care compared to nonethnic minorities (McGuire and Miranda 2008). Disparities can develop from lack of health insurance, poor treatment, or bias and discrimination on behalf of the health-care provider (McGuire and Miranda 2008).

Major depressive disorder

Depression is one of the most commonly diagnosed mental disorders (NIMH 2017). It is characterized by prolonged feelings of sadness or hopelessness. “Instead of just feeling ‘down,’ the client might not be able to work or function at home, might feel suicidal, lose his or her appetite, and feel very tired or fatigued. Other symptoms can include loss of interest, weight changes, changes in sleep and appetite, feelings of worthlessness, loss of concentration, and recurrent thoughts of death” (USDHHS 2005, pp. 25–26).

Mental health disorder prevalence

The prevalence of mental health disorders refers to how many people have a diagnosed mental disorder within a given population. The United States has a mental health disorder prevalence rate of around 18% for adults (SAMHSA 2017). However, certain racial/ethnic minorities, homeless individuals, veterans, people who are incarcerated, and other special populations experience higher prevalence rates of mental illness (SAMHSA 2017).

Parity

Referring to fairness or equality between mental health services and medical health services. The Mental Health Parity and Addiction Equity Act [MHPAEA] was passed in 2008. Under MHPAEA, health insurance groups are required to provide the same financial assistance and coverage for treating mental health and substance use disorders that they provide for treating medical and surgical health conditions (CMS n.d.).

Post-traumatic stress disorder (PTSD)

Commonly diagnosed in people who have experienced a traumatic life event, such as assault, combat, a natural disaster, or other life-threatening situations. Common symptoms include sleep disturbances, re-experiencing the trauma, and developing a mood disorder (NAMI 2017b). PTSD has a higher prevalence rate among the veteran population (U.S. Department of Veterans Affairs 2016).

Readmission

Readmission refers to how often people with a mental illness return to a service facility to receive treatment after being released from care. Out of patients who were discharged from the hospital due to a mental health episode, 13% were readmitted within 30 days (Kaiser Family Foundation 2017). This rate is higher among individuals with severe mental illness, with 22% being readmitted within the same time frame (Kaiser Family Foundation 2017).

Recovery model

A treatment philosophy pronounced during President George H. Bush’s New Freedom Commission on Mental Health era where the prevailing belief was that with supportive services and treatment, those suffering mental illness can assume an independent life. Patients’ rights proponents embrace the recovery model. Some define the recovery model as an approach to treatment that enables the individual to maintain control and personal agency, not adhering to the often unattainable goal of premorbid functioning. The complete eradication of symptoms is not the goal in the recovery approach, and such is believed to be unnecessary for adequate functioning (Jacob 2015).

Schizophrenia

“This is one of the most common psychotic disorders and one of the most destructive in terms of the effect it has on a person’s life” (USDHHS 2005, p. 25). Common symptoms include hallucinations, the inability to manage emotions, delusions, and disorganized speech (USDHSS 2005). Treating schizophrenia often requires a multitude of treatment approaches, including medication, inpatient services, and therapy (NAMI 2017c).