National Coalition of Mental Health Professionals and Consumers, Inc.

an educational foundation and advocacy organization serving mental health consumers and professionals

State of the Coalition

The Coalition continues to survive, if not thrive. As you can see, we have recently undergone several; changes with the resignation of two board members, Gordon Herz and Frank Froman. In addition, Dave Byrom stepped down as president after four years in the job.  The good news is that Dave continues to serve as hair of the Liaison Committee and our new board member, Christine Glenn, has become an active and important voice in our discussions.  It is clear, however, that we lack the manpower and money power to accomplish many of our ambitious and far-reaching goals.  Our membership base has also been reduced, with many former supporters regretfully informing us that their own financial difficulties limit ability to support the Coalition.  Michaele Dunlap, Membership Chair, continues to explore ways to identify and reach out to new members.  Our core support continues to be mental health professionals, however, and may professionals are increasingly discouraged by the impact of managed are on their practices and livelihood.

 So what can we do?  What are we doing? Over the last few years, our efforts have been directed toward developing strategic alliances with groups that support and can advance our agenda.  This has included professional, grassroots and advocacy organizations.  Michaele Dunlap has been active in exploring how the Coalition can make common cause with American Mental Health Alliance as well as the Psychotherapy Guilds, such as Ivan Miller’s group in Colorado.  Ideas have ranged from uniting into one group to a more limited partnership to support each other’s vision.  I continue to be in touch with the Interdivisional Task Force (Division 39 and 42) of the American Psychological Association (APA), collaborating with their efforts to move APA to adopt a health care policy for the first time in its history.  Karen Shore has been active in the Los Angeles Psychological Association; and Dave Byrom has been very successful this year in making strong connections with the New York State Psychological Association as well (see page 4 for more on this). These and other efforts are directed toward identifying professional organizations and groups that share our goals and can strengthen our efforts to succeed.  More on this later. 

In the area of grassroots organizing, Dave Byrom has soldiered on for any number of years, although his most recent project, the Citizen’s Healthcare Working Group, has been a successful project brought to a conclusion last summer.  In addition to participating in many meetings as part of this citizen’s input into healthcare legislation, Dave has been influential in keeping mental health and substance abuse treatment “on the table,” not only with this group but with other grassroots organizations, including Universal Healthcare Action Network (of which Dave is a board member) and Families USA.  Of course, our Web site, managed by Kathie Rudy, remains an important area of outreach to the public and professionals alike and the discussion list, NCTalk (NCMHPCTalk@yahoogroups.com)*, has also become a venue for both members and others interested to ask questions and communicate their concerns.

 What Happened to Privacy?

Up until last summer, one of our most important projects was supporting the lawsuit brought by the Medical Privacy Coalition.  The group was formed by many disparate groups to challenge the Bush administration’s rules implementing HIPAA and seeking to overturn the “disclosure rule” that allows relatively easy access patient’s health data for “covered entities.”  The result of this rule making has been to lower the bar on privacy rights and putting the burden of securing medical data the responsibility of the patient.  For readers of the Coalition Report, you will remember all the details as this drama unfolded over several years, with Jim Pyles, as the lead attorney for the lawsuit, continued to argue this case all the way to the Supreme Court… or almost.  As you know, the court refused to hear the case and the previous finding that the plaintiff’s had not standing was allowed to be the deciding factor in ruling against the lawsuit.  There were small victories along the way in that the court rulings did not rule the “disclosure rule” was correct but by a strange sort of logic, the courts ruled that violations of privacy were not the fault of the government’s rule, but of corporate entities errors or illegal actions.  Another positive result was that the work Jim Pyles did in gathering information to try the case may be helpful in other cases where privacy is an issue and the threat of harm more “visible” to the court and public.  As is often the case, it will only be after a accumulation of dramatic harm that will move the courts and the legislature.  The insidious nature of the erosion of privacy that will mount as patient’s simply choose not to reveal potentially embarrassing or harmful information to physicians and mental health professionals will go unrecognized, at least for now.

