Dear CSWA Affiliated Society Member,

As you know from the numerous CSWA posts about the Senate mental health bill, S. 2680, the Mental Health Reform Act of 2016, this bill is the best option in terms of passing a real mental health plan that works. The House bill, HR 2646 is considerably weaker. S. 2680 creates the enforcement that the Mental Health Parity and Addiction Equity Act failed to implement. It will make psychotherapy available to the 50% of Americans who currently do not have access to treatment.

Please send the following message to your senators at http://www.senate.gov/senators/contact/ BY TOMORROW, September 3. Apologies for the late notice but the strategy including rolling contacts by mental health associations and today is the day for CSWA to send our support.

Dear Sen. ______:

I am a constituent and a member of the Clinical Social Work Association, writing today to urge your Senate leadership to bring up S. 2680, the Mental Health Reform Act of 2016, for immediate consideration. This bill is the best option for giving the 68 million Americans who live with mental illness the help they need, including the 117 people who die every day by suicide. Mental health parity has failed to provide the equal coverage that it promised. Please vote for S. 2680 when it comes to the floor. Sincerely, [Your name, license, address, contact information]

As always please let me know when you have sent your messages.

Laura W. Groshong, LICSW, Director, Policy and Practice
Clinical Social Work Association
206-524-3690
lwgroshong@clinicalsocialworkassociation.org
Seattle, WA

CSWA - "The National Voice for Clinical Social Work"
Strengthening IDENTITY, Preserving INTEGRITY, Advocating PARITY

Dear CSWA Members,

You may have heard that hard on the heels of the passage of the Helping Families in Mental Health Crisis Act of 2016, HR 2646, another bill related to clinical social work practice passed the House of Representatives today, the Comprehensive Addiction and Recovery Act (CARA), S 524/HR 963.  

This bill has great policy objectives including including prevention, treatment, recovery support, criminal justice reform, overdose reversal, and law enforcement which will help those with addictions, often in combination with mental health disorders.  Approximately 129 people die every day because of addictions. 

The huge problem with the bill is that there is no additional funding for the increased benefits.  Those who supported the bill felt it was better to get a bill passed and worry about funding later, a strategic decision.  CSWA hopes that the strategy pays off and the bill will be more than a policy statement.  I wanted you to be aware of the pros and cons as you hear about CARA over the coming days and months

Dear CSWA Members,

Thanks to all the many CSWA members who sent their emails to their Representatives.

Today the House of Representatives passed HR 2646 by an overwhelming majority of 422-2! 

Please send the following message to your Representative, even if you did not ask your Representative to vote in favor of the bill:
“I am a member of the Clinical Social Work Association and a constituent.  Thank you so much for voting in favor of the Helping Families in Mental Health Crisis Act of 2016 which will improve access to mental health services for our citizens. [Name, License, Address, email]” 

You can find your Representative's email at http://www.house.gov/representatives/find/ ; .

Now we will wait to see what happens with the Senate bill and hopefully have a compromise committee to combine the best of both bills.

Dear CSWA Members,

On June 15th, HR 2646, the Helping Families in Mental Health Crisis Act of 2016, a bill that CSWA has been following for the past three years, unanimously passed out of the House Energy and Commerce Committee.

This bill will be voted on by the whole House of Representatives next Tuesday, July 5.  Please email your representative as soon as possible.  It is very important to support this bill which will increase funding for many parts of the mental health system, create an Assistant Secretary of Mental Health in DHHS, and create a Minority Fellowship Program.  While there are other parts of the bill that CSWA would like to modify, getting the bill passed out of the House so that we can continue the discussion is crucial at the moment. The Senate mental health bill has also been passed out of committee and needs to be passed out of the Senate, but is not yet scheduled.  To get the Senate bill scheduled, the House bill must pass.

You can find the email address of your Representative at http://www.house.gov/representatives/find/ . Please send the following message to your Representative: “I am a member of the Clinical Social Work Association and a Constituent.  Please vote for passage of the Helping Families in Mental Health Crisis Act of 2016 on July 5 and improve access to mental health services for our citizens. [Name, License, Address, email]”

As always, please let me know when you have emailed your message.

