DBSA Public Policy Positions and Testimony
Public policy positions are a key strategy in DBSA’s mission to improve the lives of people living with mood disorders. Click on the topics below to read DBSA’s stance on each issue.
When possible, DBSA representatives testify in front of government panels on issues affecting the well being of individuals living with mood disorders. Click on the links below to find summaries of important testimony.
Public Policy Position Statements
Overcoming the Stigma of Mental Illness
Click here for the full Stigma: A Public Attitude that Shapes Public Policy
Mental illness is one of the most unrecognized and unreported health problems in the United States. Although it is one of the most pervasive and disabling illnesses, it is not viewed as a real illness, such as cancer, heart disease, or diabetes. As a result stigma becomes one of the major barriers to accessing mental health services. Stigma also causes discrimination in many other aspects of a person’s life, including the work place, academia, the local community, and even relationships with family and friends, whose support is so crucial to recovery. For many, the stigma is worse than the illness itself!
The most devastating result of all is when stigma has a damaging effect on a person’s recovery and the ability and will needed to find appropriate treatment, access to critical services, and support from health care providers and insurers. The Depression and Bipolar Support Alliance (DBSA) believes governments and others must take the following steps to help end the stigma and discrimination surrounding mental illnesses:
-
Federal officials should provide leadership and resources to decrease the stigma against mental illness that prevents people from acknowledging their illness and seeking treatment. -
Federal, state, and local governments must provide needed resources for ongoing, public awareness programs to communicate that mental illnesses are real, medical, and treatable illnesses. -
Governments, media, consumers, and advocacy organizations must educate the public that mental heath is integral to overall health and that with appropriate treatment, consumers can recover and live full and productive lives. -
Federal and state governments must provide funding for additional and improved community based mental health services for families facing the devastating decision of custody relinquishment of a seriously-ill child in order to receive necessary treatment. -
Federal and state governments must provide the means for local advocacy organizations to work with law enforcement and criminal justice systems to meet the need for better assessment, counseling services, and training that prevent incarceration and post recidivism of persons living with a mental illness. -
Mental health consumers must always be included in the development, implementation, and evaluation of all federal, state, community-based, and private sector programs to ensure accuracy and efficacy in addressing mental illness.
DBSA believes congressional committees and relevant federal government agencies must take a proactive role in funding and working with peer-based, mental health advocacy organizations to alleviate the stigma surrounding mental illness. Elected officials on the federal, state, and local levels — who have lived with mental illness personally or through the lives of their families — should be encouraged to share their experiences with the public. Such outreach should be aimed at educating and informing the general public that mental illnesses are no different than physical illnesses and can be treated effectively, with recovery an ultimate and achievable goal.
Back to top of page
Mental Health Parity
Click here for the full DBSA BACKGROUND PAPER: Mental Health Parity
Each year, one in ten Americans suffers from a severe mental illness and one in five experiences a diagnosable mental illness. More than 50 million adults and nearly ten million children suffer from such illnesses. While mental illness ranks first among illnesses that cause disability in the United States, most individuals go without treatment as a result of inadequate or inequitable insurance coverage combined with the stigma surrounding mental illness.
The Depression and Bipolar Support Alliance (DBSA) believes the federal government must take a proactive role in making mental health services accessible to everyone by enacting legislation that ends health insurance discrimination against mental illness. Enactment of comprehensive parity legislation would result in affordable and effective mental health care, as well as reduced costs for government, businesses, and society. Outlined below are the policies DBSA endorses for federal involvement in promoting mental health parity:
-
Federal health care policy should recognize that mental health is essential to overall health and that mental illness is the leading cause of disability in the United States. -
The federal government should provide full mental health parity in all federal health care programs, such as Medicare and Medicaid, just as federal employees have enjoyed since 2001. -
Federal law should require self-insured businesses, health plans, and employers offering health insurance to provide comparable benefits for mental health and physical health. -
Federal law should prohibit insurers from establishing different financial requirements or limits for mental health benefits, including annual or lifetime dollar limits, copayments, coinsurance, deductibles, out-of-pocket maximums, and day or visit limits. -
Federal law must not preempt state parity laws that provide greater protection against insurance discrimination than federal law. State parity laws that provide less protection should be required to match the federal minimums. -
Federal parity legislation should not include opt out provisions for companies and health plans claiming increased costs from mental health parity. -
The federal government should provide leadership and resources to decrease the stigma against mental illness that prevents people from acknowledging their illness and seeking treatment. -
The federal government should highlight the savings attributable to parity, such as increased productivity, decreased disability costs, and decreases in other health care costs.
