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Legislation And Government Policies Related To Clinical Mental Health Counseling

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Disability Benefit Of Persons With Mental Illness

Disability in mental illness is a state where the patient has shown symptomatic recovery with the available treatment modalities, however, has deficits that lead to significant problems with self-care, interpersonal, social, and occupational functioning, and impaired quality of life that may need aggressive rehabilitation. Balakrishnan et al. scholarly reviewed various aspects of the Rights of Persons with Disabilities Act, 2016, especially regarding the certification guidelines. They point toward the ambiguity related to screening instruments, resource allocation, and the need for inclusive education. They recommend increased focus and reservation for patients who have a disability due to mental illnesses and specific learning disorders and decentralization of the disability certification, for example, certification of severe or profound intellectual disability at the primary health center itself. This would prevent inconvenience to end users, reduce workload at tertiary level psychiatric centers, would be cost-effective and less time consuming, and would lead to higher recruitment of mental health professionals, especially qualified psychiatrists and clinical psychologists at PHC itself. However, such certification should be done by a medical board mandatorily comprising a qualified psychiatrist and clinical psychologist and not by other professionals such as pediatricians.

Lobbies Groups And Organizations Dedicated To Mental Health Policy

Changes to mental health policy dont happen by accident. Often, they come about through the work of lobbying groups that advocate for the well-being of patients with mental health disorders. Several major groups and numerous smaller ones participate in lobbying and policy formation on mental health issues.

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Psychiatrist Appearing In The Court

In their article, Psychiatrist in Court: Indian scenario, the authors discuss the legal aspects of psychiatric care when psychiatrists are summoned as an expert witness. They opine that the psychiatry residents often do not get first-hand exposure to the Court proceedings. The reason for this may be threefold. First, many residents get trained in General Hospital Psychiatry Units that are not directly attached to forensic psychiatry units. They have a peripheral posting of just around 24 weeks to such centers. Second, the residents, being doctors-in-training, work under the supervision of faculty hence, the Honorable courts do not consider them competent to give evidence. Third, the faculty members may not involve them in legal aspects of patient care, believing it is not their responsibility. In my place of work, which is a tertiary level teaching public hospital, the psychiatry residents are routinely involved in legal aspects of patient care. The faculty should make sure that the residents are actively involved in the legal aspect of patient care, such as medical boards, discharge committee meetings, certification, etc. Only when they are exposed at this stage of their career, once out of residency, they would be in a position to manage such issues independently.

Key Changes Made By Mhpaea

Lawmakers push legislation to address Montanas mental health crisis ...

Key changes made by MHPAEA, which is generally effective for plan years beginning after October 3, 2009, include the following:

  • If a group health plan or health insurance coverage includes medical/surgical benefits and MH/SUD benefits, the financial requirements and treatment limitations that apply to MH/SUD benefits must be no more restrictive than the predominant financial requirements or treatment limitations that apply to substantially all medical/surgical benefits .This test is discussed in greater detail in the MHPAEA regulation and the summary of the MHPAEA regulation found below.
  • MH/SUD benefits may not be subject to any separate cost-sharing requirements or treatment limitations that only apply to such benefits
  • If a group health plan or health insurance coverage includes medical/surgical benefits and MH/SUD benefits, and the plan or coverage provides for out-of-network medical/surgical benefits, it must provide for out-of-network MH/SUD benefits and
  • Standards for medical necessity determinations and reasons for any denial of benefits relating to MH/SUD benefits must be disclosed upon request.

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Lack Of Adequate Information Regarding Forensic Patients With Mental Illness

Diagnosis is of paramount importance to manage psychiatric patients effectively which rests on adequate history from significant others, as psychiatrists cannot rely solely on mental status examination. When individuals are admitted involuntarily through Honorable courts and prisons into tertiary level public hospitals, there is a lack of adequate history. This is more common with those referred from prisons. Attempts are made to discuss with the prison medical officer and caregivers. The caregivers are either untraceable or unwilling to discuss. Also, because of unawareness regarding mental disorders, the only history obtained from the medical officer is of the patient being irritable or displaying suicidal threats. This is not enough to arrive at a diagnosis. Thus, the lack of adequate history is a major problem in a forensic psychiatric setting. The management of such patients, thus, is mostly based on inpatient observation. In recent times, in India, there is an increased focus on training of judiciary and prison medical officers which is a welcome step. There is also a dire need to have a judicial policy that mandates caregiver’s and/or family member’s presence while referring such individuals to psychiatry hospitals.

Section : Clinical Mental Health Counseling


Students who are preparing to specialize as clinical mental health counselors will demonstrate the knowledge and skills necessary to address a wide variety of circumstances within the context of clinical mental health counseling. Counselor education programs with a specialty area in clinical mental health counseling must document where each of the lettered standards listed below is covered in the curriculum.

