School programs, insurance, ‘outpatient commitment’ are discussed in wake of Newtown
Hartford — Her 7-year-old son was one of the “runners” at Sandy Hook Elementary School and has nightmares. Her middle child, age 11, is doing remarkably well. It is her oldest child who worries Jennifer Maksel of Newtown the most.
“I am reaching out as a mother with a son who is increasingly getting more and more withdrawn,” Maksel said.
Her oldest child, who is 12½ years old, has the emotional level of a 9-year-old, is frequently violent at home and is not responding to social skills programs at school, she said.
When she asked school officials what else could be done, she was told, “We don’t have the resources in your area,” Maksel said. Tired of fighting with the school system, insurance companies and hospitals, Maksel said, “I just think that I just need help. I don’t know what else to say.”
Help is what state legislators said they hope to provide after they gather information from the mental health services working group, which met Tuesday in the Legislative Office Building. Numerous mental health experts discussed the need for more mental health services in schools and for better private insurance coverage and the pros and cons of “outpatient commitment.” Many members of the public with mental illnesses said they did not want outpatient commitment — people being forced to receive mental health services. They would rather have Connecticut’s recovery-oriented care system enhanced.
“I am here today to respectfully request that you take a position against proposed legislation that would limit the rights of youth or young adults to choose at what point and where they access mental health treatment,” said Michaela Fissel of Windsor.
Fissel said she struggled during her entire adolescence with untreated bipolar disorder.
If it were available, she said, “I am confident the outpatient commitment would have been the solution that my family would have sought.”
She spent six months as a young adult on a medication treatment plan that left her completely unresponsive, she said. Fissel said she couldn’t take it anymore and overdosed on the prescribed medication.
“Is that what you are trying to seek?” she asked legislators.
The mental health system would benefit more from recovery-oriented care, such as peer support, she said. Peer support might come from someone else living in the community with a mental illness.
The psychiatrist-in-chief for The Institute of Living in Hartford, Harold Schwartz, said he highly recommends that the legislature adopt involuntary outpatient treatment.
“Chronic schizophrenia and certain other chronic and severe mental illnesses are often marked by denial of illness,” he said. For many people hospitalization becomes a revolving door and people might become estranged from family and friends, become homeless or be arrested, he said.
An outpatient commitment program would affect a very small percentage of patients with severe psychiatric illnesses, he said. The “take-home message” is that when done correctly outpatient commitment is a part of the solution, he said.
He doubted this kind of bill would affect the people with mental illness who spoke at Tuesday's public hearing, Schwartz said.
Where the public and experts agreed was in increasing access to mental health services. School-based health centers were suggested as a possible solution.
This program is currently in 20 communities and 80 schools, said Jesse White-Frese, executive director of the Connecticut Association of School Based Health Centers. The centers allow mental health clinicians to screen individuals for mental health issues and provide direct support or referrals for youths dealing with issues such as peer conflict, ideas of suicide, trauma or substance abuse, White-Frese said.
Nelba Marquez-Greene, the mother of 6-year-old Newtown victim Ana Marquez-Greene, also asked that access to mental health services in Connecticut be improved. Her sister, Taina Amaro, read Marquez-Greene’s testimony.
“My prayer is that she (Ana) will be survived by a state and a country that will use this tragedy as an impetus for change,” Amaro read.
Mental illness first needs to be de-stigmatized, then the state needs to identify the gaps in the current mental health system and, finally, new family-strengthening programs need to be created, Amaro said.
Jeremy Richman, father of Newtown victim Avielle Rose Richman, 6, said he and Avielle’s mother, Jennifer Hensel, have created the Avielle Foundation to determine why the tragedy had occurred.
The objectives would be to determine the mental underpinnings that lead to violent behavior, to understand the biological and environmental factors associated with violence and to ensure that everyone is considered a valuable part of their community.
“We ask you as a parent, as a responsible member of many communities and as a citizen of the United States of America to help craft polices that will protect our precious loved ones from this type of violence,” Richman said.
Multiple experts at the hearing also said the lack of mental health coverage by private insurance plans has to be addressed.
The state’s Department of Mental Health and Addiction Services primarily serves individuals ages 18 and above who are underinsured or uninsured, Commissioner Patricia Rehmer said. Medicaid has co-pays only for medication, and puts no limitations on outpatient visits or case management services through public mental health services, she said.
“The bigger gaps are for individuals with private insurance,” Rehmer said. For example, in the private sector a person who needs “acute inpatient treatment” is limited to five to seven days in a hospital, she said.
There are also people who have insurance but choose to pay out-of-pocket to keep their loved ones’ diagnoses from going on a medical record and, consequently, get even less financial support for treatment, Rehmer said.
If the stigma surrounding mental illness isn’t addressed, “we will have a very hard time increasing their access to services or at least to utilize whatever means they have to pay for these services,” she said.
The legislature's bipartisan task force will reconvene at 6 p.m. today at Newtown High School.