DBSA urges the federal government to participate fully in providing equal access to mental health services compared to other health services. Such participation will ensure a healthier and more productive population and save untold billions of dollars. The enactment of federal parity legislation is one of the most important reforms of our health care system.
Adopted by the DBSA Board of Directors, March 21, 2008
Back to top of page
Restricting Access to Medication
DBSA believes that enacting any policy that restricts patients access to medication is not good medicine, it is not good business, it is not good practice, it is not good government.
There are several compelling reasons that restricting access to medication by enacting a fail first initiative (or otherwise restricting medication for Medicaid and/or Medicare patients) has proven efficacious will not prove beneficial for patients, state budgets or the citizens of states in which these policies are enacted:
- Mental illnesses are complex biological illness where there are no real standard effective treatments. There are far too many variables to consider when prescribing a pharmaceutical therapy to make any limited selection of drugs a viable option.
- Limiting medications through a complex and lengthy prior authorization program will cause needless suffering and, for persons suffering from rapid cycling bipolar illness, changing medications may cause the illnesses to be come more treatment resistant.
- Numerous studies show that limiting available medications through a prior authorization program or a restrictive formulary actually increases usage of all other services including emergency room visit, hospitalizations, doctor visits, outpatient care and even in pharmaceutical costs as medications are layered to try and provide the same relief as a single non-authorized medicine. Net Medicaid costs will go up, not down.
- States becomes much more vulnerable to lawsuits under a restrictive environment. Suicide is the all-too-frequent result of untreated, under-treated, or mistreated mood disorders. Persons with mental illnesses may also become a danger to the public when untreated or under-treated. Persons under-treated for mental illnesses and therefore forced to endure lengthy hospitalizations may be able to make a case for civil liberties violations.
Additional information: DBSA's Medication Access page
Back to top of page
Funding for Research
Researchers are making great strides in their knowledge about the brain and the disorders that affect it, including mood disorders. The federal government plays a crucial, leadership role in advancing research on the brain and its disorders through a variety of agencies -- The National Institute of Mental Health, The National Institute on Drug Abuse, The National Institute on Alcohol Abuse and Alcoholism and the Center for Mental Health Services. DBSA strongly supports federal research into the causes, effects and treatment of disorders of the brain. We believe medical research funding should be determined by the burden of illness, as this would substantially limit stigma. Research holds the key to winning the battle against depression and bipolar disorder. Advances in basic research are making possible significant improvements in treatment. Despite its clear leadership role in funding mental health research, the federal government spends only a fraction on mental illness research as it spends for research on other major diseases such as heart disease or cancer. DBSA not only supports current research efforts but also supports increased funding for all mental health research.
Back to top of page
Consumer Partnership
The following document is a consensus statement developed at a forum of consumer advocates who met in November, 2003 to consider the President's New Freedom Mental Health Commission report from a consumer perspective (follow the additional information link at the end of this section for a complete list of participants. DBSA was represented at this meeting and stands in support of these recommendations.
The following recommendations represent concerns and definitive action steps to increase consumer involvement and expand peer support services; reduce discrimination and stigma; increase opportunities for a consumer and family-driven system; protect and enhance patient's rights; and ensure that disparities in mental health care are eliminated. These issues mirror similar recommendations set forth in the President's New Freedom Mental Health Commission report but are articulated solely from a consumer perspective. These recommendations are the result of dialogue at a historic meeting held on November 14-16, 2003 where consumer leaders were convened in Baltimore, Maryland to identify major areas of consensus and action. DBSA was represented at this meeting and stands in support of these recommendations.
