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HomeMy WebLinkAboutItem 2C: Resolution on Mental Health Treatment ECC DR UGENE ITY OUNCIL AIS GENDA TEM UMMARY Adoption of Resolution 4989 Affirming the City’s Commitment to Human Rights and Choice in Mental Health Care Meeting Date: October 26, 2009 Agenda Item Number: 2C Department: City Manager’s Office Staff Contact: Holly LeMasurier www.eugene-or.gov Contact Telephone Number: 682-5619 ISSUE STATEMENT The Human Rights Commission is asking the council to adopt a resolution affirming choice in mental health care as a human right. BACKGROUND The Human Rights Commission’s Mental Health and Human Rights Subcommittee was established in 2005 to address issues related to the protection of human rights for persons who are clients of mental health care. The group met for 18months, holding two successful public forums and consulting with mental health care providers, clients, advocates and families. The work peaked with a Choice in Mental Health Care as a Human Right: a Vision for Recovery and Success Conference in October 2006. More than 300 people attended 28 workshops, and participants identified priorities and feedback on a proposed resolution for adoption by the council affirming the City of Eugene’s commitment to human rights and choice in mental health care. Although the Mental Health and Human Rights Subcommittee completed its work, the Opal Network has continued to meet, bringing together representatives of more than a dozen groups working in the mental health field as a way to amplify the voices of mental health consumers and psychiatric survivors. The Lane County Consumer Council is a group of mental health consumers who meet monthly, advising Lane County Mental Health and LaneCare, the managed care organization for the Oregon Health Plan in Lane County. The Consumer Council has proposed a set of principles emphasizing choice in mental health care, including the need to focus treatment on recovery. These principles were incorporated into the "Lane County and LaneCare Guidelines Relative to Consumer Participation and Empowerment," approved by Lane County Mental Health and by LaneCare in late 2008. Several years of dialogue, leadership, best practices, and enrichment and understanding of mental health care services in Eugene have brought increasingly healthy and safe treatments, perspectives, approaches, and practitioners to our community. The proposed resolution recognizes the significant accomplishments of Eugene’s community service providers, mental health care services providers, mental health care consumers, advocates and their families -- and of our community’s contributions to national and international leadership in mental health care. Z:\CMO\2009 Council Agendas\M091026\S0910262C.doc In 2005, the year the Mental Health and Human Rights Subcommittee began its work, the United Nations dedicated 2005 as a year to examine the rights of persons with mental health disorders and disabilities, identify and eliminate barriers, respond to the sources of frequent rights violations, and prioritize resources and education. The Eugene community continues to address these challenges and the remarkable legacy of the Human Rights Commission’s Mental Health and Human Rights Subcommittee. This resolution acknowledges the human rights of persons with psychiatric and social disorders, also known as the “invisible disabilities,” by encouraging greater choice and alternatives in health care. RELATED CITY POLICIES The resolution supports the council’s adopted vision, which states in part: “Value all people, encouraging respect and appreciation for diversity, equity, justice, and social well-being. We recognize and appreciate our differences and embrace our common humanity as the source of our strength,” – as well as the Safe Community Goal: “A community where all people are safe, valued and welcome.” COUNCIL OPTIONS A.Adopt the resolution as proposed or with revisions. B. Decline to adopt the resolution. C. Take other action, as directed by the council. CITY MANAGER’S RECOMMENDATION The City Manager recommends that the council adopt the proposed resolution. SUGGESTED MOTION Move to adopt Resolution 4989 affirming the City’s commitment to human rights and choice in mental health care. ATTACHMENTS A.Proposed Resolution B.Letter from Ron Unger, LCSW, Mental Health and Human Rights Subcommittee member C.Choice in Mental Health Care as a Human Right 2006 Conference Brochure D.Lane County and LaneCare Guidelines Relative to Consumer Participation and Empowerment FOR MORE INFORMATION Staff Contact: Holly LeMasurier, Human Rights Analyst Telephone: 682-5619 Staff E-Mail: holly.k.lemasurier@ci.eugene.or.us Z:\CMO\2009 Council Agendas\M091026\S0910262C.doc RESOLUTION NO. __________ A RESOLUTION AFFIRMING THE CITY’S COMMITMENT TO HUMAN RIGHTS AND MENTAL HEALTH CARE. The City Council of the City of Eugene finds that: A. The City Council of the City of Eugene recognizes that the diversity of our population is vital to our community's character, and that we have a long tradition of protecting and expanding human rights and civil liberties protections for all of our residents, including persons with all types of disabilities. B. U.S. Courts have affirmed a number of rights for people diagnosed with mental disabilities. At the national level, the right to choose to live in the least restrictive environment that is reasonably available has been affirmed. At the state level, a number of courts have affirmed a person's right to refuse psychotropic medications, even when the state has a "compelling interest" in providing treatment, if less intrusive, effective treatment alternatives exist. These decisions are consistent with the principle that all people have the right to lives free of unnecessary restrictions and intrusions. C. Many people determine that psychiatric medications are quite helpful for their