  • history and development of clinical mental health counseling
  • theories and models related to clinical mental health counseling
  • principles, models, and documentation formats of biopsychosocial case conceptualization and treatment planning
  • neurobiological and medical foundation and etiology of addiction and co-occurring disorders
  • psychological tests and assessments specific to clinical mental health counseling
  • roles and settings of clinical mental health counselors
  • etiology, nomenclature, treatment, referral, and prevention of mental and emotional disorders
  • mental health service delivery modalities within the continuum of care, such as inpatient, outpatient, partial treatment and aftercare, and the mental health counseling services networks
  • diagnostic process, including differential diagnosis and the use of current diagnostic classification systems, including the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases
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    Summary Of Mhpaea Protections

    The Mental Health Parity Act of 1996 provided that large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/surgical benefits.

    MHPAEA preserves the MHPA protections and adds significant new protections, such as extending the parity requirements to substance use disorders. Although the law requires a general equivalence in the way MH/SUD and medical/surgical benefits are treated with respect to annual and lifetime dollar limits, financial requirements and treatment limitations, MHPAEA does NOT require large group health plans or health insurance issuers to cover MH/SUD benefits. The law’s requirements apply only to large group health plans and health insurance issuers that choose to include MH/SUD benefits in their benefit packages. However, the Affordable Care Act builds on MHPAEA and requires coverage of mental health and substance use disorder services as one of ten EHB categories in non-grandfathered individual and small group plans.

    Legislation Related To Mental Health

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    • Legislation related to mental health can be overwhelming and confusing. Thankfully there are agencies like the ones below that have made it easier to search, find, and read current legislation related to mental health in Texas. Use the Texas Legislature Online Resource to track Texas Legislature.

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    State Superintendent Tony Thurmond Announces Support For Bill That Helps Recruit 10000 Mental Health Clinicians For California Schools

    SACRAMENTOState Superintendent of Public Instruction Tony Thurmond and Senator Mike McGuire today joined mental health leaders and professionals to urge support of a bill that would provide grants of $25,000 to aspiring clinicians who commit to serving two years in communities of high need. Seeking solutions to lower student-to-counselor ratios in schools is not a new effort or one unique to California. However, through Senate Bill 1229, California is pursuing an ambitious plan to help recruit 10,000 professionals to help support the growing mental health needs of students. The California Department of Education is proud to partner with Senator McGuire on this priority legislation.

    During this pandemic, our students have experienced extreme levels of depression, we’ve seen a doubling in the percentage of Black students who have expressed suicidal feelings, and we know theres an increase in hospitalizations for young people and adults, said Superintendent Thurmond. California has had enough mental health professionals to provide services to about 30 percent of those who needed it even before the pandemic, and those challenges were even greater in rural communities. We’ve got to build out our school workforce in many places: teachers and classified staff and certainly mental health clinicians in order to meet the needs of our six million students.

    An archived broadcast of the full press conference can be viewed on the .

    Comprehensive Addiction And Recovery Act

    The Comprehensive Addiction and Recovery Act of 2016 authorizes over $181 million each year to respond to the epidemic of opioid abuse, and is intended to greatly increase both prevention programs and the availability of treatment programs. CARA launched an evidence-based opioid and heroin treatment and interventions program strengthened prescription drug monitoring programs to help states monitor and track prescription drug diversion and to help at-risk individuals access services expanded prevention and educational effortsparticularly aimed at teens, parents and other caretakers, and aging populationsto prevent the abuse of opioids and heroin and to promote treatment and recovery expanded recovery support for students in high school or enrolled in institutions of higher learning and expanded resources to identify and treat incarcerated individuals suffering from addiction disorders promptly by collaborating with criminal justice stakeholders and by providing evidence-based treatment. CARA also expanded the availability of naloxone to law enforcement agencies and other first responders to help in the reversal of overdoses to save lives. CARA also reauthorizes a grant program for residential opioid addiction treatment of pregnant and postpartum women and their children and creates a pilot program for state substance abuse agencies to address identified gaps in the continuum of care, including non-residential treatment services.

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    Federal Government Mental Health Legislation

    One stumbling block of this Act is that coverage varies depending on where you live.

    There Are Various Kinds of Mental Health Policies, According to The National Alliance on Mental Illness, and Each State Is Different:

    Scope of Mental Health Act in The USA

    Act is a patchwork of various laws that deal with different aspects of mental health. For example, laws that regulate insurance companies to provide benefits to both psychological patients and physically ill or those laws which protect children may be found amongst Act. The problem arises when two unrelated rules are located within the same piece of the law. For instance, a law protecting children from neglect or drug abuse may be included in mental health laws, leading to confusion.