Additional information: DBSA's Platform For Change (.pdf)
Back to top of page
Co-Morbid Illnesses
Co-Morbid Illnesses demand more attention from both policy makers and from the medical community. Currently, too many people believe that depression is an inevitable part of a chronic illness. To change that, education must take place on many levels so people learn that depression is a separate illness that frequently co-occurs with illnesses like diabetes and coronary disease. Research has indicated that people with diabetes are twice as likely as non-diabetics to suffer from depression, that depression often precedes and helps trigger the onset of diabetes, and that diabetes treatment are not as effective for people with depression. Similarly, The Journal of the American Medical Association (JAMA) reports that "major depression may play a role in an increased risk of death and hospitals readmissions for patients with congestive heart failure." Similar statistics can be found in relation to people diagnosed with depression and AIDS or liver, pulmonary and Parkinson’s diseases. More research is needed to show more causal relationships. People need to know that medical treatments have a greater success rate if the depression is treated.
Additional information: DBSA's Co-Morbid Illnesses page
Back to top of page
Dual Diagnosis
The issue of dual diagnosis among people living with mood disorders is a critical issue that is often overlooked. Individuals who suffer from mental illness have a higher incidence of substance abuse than the general population. According to the National Institute of Mental Health, while the rate of alcohol and drug abuse in the general population is approximately 6%, it is approximately 60% in people with bipolar disorder. This dual diagnosis of co-occurring mental illness and substance abuse is of particular concern to DBSA.
Separate treatment can lead individuals to seek help for one issue while leaving the other untreated. Addressed in isolation, one treatment or the other often will fail. Medical experts agree that it is critical that patients in treatment for mental illness address any alcohol or substance abuse issues in collaboration with their mental health needs. Integrated treatment by dually trained professionals is essential for the success of either program.
The current system of separate block grant funding for these treatments, one treatment for mental illness and another for alcohol and substance abuse is outdated and is ineffective. State Bureaus of Mental Health, Drug Addiction, and Alcoholism have been designed to provide service to individuals with a single disorder of mental illness, drug addiction or alcoholism.
DBSA supports appropriate integrated treatment from dually trained professionals who are experts in the unique problems associated with the dually diagnosed population. We support legislation that would allow federal block grant funds to be used in a way that would most effectively treat the individual without needlessly separating the two treatments. We believe it is imperative that the Substance Abuse and Mental Health Services Administration (SAMSHA) move quickly to integrate treatment programs for dually diagnosed individuals.
Additional information: DBSA's Dual Diagnosis page
Back to top of page
Protection of Mental Health Records
Confidentiality is the foundation on which effective patient care must be built. Confidentiality is crucial in every part of the health care delivery system -- from first diagnosis to successful treatment. Confidentiality is the cornerstone in the doctor - patient relationship. The inadvertent disclosure of a patient's identity by a doctor can have terrible repercussions for the patient. Confidentiality is of critical importance in the management of all medical records from hospital records, both inpatient and outpatient, to physician records and prescription records. DBSA is firmly opposed to the commercial use of all medical records to any government action that would have the possibility of endangering patient confidentiality at any stage in the treatment or research process. Protection of confidential data concerning research subjects must be assured. It should never be permissible to submit confidential research information to employers or insurance companies without permission of the patient.
Back to top of page
Advance Directives
An advance directive is a legal document that tells what healthcare services you want to receive if an illness makes you unable to make decisions for yourself.
Everyone should be allowed to make the important decisions regarding their health care. Whether it is choosing to undergo a surgical procedure, take a certain medication or receive life support, every individual should have the final say in how they are cared for.
Advance directives are legal documents that provide a statement of a patient’s treatment preferences or wishes in the event that person becomes incapacitated.
Advance directives empower patients during their treatment and recovery periods; open the lines of communication between patients, their loved ones and treatment providers about the patient’s needs and concerns; and protect the patient from unwanted or harmful treatments, or treatments they know to be ineffective to their care.