Dear CSWA Members,

CSWA received this message from the Association of Social Work Boards today and has requested that we send it to members.  To summarize, ASWB does a practice review of social work every 7-10 years and is beginning one now.  Approximately 250,000 of the 600,000 social workers in the country will receive a copy of the survey on social work practice.  Please participate if you receive this survey.

Below is the message:

I am writing on behalf of the Association of Social Work Boards (ASWB) to let you know that ASWB has launched its latest practice analysis of social work, the study of current social work practice that serves as the foundation for content included in the ASWB social work licensure examinations. Conducted every seven to ten years, the practice analysis begins with a survey of licensed social workers in the United States and Canada. The survey is designed to gather information about the knowledge and skills needed by those in the social work profession. It was sent to more than 250,000 licensed social workers, including social work practitioners and educators, earlier this month.

We are contacting your organization to let you know what was happening and to encourage you to  forward to ASWB any questions or concerns you might receive from your members about the survey.  

To explain more fully, the survey requires social workers to respond to statements about tasks that social workers perform (or do not perform) or about the knowledge that social workers need to perform those tasks safely and competently. All responses are confidential and will be combined with those from other social workers responding to the survey. Additional information on the process—including the results of the last practice analysis conducted by ASWB—may be found at www.aswb.org.  

ASWB remains committed to producing a valid and reliable social work licensing examination, and we are excited about the next chapter in its development. We look forward to the responses from the practice analysis survey.

Thank you for your commitment to our profession and the public it serves.

Lavina G. Harless, LCSW
Examination Development Manager
Association of Social Work Boards

Dear CSWA Members,

The attached "Statement on Discrimination” is CSWA’s way of addressing the appalling legislative attempts in several states to create laws that implement discrimination against LGBT citizens. While only four states have passed legislation – North Carolina, Mississippi, Tennessee, and Georgia – have actually passed such legislation, there are several other states considering doing so.

As stated in the CSWA Code of Ethics, “Clinical social workers do not, in any of their capacities, practice, condone, facilitate, or collaborate with any form of discrimination on the basis of race, religion, color, national origin, gender, sexual orientation, age, socioeconomic status, or physical or emotional disability. (CSWA Code of Ethics, Section VI(a), 1997.)” It is with these fundamental values in mind that CSWA encourages its members to take a stand against discrimination in any form. 

If you live in one of the states that has passed a discriminatory law, please send the following message to your state and Federal legislators: “I am a member of the Clinical Social Work Association [and your state Society] which strongly opposes any laws which are based on discrimination. [Bill/Law in your state] is extremely discriminatory of our LGBT citizens and should be removed from [our laws/consideration] in our state. This law is a violation of my Code of Ethics as a clinical social worker and our national Bill of Rights.”

 You can find the addresses for your members of Congress at https://www.congress.gov/members  State legislators can be found at your state government websites.

As always, please let me know when you have sent any messages.

Laura Groshong, LICSW, CSWA Director, Policy and Practice

Dear CSWA Affiliated Society Members,

    Yesterday the HELP Committee (Health, Education, Labor and Pensions) passed S. 2680, the Mental Health Reform Act of 2016. CSWA sent a summary of this bill last week and is in support.  The bill was introduced by Senators Lamar Alexander (R-TN), Patty Murray (D-WA), Bill Cassidy (R-LA), and Chris Murphy (D-CT), this bipartisan legislation provides vital reforms to mental health funding to increase patients’ access to effective and evidence-based care particularly focused to those with serious mental illness (SMI).  

    S. 2680 incorporates and builds upon S. 1945, the bill created last year by Sens. Murphy and Cassidy. Here is a summary of the bill:

• Supporting SAMHSA by establishing a new Inter-Departmental Serious Mental Illness Coordinating Committee.
• Creating an Assistant Secretary of Mental Health position to give mental health a higher administrative level.
• Significantly improving grant programs promoting integration of primary and behavioral health care.
• Clarifying disclosure of protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA) and requirements for communication between providers, patients, and families.

    There is more work to do but this is a significant step forward.  Clinical social workers are included in S. 2680 as covered providers several times, as they were in the House bill H.R.1945 in 2014 after CSWA, with NASW’s support, first raised the issue of including LCSWs.  Whatever bill emerges from the mental health bills being considered by Congress, the place of clinical social workers appears secure.

