Our Health Policy Matters

One of the most controversial elements of bipartisan mental health reform bills in Congress is a surprising one. It’s an effort to amend a 45 year-old regulation that outlived its useful life twenty-five years ago when the Americans with Disabilities Act (ADA) was signed into law.  It is referred to in Washington as “42 CFR Part 2.”  You might know it as the rule that forces you to sign at least two authorizations, instead of one, just to get your own health records sent from one place to another. Today, if you sign an authorization stating “please share all of my health records and medical history with another provider,” you might think that second provider is going to get everything.  But 42 CFR says substance use disorder isn’t covered by that – for that, you need a second one. Keep in mind that in 1970, when 42 CFR was being considered, you could discriminate against someone with a substance use disorder.  You could even fire them from their job....

One of the most controversial elements of bipartisan mental health reform bills in Congress is a surprising one. It’s an effort to amend a 45 year-old regulation that outlived its useful life twenty-five years ago when the Americans with Disabilities Act (ADA) was signed into law.  It is referred to in Washington as “42 CFR Part 2.”  You might know it as the rule that forces you to sign at least two authorizations, instead of one, just to get your own health records sent from one place to another. Today, if you sign an authorization stating “please share all of my health records and medical history with another provider,” you might think that second provider is going to get everything.  But 42 CFR says substance use disorder isn’t covered by that – for that, you need a second one. Keep in mind that in 1970, when 42 CFR was being considered, you could discriminate against someone with a substance use disorder.  You could even fire them from their job....

For the past several months, I've been traveling around the country for Mental Health America. I have been delivering two messages.  The first is that it was a mistake to use a "danger to self or others" standard as a trigger to treatment for people with serious mental illnesses.  Because this has made mental illnesses the only chronic diseases we wait until Stage 4 to treat, and then often only through incarceration. The second is that if we are to treat people with mental illnesses the same way we treat people with other chronic conditions, we have to act before Stage 4.  We have to start with prevention and then invest in early identification and intervention.  We have to integrate health, behavioral health, and other services.  And we have to give people an opportunity to recover at all stages in the disease process. May is  Mental Health Month . Since 1949, it has been a signature program of Mental Health America, formerly known as the Nat...

For the past several months, I've been traveling around the country for Mental Health America. I have been delivering two messages.  The first is that it was a mistake to use a "danger to self or others" standard as a trigger to treatment for people with serious mental illnesses.  Because this has made mental illnesses the only chronic diseases we wait until Stage 4 to treat, and then often only through incarceration. The second is that if we are to treat people with mental illnesses the same way we treat people with other chronic conditions, we have to act before Stage 4.  We have to start with prevention and then invest in early identification and intervention.  We have to integrate health, behavioral health, and other services.  And we have to give people an opportunity to recover at all stages in the disease process. May is  Mental Health Month . Since 1949, it has been a signature program of Mental Health America, formerly known as the Nat...