Each state has different rules about how advance directives must be written and approved. Be sure to contact your state's protection and advocacy program, a lawyer, paralegal, or advocate to make sure you have all the information you need.
Additional information: DBSA's Advance Directives for Mental Health Treatment page
Additional information: View a Sample Advance Directive (.pdf)
Back to top of page
Involuntary Treatment
Central to DBSA’s core values is the belief that patients must be equal partners with their health care professionals, making decisions in a mutually agreed upon way and that patients must be empowered to work as a team, along with physicians, in order to reach optimal wellness.
There are times, however, when patients may be unable to speak or act in their own best interests because of an episode that could put the patient in serious jeopardy.
Advance Directive
Ideally, the patient, their family, and the health care team leader have spoken in advance about what the patient would like done in the extreme case that he/she is unable to make an appropriate decision to protect his/her life. This document should be on file within the patient's medical records and easily accessible to both the healthcare team and the family members unless the patient had indicated he/she does not want the involvement of family members.
If this advance directive has not been created prior to an incident, DBSA mandates that the life of the patient be preserved at all reasonable costs while protecting the dignity of the individual. Specifically:
- The goal of any involuntary treatment must be to restore maximum independent living as rapidly as possible, using the appropriate level of care for the appropriate illness.
- Patients and their families should be given information about the nature of their illness; the efficacy of proposed treatments; the benefits, risks and alternatives to proposed treatments.
- Family and friends should be closely involved in treatment decisions so that treatment is as closely aligned to the wishes of the patient as possible unless the patient has indicated that there is to be no family and friends involvement.
- All reasonable options for care outside of full time hospitalization should be explored thoroughly before involuntary hospitalization occurs.
- Extreme sensitivity to the use of medication must be required. The overmedication of patients as a means of "chemical restraint" must never occur.
Timeliness in Receiving Treatment
Involuntary commitment and court-ordered treatment decisions must be made expeditiously and simultaneously in a single hearing so that individuals can receive treatment in a timely manner.
Involvement of the Courts
The role of courts should be limited to review to ensure that procedures used in making these determinations comply with individual rights and due process requirements, and not to make medical decisions.
The legal standard for states to meet in order to justify emergency commitments for initial 24 to 72 hours should be "information and belief." For involuntary commitments beyond the initial period, the standard should be "clear and convincing evidence." Involuntary commitments and/or court-ordered treatment must be periodically subject to administrative, judicial and medical review to ascertain whether circumstances justify the continuation of these orders.
Insurance Coverage
Private and public health insurance plans must cover the costs of involuntary inpatient and outpatient commitment and/or court-ordered treatment.
Back to top of page
Prescribing Authority
The Depression and Bipolar Support Alliance (DBSA, previously the National Depressive and Manic-Depressive Association), the nation’s largest patient-directed, illnesses-specific advocacy organization, believes it is in the patient's best interest to restrict psychotropic medication prescription to medical doctors.
To safely prescribe psychotropic medication, extensive education of the physiology of the entire body is necessary. Safe and effective use of medications to treat brain disorders requires medical training to ensure a thorough understanding of physiology, chemistry, drug interactions and medical problems that mask symptoms of mental illness. Diagnosing and medication treatment for mental illnesses such as clinical depression and bipolar disorder (also known as manic-depression) requires the same level of medical skill and knowledge as diagnosing and treating all serious, life-threatening illnesses, such as heart disease and hypertension.
The psychotropic medications used to treat depression and bipolar disorder can have significant effects on the entire body, not just the brain. If not appropriately prescribed and monitored, these medications can cause potentially disabling side effects. In addition, if not efficacious, they can create a life-threatening situation. Only medical doctors have the education required to manage these biologically complex medical illnesses.
As patients, we demand the safest, most tolerable and most effective treatments available. DBSA believes:
- The best approach to the treatment of mood disorders is a combination of psychotherapy, medication and peer support, each of which should be managed by the appropriate professional.
