Bazelon Center Mental Health Policy Reporter

Welcome to the Bazelon Center Mental Health Policy Reporter. Available exclusively online and to our email subscribers, the Reporter supplements the Bazelon Center 's Action Alerts by providing a periodic bulletin on significant policy developments that affect people with mental illnesses.

Volume VIII, No. 4, May 27, 2009

Schools and Mental Health Lead Legislative Agenda

Focus on Supreme Court Nomination Dominates News

In this issue

• Use of Restraint and Seclusion in Schools Decried
• Bills Re-introduced to Enhance Learning and Mental Health in Schools; Please Help Enlist Co-Sponsors
• Sign On to Support the JJDPA Reauthorization Bill
• Homeless Assistance Passed
• Mental Health Parity Comments Encouraged

Newsbytes

• HHS Makes $75 Million Available to States to Expand Health Insurance Coverage
• Congressional Briefing n People with Serious Mental Illnesses in Jails

All eyes are currently on the Senate and how its Judiciary Committee will review President Obama’s felicitous nomination of Judge Sonia Sotomayor to the U.S. Supreme Court. See the Bazelon Center’s initial response and an analysis of her record in disability cases, at http://www.bazelon.org./issues/disabilityrights/sotomayor5-09.pdf. Meanwhile, Congress is at work to improve prospects for the nation’s schoolchildren—challenging seclusion and restraint and instead encouraging the use of positive behavioral support and the expansion of mental health services in schools—and to expand access to healthcare and housing for people with mental illnesses and other disabilities.

Use of Restraint and Seclusion in Schools Decried

Although federal law regulates the use of seclusion and restraint on children in hospitals, residential treatment centers and other facilities receiving federal funds, children in public and private schools have no such protections. This omission prompted House Education and Labor Committee chairman George Miller (D-CA) to request an investigation of the practices by the Government Accountability Office (GAO) and to convene a hearing on May 19 to highlight abuse of these procedures in schools.

Released in connection with the hearing was the GAO’s report, Seclusions and Restraints: Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers (http://www.gao.gov/new.items/d09719t.pdf). The report cited hundreds of allegations of such cases since 1990, almost all involving children ith disabilities.

Mothers Describe Harm to Their Children
Presenting poignant testimony before the committee were two mothers: Ann Gaydos, whose daughter was diagnosed with Asperger’s syndrome and bipolar disorder at a young age and repeatedly faced harmful restraints in a California school, and Toni Price, whose foster son was killed at age 14 when his teacher sat on him until he could no longer breathe. Other witnesses were Greg Kutz, GAO managing director of special investigations, Dr. Reece Peterson, a professor of Special Education at the University of Nebraska; and Elizabeth Hanselman, Assistant Superintendant for Special Education and Support Services in Illinois. Their comments and video of the hearing are available at http://edlabor.house.gov/hearings/2009/05/examining-the-abusive-and-dead.shtml

Mr. Kutz pointed out that in the absence of federal regulation of these dangerous procedures, state policy is “widely divergent.” Nineteen states have no laws or regulations regarding restraint and seclusion, seven restrict restraint but not seclusion, 17 require staff to be trained to practice restraint, 13 require schools to gain consent before implementing punitive punishment, and eight prohibit restraint tactics that inhibit the ability to breathe.

Education Secretary to Seek State Policies
The hearing and report produced an immediate response by Education Secretary Arne Duncan, who told committee members that he is asking all state school chiefs to submit plans for using such practices in their schools. He announced plans to ensure that all states have clear policies in place on seclusion, restraint and other physical interventions used in schools for the coming academic year.

To date, federal policy has been enacted to regulate usage of restraint and seclusion only in residential facilities receiving federal funding, through the Children’s Health Act of 2000 (P.L. 106-310) (see a summary of the regulations implementing this law at http://www.bazelon.org/issues/children/restraint/restraingtandseclusion.htm) and, more recently, H.R. 911, the Stop Child Abuse in Residential Programs for Teens Act of 2009.

Stressing bipartisan support for controls on the practices, Rep. Miller noted that H.R. 911 had received support from both parties.

Positive Behavioral Support is Better Alternative
With the goal of limiting and, ultimately, ending the use of restraint and seclusion in our nation’s schools, the Bazelon Center is working to encourage the use of school-wide positive behavior supports (PBS) as a proactive approach to better manage challenging student behavior. This approach implements behavioral expectations and effective interventions for all students, including those with significant mental health needs. (See the Bazelon Center’s statement at http://www.bazelon.org/newsroom/2009/5-19-09PBS-not-seclusion_restraint.htm).