mental and emotional conditions, and are grateful to have the opportunity to take them. Others find medications to be harmful to their health, unhelpful and/or excessively intrusive and problematic. When people seek treatment and are offered medication as the only treatment option, they may feel coerced into choosing that option. Many of the medications currently provided are typically associated with significant medical risk, are often experienced as subjectively harmful, and their long-term effectiveness remains controversial. Furthermore, there are widely researched psychosocial alternative treatments likely to be at least as effective for many, with fewer harmful effects. D. Many mental health problems are caused by trauma and human rights violations, such as child abuse, war, racism, lack of housing and economic opportunities, domestic violence, and others. A key element in any kind of trauma is the denial of choice. When people who have been traumatized are denied choices in recovery, an effect may be retraumatization. E. Serious psychiatric disorder is often thought of as inevitably a permanent condition requiring a lifetime of medication, however research shows that a substantial fraction of those with even the most serious diagnoses do fully recover, eventually not requiring treatment. Treatment choices, designed to foster rehabilitation and recovery, which include working, living, and participating in the life of the community, have been shown to increase such recovery. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF EUGENE, a Municipal Corporation of the State of Oregon, as follows: Section 1. All mental health service providers within the City of Eugene are encouraged to incorporate self determination and consumer choice as much as possible, with accurate Resolution - Page 1 of 1 information provided to consumers and to families about those choices. Special emphasis should be placed on providing diverse alternatives in treatments, including non-drug alternatives, whenever possible. Section 2. All mental health service providers within the City of Eugene are urged to offer a full range of choices designed to assist in complete recovery. Section 3. This Resolution shall become effective immediately upon its adoption. The foregoing Resolution adopted the ____ day of October, 2009. ____________________________________ Acting City Recorder Resolution - Page 2 of 2 ATTACHMENT B Ron Unger LCSW 1257 High Street Suite 7 Eugene, OR 97401 541-513-1811 ronunger@efn.org City of Eugene 777 Pearl St. Eugene, OR 97401 October 19, 2009 Dear Councilors, I am writing to you as a representative of the Mental Health and Human Rights Subcommittee of the Education and Outreach Committee, urging you to support the proposed resolution affirming the city’s commitment to human rights within mental health care. The draft version of this resolution was first distributed at the historic “Choice in Mental Health Care as a Human Right” conference held on October 20, 2006. Judi Chamberlain, one of the keynote speakers at this conference and a veteran of 30 years as a leader of the mental health consumer/survivor movement, noted the resolution affirmed Eugene’s leadership in the field. Since then, 1000 printed versions of the resolution have been distributed, and an unknown, but large, number of electronic versions. Some of the major email distribution lists used were those of LaneCare, MindFreedom, and the Trauma Healing Project. Since the LaneCare list includes all the major public providers of mental health services in Lane County, they were all made aware of this resolution and invited to comment in various forums. We did receive some submitted, written comments on this proposed resolution, 24 in total. Seventeen were from individuals who fully supported the resolution, two were from representatives of agencies that fully supported it, two were from individuals who “largely supported” it, one individual expressed “concern” and appeared to oppose the resolution, one said he was not allowed to comment publicly, and one person expressed neither support nor opposition but offered some ideas for revisions. The two agencies that supported the resolution were Laurel Hill Center and ShelterCare. These agencies are important because they are the two non-profits most active in caring for people with the most serious mental health diagnoses in Eugene. In addition, the Lane County Consumer Council voted to support this resolution in a public meeting, but apparently failed to translate that into a written comment. The individuals who “largely” or “generally” supported the resolution also each expressed a reservation. Gary Cornelius, an ex-LCMH worker, stated he felt that the resolution downplayed the helpful role medication has played in the lives of many people. A second individual, Al Levine, director of LCMH, stated that he felt the draft resolution placed an inordinate focus on the medication issue. In response to these concerns, a couple of sentences were added to sections in order to clarify that the resolution is intended to address the concerns of those whose needs are not being met by the current treatment paradigm, as well as support all consumers of mental health care. Overall, the subcommittee feels the degree of emphasis on medication in the resolution is appropriate and reflects the concerns of mental health consumers we have spoken with at our public forums and at the conference. John Lipkin M.D., a psychiatrist connected with the Johnson Unit, provided the only submitted,written opposition to the resolution. His concern appeared to be that encouraging support for alternatives, with which he agreed in principle, may risk drawing funding away from involuntary treatment and medication which he believes is necessary at times. He stated he preferred to see the City make “an active effort to fund wider treatment options” encouraged in this