- Prescribing the powerful medications used to treat mental illnesses demand a thorough understanding of physiology, chemistry, drug interactions and medical problems that can mask symptoms of mental illness. An understanding of the entire body and how systems interact with each other can only be achieved through a rigorous medical education involving undergraduate and graduate medical training, and an extensive residency.
- Prescriptions for psychotropic medications should be written and monitored only by someone trained in assessing all adverse physical reactions, drug-induced physical side effects, and drug/drug interactions.
We advocate that physicians and mental health professionals work together to provide the best treatment possible for patients, and call for psychotropic prescription authority to remain the purview of medically trained physicians and only by other professionals when under the care of a physician.
The experience, broad knowledge base, standards of care, and expertise make medical doctors the only professional DBSA believes should be sanctioned to prescribe psychotropic medications.
Back to top of page
Testimony
Veteran Affairs and Peer Support
Thursday, July 19, 2007
On behalf of the Depression and Bipolar Support Alliance (DBSA), thank you for the opportunity to testify today about the types of mental health services offered to and needed by our veterans through the veterans centers of the Veterans Administration. DBSA further thanks you and the other members of the Committee for your efforts in focusing the attention of the nation on the plight of the men and women of our military forces who are returning from combat with their mental health damaged.
DBSA is the nation’s largest peer-directed mental health organization in the country, with more than 1,000 state and local chapters in all 50 states. By peer-directed, we mean that our organization is led and directed by people living with mental illnesses, people like me, people who have experienced the debilitating effects of mental illnesses first-hand. Our organization focuses on the power of peer support as a key component in recovery from mental illnesses.
DBSA regularly partners with the Veterans Administration (VA) to provide peer support training and technical assistance to veterans both nationally and at local facilities. Additionally, DBSA has long been represented on the U.S. Department of Veterans Affairs Consumer Liaisons Council to the Committee on Care of Veterans with Serious Mental Illness.
One of the most important services DBSA offers indeed, our cornerstone is helping people diagnosed with mental illnesses to help each other. We establish and train individuals and support groups throughout the country, preparing them to help and assist their peers on the road to recovery.
Let me first briefly describe our perspective on the need faced by veterans today, a need of which I know this committee is all too aware, but which helps lay the groundwork for an effective and cost-effective solution.
Recent and continuing conflicts in Afghanistan and Iraq have placed a heavy burden on our country’s National Guard and Reserves, in addition to the standing armed forces. Not unexpectedly, these conflicts have taken a toll on the mental health of the men and women serving.
With more than a quarter of a million individuals returning from active military service in FY2006, many of them coming from postings of extreme danger and stress, there is an overwhelming need for mental health care for veterans. More than 35% of Afghanistan and Iraq veterans treated at the VA have been diagnosed with mental disorders.
The Defense Medical Surveillance System, in data reflecting the health self-assessments of service members who had returned from Iraq since June 2005, showed the 50% of Army National Guardsmen and approximately 45% of Army and Marine reservists reported mental health concerns. Much of the mental health treatment these service members receive is provided by the VA, which estimates that 35% of the care provided through its facilities from 2002 to 2006 was related to the diagnosis or treatment of a mental health disorder.
According to a recent article published in the Archives of Internal Medicine, veterans ages 18 to 24 returning from Afghanistan and Iraq are nearly three times more likely to be diagnosed with mental health or posttraumatic stress disorders, compared with veterans 40 years or older
Dr. Karen Seal, a physician at the San Francisco VA Medical Center and lead author of this new research, states, “You have a young population possibly not getting treatment for these conditions, and going on to have chronic mental illness … It’s potentially a big public health problem.”
In answer to calls by veterans and their families, screening of returning veterans for symptoms of mental illness is now more widespread. Yet this screening does not identify many affected individuals. Some veterans do not immediately experience symptoms, which arise much later after their return to civilian life. A high proportion of soldiers misinterpret or ignore symptoms in order to speed their trips home, or in response to the pervasive stigma of mental illness in the military.