Two Education Bills Re-introduced

Positive Behavior for Safe and Effective Schools Act
On May 21, Representative Phil Hare (D-IL) re-introduced the Positive Behavior for Safe and Effective Schools Act (H.R. 2597). The legislation is designed to encourage the use of school-wide positive behavior support (PBS) to help improve school climate and foster students’ academic and social success. School-wide PBS reinforces desired behavior and eliminates inadvertent reinforcement of problem behavior. It has been shown to improve instructional time, reduce disciplinary problems and increase test scores. (See a description of the Bazelon Center report, Way to Go, for details about PBS.)

The legislation would amend the Elementary and Secondary Education Act (ESEA). Specifically, it:

• Provides flexibility for use of Title I funds so state agencies may provide technical assistance and support the implementation of PBS;
• Amends the Safe & Drug Free Schools and Communities Program to emphasize initiatives that improve the whole school climate in order to foster learning;
• Authorizes local education agencies to use funds for school-wide programs as a way to promote a school environment that is safe and conducive to learning;
• Offers instructional leadership skills to help teachers administer PBS and enhance their understanding of the social and emotional learning of children to improve the learning climate;
• Establishes a new office in the Department of Education to help coordinate and administer assistance to mental health and related services professionals who work with students on PBS and other evidence-based approaches to help improve their academic and behavioral outcomes.

The bill is sponsored by Representatives David Loebsack (D-IA), Danny Davis (D-IL), Elijah Cummings (D-MD), Janice Schakowsky (D-IL), Carol Shea-Porter (D-NH) and Joe Courtney (D-CT). It has been referred to the House Education and Labor Committee.

Mental Health in the Schools Act
Representative Grace Napolitano (D-CA) and Tim Murphy (R-PA) re-introduced the Mental Health in the Schools Act of 2009 (H.R. 2531) to expand school-based mental health services for children in K-12. The two co-chairs of the Congressional Mental Health Caucus, in their “Dear Colleague” letter on the bill, highlighted how the bill would expand essential services. It: 

• Revises, increases funding for, and expands the scope of the Safe Schools-Health Students program to provide access to more comprehensive school-based mental health services and supports;
• Authorizes competitive grants to local school districts to assist them in implementing effective mental health programs for students (K-12), administered by state licensed or certified mental health professionals
• Provides for comprehensive, culturally and linguistically appropriate, staff development for school and community service personnel working in the school to identify and support students in need of immediate mental health care and those at-risk for behavioral mental health disorders, allowing teachers to concentrate on teaching;
• Promotes positive mental health education and support for parents, siblings, and other family members of children with mental health disorders, as well as concerned members of the community;
• Requires schools to thoroughly document measures of outcome and demonstrate the actions they are taking to continue sustaining the program independently of grant funds.

Most recently, on May 7, Reps. Napolitano and Murphy shared remarks on the bill, alongside actress Goldie Hawn, at a legislative briefing on school mental health services sponsored by the Bazelon Center, NAMI, Mental Health America and the Federation of Families for Children’s Mental Health (see http://www.bazelon.org/issues/children/positive_behavioral_support.htm).

The bill has been referred to the House Energy and Commerce Committee.

What You Can Do

Co-sponsors are needed for both bills. Please contact your Representative in Congress this week to urge him or her to co-sponsor the Positive Behavior for Safe and Effective Schools Act (H.R. 2597) and the Mental Health in the Schools Act of 2009 (H.R. 2531).

• Phone: You can reach your Representative (and his or her legislative staff) by calling the Capitol switchboard at 202-224-3121. You can also call the direct line, available on your Representatives website through www.thomas.gov/
• Email: Much less effective than a phone call, email must come through the link on the lawmaker’s website to be counted (rarely read). You can find your Representative’s website on http://www.house.gov/
• Postal mail: Find the postal address on the member’s website or write to:

  The Honorable (first and last name)
  U.S. House of Representatives
  Washington, DC 20515

Sign On to Support the JJDPA Reauthorization Bill

The Juvenile Justice and Delinquency Prevention Reauthorization Act of 2009 (S. 678) strengthens critical core protections for youth who are involved in or at risk of entering the juvenile justice system. It also provides for prevention, intervention and treatment services designed to reduce crime and recidivism among youth, including those with mental health and addiction needs (see details in the Bazelon Center’s last Policy Reporter).

The Act 4 JJ working group of the National Juvenile Justice & Delinquency Prevention Coalitions asks state and local organizations across the country to sign onto a letter to key Senators in support of S. 678, http://www.campaignforyouthjustice.org/documents/S.678SignOnLetter_000.doc

Please ask organizations in your network to sign on by 5 pm EST on Tuesday, June 2. To sign on, email Shanta Gray at sgray@cfyj.org.