    Betterment of Society: Act has been enacted to promote better social services in the U.S. However, there are some conflicting interests among different countries. For instance, a person who suffers from mental disorders may wish to seek treatment in another country where such treatment may be available. Similarly, some persons with mental disorders reside in two or more states. The laws on the possession of firearms between states may also differ. Thus, there can be confusion when two different laws on the same problem co-exist, there is no exemption in the Mental Health Act of the USA.

    The Federal Role In Mental Health

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    The federal government works in partnership with the states to address mental health. The federal role in mental health includes regulating systems and providers, protecting the rights of consumers, providing funding for services, and supporting research and innovation. As a major funding source for mental health services, the federal government establishes and enforces minimum standards that states can then expand upon.

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    Brain And Behavioral Research Foundation

    The Brain and Behavior Research Foundation has been around since 1987, and in that time it has awarded more than $408 million in grants for mental health research. Its work has supported thousands of scientists across the world, including those involved in the development of now-common mental health treatments such as transcranial magnetic stimulation and rapid-acting antidepressants.

    Legislation And Government Policies In Clinical

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    National Alliance On Mental Illness

    The stated mission of the National Alliance on Mental Illness is to deliver advocacy, education, support and public awareness so that all individuals and families affected by mental illness can build better lives. The organization was started in 1979 and has grown to become a leading promoter of mental health awareness. NAMI organizes educational programs in thousands of communities across the U.S. It also provides a toll-free hotline where individuals may seek individualized information and support.

    Absconding Behavior In Patients With Mental Illness

    Telebehavioral Health What Every Provider Needs to Know

    When PWMI abscond from psychiatric hospitals, especially closed wards, it places an enormous burden on the hospital staff in terms of the legal implications. The absconders may not take care of self and may be at risk of harm to self, others, and property. Though absconding from psychiatric hospitals or nursing homes is quite common, no Indian data are available in the published literature, probably because of the concern that it may reflect negatively onto the staff and hospital administrators. Though this is an unfortunate event, we need not feel inhibited researching this as absconding is common in any closed setting including high secure prisons and general hospitals, and psychiatric hospitals worldwide, and in India, are no exception.

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    The Mental Healthcare Act 2017

    In their article pertaining to MHCA 2017, the authors, critically evaluate the pros and cons of the new ACT. They commend the act for endorsing the rights of PWMI and recommending decriminalization of suicide and the . They also mention the non-representation of the Indian Psychiatric Society and inadequate address of the burden of care experienced by the caregivers. The caregivers of PWMI are the real ambassadors of mental health they sincerely understand the genuine service that psychiatrists have provided in this country over many decades. No doubt, human rights of PWMI have to be protected at all times however, it cannot be one-sided. There is an equal and strong need to involve the caregivers in framing mental health policies that are ethically and legally sound and at the same time tailoring to their needs and the ground realities of this developing country, such as poverty, illiteracy, unawareness regarding mental illness, stigma, discrimination, etc. In view of the new challenges thrown by MHCA 2017, such as mental health capacity assessment, advance directive, nominated representative, etc., the authors stress regarding the need to actively collaborate with the media, police, NGOs, human rights activists and police.

    The States’ Role In Mental Health

    States have significant power in making decisions about their mental health systems so mental health regulations and available services can look very different from state to state and even from county to county. State mental health systems must meet certain standards set by the federal government, but they are free to expand beyond what exists at the federal level and improve services, access, and protections for consumers. This freedom to experiment with new or innovative services and delivery models allows states to create improvements that can ultimately be translated across the country.

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    National Council For Behavioral Health

    The National Council for Behavioral Health describes itself as a group that advocates for policies that ensure people who have mental health and substance use disorders have access to comprehensive, evidence-based health care services. The organization has created a mental health first aid program that has trained more than 2 million people. It also performs political advocacy, championing increased access to mental health diagnosis and treatment.

    Legal And Ethical Aspects Of Mental Health Care

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    The Mental Healthcare Act 2017 , explicitly talks about the rights of patients with mental illness and lays down the ethical and legal responsibilities of mental health professionals and the government. The rights of PWMI are at par with the fundamental rights of human beings and need to be clearly talked about as they belong to a vulnerable group from evaluation, treatment, and research perspectives. Such rights translate into the ethics of psychiatric care that relate to respect for autonomy the principle of non-maleficence, beneficence, and justice confidentiality boundary violations informed consent etc. I will discuss the ethical, legal, and related issues pertaining to the manuscripts published in this issue of the journal.

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