At the very time the need for mental health services is the greatest, sadly, the Veterans Administration does not have the capacity to deliver these services to all veterans in need. Despite the Herculean efforts of the many dedicated service providers working on behalf of veterans throughout the VA, current capacity cannot meet demand. News reports continue to document a staggering number of unfilled VA mental health positions. These shortages result in long waits for appointments and care, sometimes with tragic consequences for veterans in need.
Many veterans, distrustful of VA services and mental health professionals, or wanting to put all reminders of military service behind them, never seek available care or seek it only after reaching the crisis point.
In 2006, a committee of VA experts declared that the “VA cannot meet the ongoing needs of veterans of past deployments while also reaching out to new combat veterans … and their families by employing older models of care. We have a new job and we need to do it in a new way.”
Chairman Michaud, we have today at our fingertips the greatest resource to help combat these grim statistics and that resource is our veterans themselves. The members of our armed forces pledge to leave no comrade behind. When the enemy becomes mental illness, our nation’s veterans stand willing to help each other on this new battlefield. Giving such support comes naturally to veterans who have been trained to rely on each other in battle, and who now face the biggest battle of their lives the struggle to overcome mental illness.
Veterans, who have successfully recovered from mental illnesses, reaching out to other veterans with mental illnesses, are an authentic and critical source of hope for the future. Veteran peer supporters can connect with other veterans at a level no clinical provider, however dedicated, can provide.
Let me illustrate the value of veteran peer support services through the example of one of your constituents. Jack Berman, as you know, Mr. Chairman, is a resident of South Portland, Maine. He is a disabled veteran of the Korean War.
Seventy-nine year old Jack Berman is a man of many talents in spite of the adversity he has faced in his life. An entrepreneur, a rehabilitation counselor, a highway-planning engineer for the New York Port Authority these are just a few of Jack’s accomplishments.
Mr. Berman was appointed first lieutenant during the Korean War; fought on the front lines and was at the perimeter where many fellow soldiers were killed. Earlier, while in training to go oversees, Jack was hospitalized and diagnosed with bipolar disorder, which included episodes of depression
In 1953, he finished his tour of duty and was awarded four medals including three bronze stars for Korean service, the United Nations medal and the American National Defense medal.
As an individual living with a mental illness, how did Mr. Berman survive and excel in so many areas? The answer was being able to talk to individuals just like him those living with a mental illness.
As Mr. Berman tells us, veterans are not often inclined to share their stories about the terrible experiences of war with those who may not be able to understand or identify with them. And as a person living with bipolar disorder and depression, Jack knew all to well the stigma faced by those living with a mental illness.
According to Jack, as a soldier, the stigma is even greater. “You would never ever tell anyone friend or fellow comrade — it just wouldn’t be accepted.” As Mr. Berman told DBSA, “These guys are willing to get their medications from a psychiatrist, but they don’t want to talk to them. They want to talk to others like them.”
“Others like them.” The healing power of peer support offers an effective and accessible avenue to reach veterans experiencing symptoms of mental illness following their service.
That is why Mr. Berman believes that peer-to-peer support would the perfect solution for our country’s many veterans who are now experiencing the impact felt by those returning from active duty.
“When a solder is able to openly share his feelings with another solider like himself, something magical happens,” Mr. Berman says. “Talking to my peers was the healing factor in my recovery.”
Our country’s third President, Thomas Jefferson, said, "Who then can so softly bind up the wound of another as he who has felt the same wound himself?”
Peer support in the mental health arena represents a bond between two in Seventy-nine year old Jack Berman is a man of many talents in spite of the adversity he has faced in his life. An entrepreneur, a rehabilitation counselor, a highway-planning engineer for the New York Port Authority these are just a few of Jack’s accomplishments.
Solid research shows that peer support is an effective tool in improving mental health, leading to improvement in psychiatric symptoms, decreased hospitalization and decreased lengths of hospital stays, enhanced self-esteem and social functioning of those served, and lower services costs overall.