resolution. If alternatives are provided successfully, they may indeed reduce the need for involuntary treatment and medications, and so the Johnson Unit in particular might experience less demand for its (very expensive) services. This resolution does not conclude that support for such alternatives should be considered as expressing the City’s “opposition” to the provision of involuntary treatment or medication in cases where that may be found to be necessary. Finally, one individual, Jeanne Schultz of Oregon Family Support Network, suggested a variety of small changes to the resolution. The subcommittee reviewed these proposed changes and included a number of them. In conclusion, the Subcommittee on Mental Health and Human Rights feels it has carefully considered community input on this issue and has incorporated that input to a great degree. We feel this resolution provides a historic opportunity for the City of Eugene to express leadership in supporting human rights for one of the most disenfranchised and stigmatized populations in our time, those labeled mentally ill. Your vote in favor of this resolution, while inspirational and symbolic, will help empower individuals and groups working to improve the mental health system and working to provide recovery to those who are currently marginalized. Thank you for your consideration of this important issue! Sincerely, Ron Unger LCSW Mental Health and Human Rights Subcommittee Member ATTACHMENT D Lane County and LaneCare Guidelines Relative to Consumer Participation and Empowerment Consumer participation and empowerment is supported by the professional community LaneCare, Lane County and County contractors help educate members about how to be effective self advocates. Within the options covered by the Oregon Health Plan, members will be provided opportunities to understand their mental health needs and preferences, select a provider and a treatment approach that matches their needs and preferences, and address concerns that occur during the course of treatment. ? Informed consumers can participate in the direction of their course of treatment. ? Informed consumers can develop individualized support services to best achieve their goals. ? LaneCare and Lane County will actively engage and develop peer mutual support networks and other consumer valued treatment alternatives ? LaneCare contractors will include in their Quality Assurance workplan a goal toward increasing their organizational empowerment and support of consumer self-determination. Alternative treatments to traditional mental health interventions are available in the community. Some alternative mental health treatments are recognized by the medical community and funded by LaneCare, while others are not. As a Medicaid contracted Mental Health Organization, LaneCare is responsible for assuring that there are medically appropriate mental health choices available for members within the contracted provider panel. (LaneCare does not take a position in support of services outside of those covered by the Oregon Health Plan.) LaneCare supports the following: Mental health treatments are medically appropriate and covered by the Oregon ? Health Plan Covered mental health interventions are strength-based and recovery oriented ? and promote resiliency. LaneCare and Lane County will give consumers information necessary to understand the risk and benefits of the treatment offered. Members can choose interventions from the range of covered services or choose alternatives not covered or reimbursed by LaneCare. Consumers are informed about the nature of their condition. Consumers are informed about what is known about their mental health condition ? with explanations that are empowering and providers do not misinform consumers with explanations that are disempowering. Mental health conditions may be related to genetics, trauma, life experiences, or biology and all associative causes should be discussed. For any given individual, it is not possible to say for certain what the cause of the mental health condition is. If the condition is described as being genetic or only biological it may not empower the consumer to believe that recovery is possible or they are in charge of their life, and the consumer may feel disempowered and hopeless. Clinicians will be careful to provide explanations for a condition that include a range of possible etiologies. Consumers are told that there is hope for improvement, that many people with ? their condition do improve, and that the current treatment, including medications, may be necessary for a period of time. Consumers are informed about the effects of treatment options offered. Consumers are fully informed about the risks and benefits of medical treatments, ? informed about alternative treatments and encouraged to select an intervention based on consumer choice. Consumers will be fully informed about the risks and benefits of psychiatric ? medications. Consumers are informed by their LaneCare medical provider that they will be ? provided medical support if they choose to reduce or end their use of psychiatric medications. Consumers are supported in participating in the direction of their course of treatment. Consumers are informed about their provider’s orientation and treatment ? approach. Consumers understand their diagnosis and consider and select the treatment ? approach and treatment provider that is the best match for them, based on their life style choices, strengths, and goals. It is essential that consumers who want to stop medications be provided medical oversight and support to reduce medical and psychiatric complications associated with reducing or stopping the taking of medications. When requested, consumers will receive assistance from their current LaneCare ? medical provider or referral to another appropriate professional for support in reducing or ending their use of psychiatric medications.