Dave Byrom and Pat Dowds spearheaded our involvement with the Medical Privacy Coalition, although Michaele Dunlap and I took over liaison duties during the last year of the lawsuit (Michaele was also a plaintiff in the suit).  We found there were many individuals and organizations out there who do not like the massive erosion of privacy that is rapidly becoming a rule rather than the exception.  The Liberty Coalition is the most recent group the Coalition has joined to ally with advocates of privacy.  One of the curious (and alarming) developments over the last year or so has been the recognition that there is virtually no privacy protection in virtual space.  Whether government or businesses misuse health information under the lax HIPAA rules, or an angry employee decides to post all company information on a blog, or whether a thief steals computer data to commit crimes, information technology (IT) has increasingly become core concern of citizens.  As Jim Pyles observed during one of our post-mortem telephone conversations, the lawsuit may have “peaked” too early to garner the attention that will be paid as unlawful and inadvertent disclosure of private records continues apace.

 Where do we go from here?  With the defeat of the lawsuit, it will be important for concerned professionals to become active at the state level to protect privacy rights in states that have them (such as New Jersey) or to fight to strengthen or restore rights (e.g., Oregon weakened its privacy protection laws in the wake of HIPAA regulations).

 What about Confidentiality and Privilege?

One project of the Coalition (and AMHA) that continues to be important has been the petition on confidentiality.  We continue to remind colleagues to review and sign the petition on confidentiality that Barney McDowell (of AMHA-Oregon) developed several years ago.  You can do this by going to our Web site; and it is also posted on the AMHA site as well the Academy for the Psychoanalytic Arts site.  This project aims to establish a “respectable minority” position stating that it is the patent’s right to request that the therapist does not keep a record of contact, up to and including no record of payment, sessions, even the person’s name.  Our professional organizations continue to assert that ethical treatment requires extensive note taking that documents all facets of the treatment.  This standard, arguably reasonable in medical systems that depend on communication with and among diverse professionals treating the same patient, make little sense in a psychotherapy practice with only one professional involved.  These standards, as many of us have found to our ruin, have been used by managed care and healthcare organizations to deny reimbursement for “substandard care.”  By establishing a “respectable minority’ position on this issue, psychotherapists may gain some leverage when confronting hostile healthcare organizations.

 On bright spot in all this continues to be the concept of patient-therapist privilege, following the Jaffee v Redmond decision in 1996.  Courts have tended to expand upon this ruling rather than seek to limit its application.  The implied acceptance of privilege in HIPAA has also been touted as a barrier against unwarranted disclosure.  Although it is certainly a positive step that psychotherapists have some increased protection in what they reveal or do not reveal about their patients, this is a slender reed for the patient who does not have the same right to assert privacy and control of his or her personal information.

 Where Do We Go From Here?

We need your support in many ways and the least important way is money at this point (that does not mean we don’t need that, too!)  If you are reading this, you are a member of the Coalition or know a supporter of the Coalition.  We need you to become a more active member.  Many of you have already received the survey Michaele sent out asking you to identify your concerns and priorities.  We now need you to do more.  Please consider one or more of the following suggestions: 

1.      Invite a small group of colleagues to your home to discuss some of the ideas and issues raised in this newsletter and find out if this group could become a Coalition partner by adopting a task or project in your area to further the goals and mission of the Coalition.

2.      Read your local paper and write a letter whenever you come across a news item that addresses a core Coalition concern.  If a drug regimen in uncritically praised, if a mental health agency’s funds are cut, if disparaging references to psychotherapy are made, please write to make your views know.  Even better, write an editorial.  Many newspapers will publish citizen editorials, and, if not, send it to me and we might be able to use it in the newsletter.

3.      Find out where your state is in protecting privacy, advocating parity, and funding mental health programs.  Get involved in the legislative process and let us know what you are doing.  There may be others in your states that can help.

4.      Sign up on Yahoogroups.com for our discussion list, NCTalk, or write to me and I will invite you to join… and then post your ideas and concerns sp others can respond.  One of the consistent comments made by professionals these days is how alone they feel in standing up for their profession in the face of discouragement and even active contempt.  Log onto NCTalk and you will not feel so alone.           

* Webmaster's note:  To subscribe to NCTalk without getting a Yahoo ID or anything else, just send an e-mail to: NCMHPCTalk-subscribe@yahoogroups.com