Laura Groshong, LICSW, CSWA Director, Policy and Practice

There is a flurry of activity in Congress this week about how to finally provide treatment for mental health and substance abuse disorders which have plagued the country for many years and have reached a crisis point.

The Senate voted 86-3 yesterday to advance the Comprehensive Addiction and Recovery Act, S. 524/H.R. 953, (CARA, http://www.addictionpolicy.org/#!cara/cix2), which would allow the attorney general to give money to programs that strengthen prescription drug monitoring, improve treatment for addicts, and expand prevention and education initiatives. There are many amendments still to be voted upon. A vote on final passage of the bill is expected later this week. 

The bill, introduced by Sens. Sheldon Whitehouse, D-R.I., and Rob Portman, R-Ohio, has not yet been taken up by the House. An identical bill has been offered in that chamber by Rep. Jim Sensenbrenner, R-Wis.

Drug overdose has surpassed car crashes as the leading cause of accidental death in the United States, according to the American Society of Addiction Medicine. Opioid addiction is driving the epidemic, with nearly 19,000 overdose deaths related to prescription pain relievers and nearly 10,600 overdose deaths related to heroin in 2014. The rate of heroin overdose deaths nearly quadrupled from 2000 to 2013 as many prescription drug abusers turned to heroin as a cheaper alternative that is easier to obtain, the society said.

The main objection to this bill is that tasking the attorney general with distributing the treatment, prevention, monitoring and education programs the bill contains is not the best way to determine what funding is needed; that the attorney general does not have the $600 million that will be needed to implement this bill; and that this ties the bill to law enforcement instead of treatment.  Senate leadership has claimed that earlier block grant funding can be used by states that choose to follow through on this bill.  CSWA sees this bill as unfunded, well-intentioned as it is, and will work to find the roughly $600 million the bill will require to implement.

Another bill called the Mental Health Reform Act of 2016 is being developed by Sens. Murray (D-WA), Murphy (D-CT), Alexander (R-TN), and Cassidy (R-LA).  The hope is that this bill will include much of the bill developed by Sens. Murphy and Cassidy, S. 1945, as well as incorporate strengthening SAMHSA, and integrate programs designed to address the substance abuse problems which have been receiving the bulk of attention this week.

CSWA will continue to provide information on how these bills evolve and work to fund them adequately.

March 1, 2016

Good morning and welcome.  My name is Margot Aronson, and I am a Licensed Clinical Social Worker.  LCSWs are the backbone of our country’s mental health treatment system.  We are responsible for close to half of clinical services provided in the USA:  assessment and diagnosis, psychotherapy, case management, and more, in clinics, hospitals, group and private practice.  

I am speaking today for the Clinical Social Work Association, which represents the interests of the 240,000 LCSWs in the US.  Our Association has a strong advocacy program with a focus on mental health issues at the national level and on professional practice issues.  The bill we’re discussing today – H.R. 3712 /S. 2173, the Improving Access to Mental Health Treatment Act – cuts across both those areas of interest.

This bill addresses problems Medicare beneficiaries have in obtaining mental health care.  As you know, Medicare - our federal insurance program – provides health insurance to Americans over 65, and also to younger people with disabilities or ALS or end-stage renal disease, through Social Security Disability Insurance (SSDI).   Overall, Medicare serves about 50 million Americans.

According to the CDC (Center for Disease Control), nearly 1 in 3 seniors do not receive treatment for an ongoing mental health condition.  Seniors may be in distress or in crisis with issues of aging such as:  loss of vision, hearing, mobility; with a diagnosis of major illness or Alzheimer’s; with the cognitive impairment – or death - of a life partner; with painful end-of-life decisions. Addiction to prescription medication and/or alcohol is at epidemic levels for the elderly.  And in fact, substance misuse is often a factor with the younger beneficiaries, who may be dealing with debilitating depression, with an anxiety disorder, with serious mental illness, with PTSD.     