HEARTH Act Passes

Congress has passed the aptly named HEARTH Act. The legislation reauthorizes, improves, and increases funding for the McKinney-Vento Homeless Assistance Programs, the primary federal funding source of rental subsidies for permanent supportive housing for people with disabilities. HEARTH has significant positive implications for disability advocates’ quest to expand the availability of truly integrated and affordable supportive housing. It also continues and strengthens the programs’ emphasis on funding for permanent supportive housing for people with disabilities. 

The legislation authorizes $2.2 billion in funds, which, if appropriated, would result in an increase from the $1.67 billion appropriated in fiscal year 2009.  Depending on the program, these funds can be used for rental subsidies, support services, or capital funding for permanent supportive housing.  

Mental Health Parity Act Comments Encouraged

The U.S. Departments of Labor, Health and Human Services (HHS) and the Treasury have published an official request for public comments on the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (Public Law 110-343) prior to further rulemaking and publication of regulations for implementation of the law. The Federal Register announcement can be found at http://edocket.access.gpo.gov/2009/pdf/E9-9629.pdf.

Signed into law by the President on October 3, 2008, the MHPAEA law aims to end discriminatory insurance practices and affirm that mental health and substance use disorder treatments are integral components of comprehensive health care. The law expands on the protections in the Mental Health Parity Act of 1996 and amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 and the Internal Revenue to require large group health insurance plans that include coverage for mental health or substance use disorders to provide these benefits at parity with the plans' medical/surgical benefits.  Small groups and individual policies are not included.  For more information on this landmark legislation, see the Bazelon Center's May 6 Action Alert.

The Bazelon Center has prepared comments for submission and you are welcome to use them as a model for your own. Please view our Alert for instructions on how comments should be submitted.  The deadline to submit is May 28, 2009.

Newsbytes

Funds to Expand Health Insurance
Health and Human Services Secretary Kathleen Sebelius announced on May 21 the availability of $75 million to help states expand health insurance access for the uninsured. With these funds, she noted, “states can look at the most effective ways to provide affordable health insurance to their uninsured residents.” The press statement described grants to be made in two categories: 1) target grants of $2-$4 million will be awarded to states with plans to target specific groups of uninsured, such as children, small businesses or uninsured seniors, and 2) comprehensive grants of $7-$10 million will be awarded to states for extensive insurance-coverage initiatives.

The grants will run for five years and will require a 20-percent match unless a state demonstrates financial hardship. The application deadline is June 15 and all applications must have the support of the state's Governor. The impact and results of state projects will be reported to Congress at the end of the five-year grant period.

Visit HRSA's State Health Access for more information about this funding opportunity.

Congressional Briefing on People with Serious Mental Illnesses in Jails
A new study on the prevalence of adults with serious mental illnesses in jails will be released at a congressional staff briefing on Monday, June 1 at 2pm in Room 226, Dirksen Senate Office Building (Washington DC).  Presenters will summarize the study findings, implications for jail systems, the courts, communities and people with serious mental illnesses. The role of the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) grant program in stimulating comprehensive evidence-based services and supports will also be discussed.

To attend, rsvp to 240-482-8583 or skelley@csg.org

Presenters are the study co-author, Fred Osher, M.D. Director, Health Systems and Services Policy, Council of State Governments Justice Center; Judge Steven Leifman, Special Advisor on Criminal Justice and Mental Health, Supreme Court of Florida; Art Wallenstein. Director, Montgomery County Department of Correction and Rehabilitation, MD; and Fred Frese, Ph.D., a psychologist who is a leading expert and spokesperson on serious mental illnesses, diagnosed with schizophrenia at age 25.

Among the key findings:

• 14.5 percent of men and 31 percent of women entering the jails studied were found to have serious mental illnesses. These rates are three to six times higher than those found in the general population.
• The gender difference is particularly important given the rising number of women in U.S. jails
• If applied to the 13 million jail admissions reported in 2007, the findings suggest that more than 2 million bookings of a person with a serious mental illness may occur annually.

This study represents the most reliable estimates in the last 20 years of the rates of serious mental illnesses among adults entering jails. 

The briefing is sponsored by the Council of State Governments Justice Center, the National Alliance on Mental Illness, the Bazelon Center for Mental Health Law, the National Association of Counties, the National Council for Community Behavioral Healthcare, Mental Health America and the Campaign for Mental Health Reform.