Saba, Levit, and Elixhauser (2008) reported that there were approximately 1.4 million hospitalizations for mental health problems and disorders in 2006. In Massachusetts, approximately 2000 adults were admitted to either state or psychiatric hospitals in 2010 (SAMHSA Center for Mental Health Services, 2011). The following paper will present an investigation and analysis of the passage of House Bill No. 4681, which afforded licensed clinical social workers (LICSWs) the ability to authorize emergency hospitalization for those with mental health issues who presented a risk of harm to themselves or others. Mental illness and mental health treatment will be defined and discussed, along with mental health issues in Massachusetts. The history of the bill and its path to law will be presented, along with the role of LICSWs in emergency hospitalizations. Lastly, the future of the law and its potential benefits to those with mental health issues and the community will be posited.
History of the Topic
Massachusetts Session Law, Chapter 278, Section 12 was recently modified in 2010 after House Bill No. 4681 was passed. The bill was “an act authorizing licensed independent clinical social workers to apply for the emergency hospitalization of persons who pose a risk of harm to themselves or others due to mental illness” (Commonwealth of Massachusetts, 2010). The main aspects of the bill focused on people with mental illness and on LICSWs as a vital component in the decision to hospitalize a person who poses a risk of harm to himself or others due to mental illness on an emergency basis (Commonwealth of Massachusetts, 2010). Prior to the passage of the bill, only physicians, psychologists, psychiatrists, and police officers could authorize an emergency hospitalization due to mental health issues (Gewirtz, 2010).
Insel (2010) defined mental illness as a psychological or behavioral disorder that is usually associated with some distress or disability. Mental illness occurs on an individual basis and is not part of the average development or culture of a human being. The elements of mental disorder concentrate on behavioral, cognitive, affective, and perceptual disabilities and distress (Insel, 2010). Tohen (2003) identified two approaches towards the treatment of mental illness. The first method is traditional and includes treatment such as psychotherapy, medical treatment, electroconvulsive therapy, counseling, and peer counseling. The second approach is psychoeducational and provides people with basic information about their mental diagnosis and courses of treatment and management (Tohen, 2003).
The approaches towards understanding mental health and mental illness have altered over the time. Different cultures have distinctive criteria for their evaluations of mental illness and there are varied systems for the evaluation and diagnosis of mental disorders and disabilities. For example, various mental disorders are diagnosed in accordance with the rate of harm that may be caused to other people (Gazzaniga, 2006). According to Gazzaniga (2006), approximately 30% of people have a mental health diagnosis during their lifetime, the majority of which are temporary disorders caused by stressors.
People with mental health issues and LICSWs are affected by the law. LICSWs are afforded additional permissions concerning people with mental illness who require treatment and hospitalization. Reamer (2007) stated that LICSWs are regarded as health practitioners, who usually are the first to diagnosis and to implement treatment. Currently, LICSWs are an integrated part of a multidisciplinary team in settings such as hospitals, community mental health centers, schools, elder care agencies, child welfare agencies, and private practice offices (Fischer, 2007).
LICSWs primarily focus on the mental, behavioral and emotional well-being of people. This holistic approach is apparent in the professional duties of an LICSW as they focus on the person in the environment, not just the mental health diagnosis. LICSWs are an integral part of treatment planning teams for clients. The professional practices of LICSWs are regulated by state licensure laws and requirements and these laws and regulations are practice guidelines for LICSWs. Therefore, there are basic requirements one must fulfill before achieving LICSW status, such as earning a Master’s in Social Work (MSW) degree that ideally is from a school accredited by the Council on Social Work Education (CSWE) and post-graduate clinical experience in a setting supervised by a LICSW (National Association of Social Workers [NASW], 2005).
Status of the Problem
Current mental health care in Massachusetts is often categorized by lengthy wait lists for community-based services. Due to inadequate funding and a lack of service providers, people with mental illness are not receiving the care they require to maintain stability. People with mental illness often struggle with homelessness and eventually seek emergency treatment in hospital emergency rooms. Approximately 3.9% of adults with mental illness in Massachusetts reported being homeless (SAHMSA Center for Mental Health Services, 2011). Also, many with mental health issues are involved with the criminal justice system (National Alliance for the Mentally Ill [NAMI], 2004). NASW and others advocated for the passage of House Bill No. 4681 to help improve the current situation by allowing another trained professional to decide if a person requires emergency hospitalization (NASW, 2010).
History of the Bill
House Bill No. 4681 was filed by Harriet Stanley, Democratic Representative from the 2nd Essex district, on May 17, 2010. The bill was recommended by the Joint Committee on Health Care Financing, as a substitute for House Bill No. 3465 with the same title (Commonwealth of Massachusetts, 2010). The NASW (2010) stated that the bill was important because at the time, social workers were already assessing clients who were experiencing suicidal or homicidal ideation. LICSWs were trained to determine and assess if a client is a danger to himself or herself, but were unable to authorize the client to receive the proper emergency mental health treatment. A majority of states allowed LICSWs to authorize emergency hospital services (NASW, 2010).