One proven method to harness the power of peer support and overcome the significant barriers to successful treatment is the Certified Peer Specialist. These individuals are trained and certified to help their peers other people with mental illnesses deal successfully with their challenges and move forward with their lives. Peer Specialists help those they assist to make informed, independent choices, and to gain information and support to achieve those goals. They demonstrate recovery from mental illness and how to maintain ongoing wellness.
Peer Specialists can offer more regular interaction with others than overworked clinical staff can provide, and outreach in the community and through veterans centers, making support accessible to larger numbers of veterans than can be reached through traditional means alone. And this new role provides opportunities for meaningful work and financial independence for individuals with mental illnesses, including veterans.
Peer Specialist services are also significantly cost-effective. As a result of implementing peer-delivered support and other recovery-focused services, the State of Georgia has realized significant savings in Medicaid-funded traditional mental health day services while demonstrating improved outcomes. Today, Georgia spends an average of $1,000/year per individual for peer supports, as contrasted with $6,491/year previously spent for traditional mental health day services.
The Veterans Administration has already identified paid Peer Specialist services as a priority in its Strategic Plan, A Comprehensive VHA Strategic Plan for Mental Health Services, and has provided some limited funding for efforts of local VA facilities through the Office of Mental Health Services. DBSA is proud to have partnered with several local Veterans Administration facilities to offer Peer Specialist training for veterans.
However, barriers to VA implementation of Peer Specialists remain. Some voluntary veteran peer support initiatives exist but are not always integrated into care and/or seen as effective by providers. Veterans need quality training to help them work effectively as peers, and VA providers need preparation to help them fully understand and accept this new approach. Many VA facilities are moving to hire veterans as Peer Support Technicians (the VA’s terminology for Peer Specialist), but no consistent guidelines and standards exist for training and integrating these positions as a key element of mental health services.
There is a critical need for implementation of a national-level pilot project that sets the gold standard for VA Peer Specialist training and delivery of services. Current and future needs require a large-scale and coordinated national effort to make quality peer support services a reality nationwide through the VA.
Therefore, we urge the committee to encourage the VA Office of Mental Health Services to do the following:
- Identify and allocate a significant increase in funding for a national veterans mental health peer training and employment initiative, including travel funding earmarked to support veteran participation in training.
- Establish and fund a VA Technical Assistance Center for Peer Support Services within the office of Psychosocial Rehabilitation and Recovery Services of the Office of Mental Health Services, using a grant or contractual arrangement with an established national organization with demonstrated experience in peer support training and services.
- Create a pilot national veteran Peer Specialist training and certification modeled on the state of Georgia and in multiple locations throughout the country.
- Allocate ongoing funding for Peer Support Technician positions with the VA.
Such actions are a small part of what we can do to equip our veterans as we provide them with the necessary tools to fight this new battle on their return home.
DBSA stands ready to assist the committee in its efforts. I thank the committee for this opportunity to offer our input and would be happy to answer any questions.
State Of Depression in America
The State of Depression in America Report examines the economic, social and individual burdens of this illness and explores opportunities to improve the availability and quality of care while working toward recovery and better lives for all Americans.
DBSA has dedicated a micro-site with much more indepth information. The information contained on the micro-site includes white papers, press releases, and a special video featuring Mike Wallace.
Additional information: DBSA's 'State Of Depression In America' micro-site.
Back to top of page
FDA Regarding SSRIs and Children
DBSA Testifies Before The FDA On SSRIs As a Risk for Suicide Among Youth
CHICAGO, IL. September 13 & 14, 2004 The Federal Drug Administration’s (FDA) Psychopharmacological Drugs and Pediatric Advisory Committees met today to determine if there is an antidepressant class risk for suicide for youth taking selective serotonin reuptake inhibitors (SSRIs). These include: Prozac, Paxil, Luvox, Effexor, Celexa, Lexapro, Serzone, Remeron, Wellbutrin, and Zoloft.
As the result of yesterday’s meeting, the FDA acknowledged for the first time that antidepressants appear to lead some children and teenagers to become suicidal. The acknowledgement comes a year after the agency suppressed the conclusion of its own drug-safety analyst who first found a link between the drugs and suicide in teenagers and children. In internal memos, agency officials wrote that the analysis was unreliable and they hired researchers at Columbia University to re-analyze the data. That study recently reached conclusions nearly identical to the initial report.