Licensed clinical social workers, along with psychologists and psychiatrists, are the only providers of mental health services for Medicare beneficiaries.  Surveys generally find that our LCSW treatment success and satisfaction rates - for the services provided by all three groups - are at least equal to those of our psychology and psychiatry colleagues (Consumer Reports, 2004, 2010). 

  CSWA spoke with leadership at CMS (the Centers for Medicare & Medicaid Services) last summer. CMS is the oversight agency for Medicare.  They told us that they need LCSWs to help the vast and rapidly expanding numbers of Medicare beneficiaries (10,000 a day for the past two years). 

Increasingly, however, LCSWs are saying that they cannot continue to work in the Medicare system because the current rates are so low that they cannot sustain their practices (25% less than other mental health providers for the same services). It is this disparity that The Improving Access bill seeks to begin to correct.

Part I of the Improving Access to Mental Health Act would increase Medicare reimbursement for LCSW services from 75% to 85% of the physician fee schedule rate.

While the bill will not totally resolve this problem, it is a start.  The increase will bring clinical social workers up to parity with other non-physician Medicare providers – turns out we’re now the only profession at 75%.  We believe that this modest financial boost, combined with the gesture of support from Congress, will go far in encouraging LCSWs to become Medicare providers.  

Let me just make a quick comment about the discrepancy in pay for the same services with the same success rate:  as you might expect, it is the cause of considerable resentment; and the legislative staffers we’ve met with have themselves identified and expressed concern about the fairness issue; in addition there is the fairness issue to women, as social work is primarily a female profession.

Part 2 of the bill increases access to LCSW services in skilled nursing facilities.

Since 1997, LCSWs have not been permitted as independent practitioners to provide treatment to patients in skilled nursing facilities, commonly called SNFs. What this restriction means in practice is that treatment gets derailed for the client who temporarily moves into a SNF because of an illness, or the need for rehab, or to recover from surgery. Sometimes the move is the beginning of what will be a major life change: such a patient may be feeling despair, but an independent LCSW cannot be made available to him to do a timely depression assessment or to provide therapy. This is especially painful for beneficiaries who have had an ongoing relationship with an LCSW that is interrupted while the client in a SNF. This would restore the ability of LCSWs to work within SNFs independently.      

Finally, Part 3 of this bill eliminates Medicare restrictions on the right of LCSWs to do Health and Behavior Assessment and Intervention services (HBAI), helping clients cope with the social and emotional issues stemming from  medical conditions (cancer, heart disease, diabetes, or Alzheimer’s, for example).  HBAI services are well within the LCSW scope of practice, and our holistic, person-in-environment framework, bringing to bear biological, psychological, social and family elements, is especially relevant in the skilled nursing setting and wherever substance abuse may be an issue. 

To summarize, the Improving Access to Mental Health Treatment Act is a clear, simple, practical bill. Here are its three straight-forward parts:  

HR 3712/S 2173 WILL IMPROVE ACCESS TO MENTAL HEALTH THROUGH MEDICARE BY:

• Make it possible for LCSWs to do what they believe is work that they SHOULD be doing – in the service of the public – while earning a fair wage
• Allow LCSWs to support longtime clients and others who have moved into skilled nursing care, rather than abandon them when they are most helpless and needy
• Letting LCSWs help Medicare beneficiaries cope with emotional, behavioral, and psychosocial concerns associated with substance use and medical conditions

We know that the elderly have a significant percentage of undiagnosed and untreated mental health conditions, and that limited access to mental health providers presents a major barrier to their overall health, leaving them at risk. This bill takes very practical steps to improving their access to mental health treatment; it is a significant bill.  Thank you.

New Legislation is Next Step to Funding Quality Mental Health Care Nationwide

Tuesday, February 09, 2016

Source: http://www.stabenow.senate.gov/news/senators-stabenow-blunt-introduce-bill-to-expand-funding-for-community-mental-health-services

U.S. Senators Debbie Stabenow (D-MI) and Roy Blunt (R-MO) introduced a bill to significantly increase funding for the program they championed to expand community mental health and substance abuse services the country. The Expand Excellence in Mental Health Act will ensure that all 24 states awarded mental health planning grants through an initiative based on Sens. Stabenow and Blunt’s Excellence in Mental Health Act can be funded. While the original law limited funding to eight states, President Obama today announced additional funding in his budget to expand the program to 14 states. 