Research supports social workers being able to determine if a person requires emergency mental health treatment. Social workers in hospital settings are often referred the patients with the most complex presentation and disposition (Hamilton, Manias, Maude, Marjoribanks, & Cook, 2004). Several research studies have supported the notion that social workers are effective practitioners in emergency room departments (Gordon, 2001; Ross, Roberts, Campbell, Solomon, & Brouhard, 2004), where approximately 6.24% of patients are given a psychiatric diagnosis (Kunen & Mandry, 2006). Social workers learn a variety of skills during their educational preparation that enable them to successfully assess those who may require a psychiatric hospitalization. Barker (1997) defines assessment as “… the gathering and interpreting of information to inform action (as cited in Hamilton, Manias, Maude, Marjoribanks, & Cook, 2004, p. 683). In both medical and community-based settings, social workers are often consulted when a patient presents with economic and social problems that may impact the admission decision in a negative manner (Auerbach, Mason, & Heft LaPorte, 2007). Social workers often pay attention to the social context of the individual, individual’s rights and choices, social needs, and family support while assessing clients. When social workers are involved in the assessment and admission process of a patient, they often meet with the patient’s families, assess the families’ ability to care for the patient in the community, and make referrals for outpatient treatment (Hamilton, Manias, Maude, Marjoribanks, & Cook, 2004).
Mental health issues and mental illness are present worldwide and treatment differs around the world. In many of the world’s countries, there is legislation to regulate mental health treatment. The decision to hospitalize on an emergency basis those with mental health issues has been debated in the international community. Proponents consider emergency hospitalization as a necessary measure to protect other citizens and dissenters regard it as a personal liberty and rights violation (World Health Organization [WHO], 2005).
The Principles for the Protection of Persons with Mental Illness and the Improvement of Mental Health Care were adapted by the United Nations in 1991. These principle established minimal human standards of practice in the mental health arena. The Convention on the Rights of Persons with Disabilities was enacted in 2006. The core purpose of the convention was to protect and enhance the rights of people with disabilities, including mental health disorders (World Health Organization [WHO], 2005).
The Path from Bill to Law
The bill successfully traveled from the House to the Senate and was approved within two months. On May 20, 2011, the bill was reported from the Joint Committee on Health Care Financing and a new draft was recommended. On June 15, 2010, a new version of the bill was presented to the House and another reading was ordered. On July 6, 2010, the final version of the bill was presented to the House and then passed on to the Senate. On July 7, 2010, the bill was referred to the Senate Committee on Ethics and Rules. On 7/30/2010, the bill was heard in the Senate and the title of the bill was changed. The Senate then voted unanimously to pass the bill (Commonwealth of Massachusetts, 2010).
On August 9, 2010, Governor Deval Patrick signed the bill into law (Gewirtz, 2010). The law as it applies specifically to LICSWs reads that:
…or a licensed independent clinical social worker licensed pursuant to sections 130 to 137, inclusive, of chapter 112 who, after examining a person, has reason to believe that failure to hospitalize such person would create a likelihood of serious harm by reason of mental illness may restrain or authorize the restraint of such person and apply for the hospitalization of such person for a 3-day period at a public facility or at a private facility authorized for such purposes by the department. (Commonwealth of Massachusetts, 2010).
Future of the Law
There is potential for benefit to the community following the passage of the law. LICSWs now have the ability to complete and sign Section 12s, potentially reducing the risk to the client, themselves, and the public (Gewirtz, 2010). Unnecessary psychiatric admissions can be reduced when social workers assess patients. McLeod, Bywaters, and Cook (2003) reported that many emergency rooms in Britain employ social workers to help reduce unneeded psychiatric admissions. When compared to physicians, nurses, and psychologists, social workers were found to recommend psychiatric hospital admissions least (Streiner, Goodman, & Woodward, 1975). Gordon (2001) found that a cost-benefit analysis model revealed that employing social workers in emergency rooms resulted in savings for large psychiatric facilities. Also, social workers in emergency rooms reduce hospital admissions through utilizing outpatient services because they are familiar with outpatient services in the area (Gordon, 2001).
The profession of social work has been around and actively assisting people in a lot of places with health and also in the social welfare, this include mental health, in American ethnic communities, welfare of the family, the care of the aged care and also in the welfare of the migrants in our country. The social works have adopted such methods in their profession such as personal counseling, engaging in community work, being part of working in groups, engagement in social action, involvement in social planning and also in the formulation of social policy. Social workers training and also environment have programs that prepare social workers to deliver in the environment of mental health. The issue of mental health care is a crucial ingredient in America’s healthcare safety net, by giving the LICSWs the responsibility over patients with mental health issues; we allow better treatment and care of this significant group of Americas. It allows the improvement and provision of quality healthcare in America. The legislation helps patients with mental health issues to have access to better diagnosis, provision of a comprehensive care and treatment. The bill will work in the provision of dignity, respect and provide some solutions to the problem of mental health issues.