It was an emotional meeting as family members of suicide victims testified, angrily denouncing agency officials for the delay in admitting the risk of suicide for antidepressants in children. In Britain , health authorities decided in December, 2003 to ban the use of most antidepressants in children and teenagers.
DBSA testified at the hearing before the 31 independent experts charged by the FDA to make a recommendation about the labeling and use of the medications.
DBSA told the committee:
- All research data on the impact of SSRIs should be made available to the general public and independent researchers.
- Only through readily available information on the risks and benefits of different medications can families and patients make informed decisions about treatments.
-
The use of SSRIs as a treatment option should also be viewed in the context of broader systemic corrections that need to be made to the health care system. -
Most children and adolescents receive general medical care in a given year. Typically, however, that does not include mental health care. Of particular concern is the availability of mental health care within the primary care settings. This problem is compounded by the insufficient number of child and adolescent mental health specialists. -
Increased training of both primary and mental health clinicians to recognize the symptoms of the early onset of mental disorders in youth is needed. By providing up-to-date data on effective treatments, parents can make informed and effective decisions about their children’s care. -
DBSA believes that the results of all clinical trials should be made available to the public.
Officials will continue their discussion throughout the following weeks. Still, just how the drugs may lead some people to become suicidal remains the subject of fierce debate.
Regarding this issue, DBSA’s primary concern is protecting the safety of all people with depression and bipolar disorder. Parents, young people, physicians and other health care providers must make informed decisions. They also must weigh the risks and lifetime impact of not treating depression with SSRIs vs. the risks of suicide and suicidal ideation.
Editors of the nation’s top medical journals have said they will not accept for publication trials that have not been publicly registered, and legislation is expected to be offered in both the House and the Senate requiring the disclosure of the results of all major drug tests on humans.
Additional information: DBSA's Testimony to the Psychopharmacological Drug Advisory Committee.(.pdf)
Additional information: DBSA's page on FDA Statement on Antidepressants.
Additional information: DBSA's page on SSRIs and Children.
Back to top of page
Social Security Administration on the Proposed Criteria for Evaluating Mental Disorders
Recently, the Social Security Administration announced plans to review and revise the criteria used to determine whether someone has a mental impairment that is disabling. These criteria are used to make the decision whether someone is, or is not, entitled to supplemental security income. In a notice in the Federal Register dated March 17, 2003, SSA asked for public input on what changes they should make. DBSA reviewed the current rules and submitted the following comments on June 16, 2003.
The Depression and Bipolar Support Alliance (DBSA) submits these comments in response to the March 17, 2003, notice in the Federal Register that the Social Security Administration (SSA) intends to revise the rules used to evaluate mental disorders in adults and children who apply for, or receive, disability benefits.
Additional information: DBSA's Testimony to the Social Security Administration
Back to top of page
DBSA’s Comments on the Movie, Tropic Thunder
[08-14-2008] - This week, Dream Works, opened its new movie, Tropic Thunder, a film that uses disparaging language and reinforces the stereotypes so often given to individuals living with an intellectual disability. As part of the mental health community, we know firsthand the challenges of living with a disability. We recognize the damage caused by mischaracterizations and the labels that are perpetuated by the entertainment industry.
DBSA joins the other advocacy organizations, such as the American Association of People with Disabilities, the National Council of Independent Living, the Special Olympics, and others in a call to end the offensive remarks that will be seen repeatedly as moviegoers continue to flock to the theatres this summer.
We, as a nation, need to call on Hollywood studios, writers and executives to end the demeaning portrayals of individuals living with an intellectual disability and instead recognize the meaningful and powerful contributions they make to their families, their communities and their country.
To signon on to a petition and make your voice heard on this critical issue, go to the Special Olympics website at: http://www.r-word.org/.
page created: May 9, 2006 |
page updated: June 23, 2009 | |