24 states, including Michigan and Missouri, were selected in October to work with interested community mental health centers, Federally-Qualified Health Centers, VA clinics, and other mental health organizations to design a state program that meets the new quality standards for Certified Community Behavioral Health Centers. Under current law, eight of these 24 states will be selected to receive full funding for comprehensive community behavioral health services. The Expand Excellence in Mental Health Act will fund community mental health services for all 24 states, which is an important next step toward fully funding quality mental and behavioral health services nationwide. 

“Fully funding the Excellence in Mental Health Act is critical to making sure communities across the country have the resources they need to improve the lives of everyone living with mental illness and addictions” said Senator Stabenow.  “I appreciate the President’s call for an expansion of community mental health and substance abuse services in the budget, and our bill is an opportunity to take that another step further. Each and every state that came forward with a plan to increase access to community behavioral health services should be allowed to move forward immediately.”

“One in four adult Americans have a behavioral health issue that is both diagnosable and treatable.  Unfortunately, those coping with a mental health issue and their families are too often confronted with a health care system that is unable to provide the access and quality of care they need,” said Senator Blunt. “The Excellence in Mental Health Act was a critical step toward improving and expanding access to behavioral health services. The legislation we are introducing today will build upon that law, and take us even further toward our goal of bringing behavioral health care in line with the way other illnesses are treated.”

“This legislation is a critical step forward in making mental health and addiction care available to every American in need,” said Linda Rosenberg, President & CEO of the National Council for Behavioral Health. “The Expand Excellence in Mental Health Act will expand Americans' access to lifesaving mental health and addiction care, while supporting providers with the resources to not only immediately help each individual who walks into a clinic, but to also coordinate their behavioral and physical health needs. Every state that is working to transform its care delivery system deserves to be able to do so. The National Council pledges to continue working with Senators Debbie Stabenow and Roy Blunt to ensure that all 24 states have the opportunity to implement Excellence Act resources.”

“Since the tragedy at Sandy Hook Elementary School that took the life of my sweet little son, Daniel, we at Sandy Hook Promise have advocated for the expansion of critical mental health services so that more people can have access to high quality, integrated mental health care, and those who are in crisis can get help before anyone gets hurt,” said Mark Barden, Advocacy Director at Sandy Hook Promise.  “TheExpand Excellence in Mental Health Act is an important step toward providing effective, quality mental health care nationwide. These grants will undoubtedly save lives and we are grateful to Senators Stabenow and Blunt for their leadership and tireless advocacy.”

“The Expand Excellence in Mental Health Act will transform behavioral health care in this country, driving a fragmented and underfunded system to one with expanded access to evidence-based treatments, integrated healthcare, and accountability,” said Brent McGinty, President & CEO, Missouri Coalition for Community Behavioral Healthcare. “Missouri's behavioral health community applauds Senators Blunt and Stabenow for being true mental health champions.”

“Our sheriff’s office is currently the gateway for the County’s mental health system, and caring for individuals with mental illness without the proper resources continues to be a growing challenge,” said Gene Wriggelsworth, Ingham County, Michigan Sheriff. “I have worked with Senator Stabenow to strengthen community mental health services in Ingham County for decades and appreciate her leadership to help law enforcement address this challenge and ensure patients across the nation get the care they need.”

Senators Stabenow and Blunt first introduced the Excellence in Mental Health Act in February 2013 to put community mental health centers on an equal footing with other health centers by improving quality standards and fully-funding community services and offering patients increased services like 24-hour crisis psychiatric care, counseling and integrated services for mental illness. The bill was signed into law by President Obama in 2014 and is one of the most significant steps forward in community mental health funding in decades.

The Expand Excellence in Mental Health Act is supported by over 50 mental health organizations including: American Foundation for Suicide Prevention, Association for Behavioral Health and Wellness, American Psychological Association, Clinical Social Work Association, Depression and Bipolar Support Alliance, Eating Disorders Coalition, Mental Health America, National Alliance on Mental Illness, National Council for Behavioral Health, Sandy Hook Promise, among many others.