American Journal of Law & Medicine最新文献

Artificial intelligence (AI) is being tested and deployed in major hospitals to monitor patients, leading to improved health outcomes, lower costs, and time savings. This uptake is in its infancy, with new applications being considered. In this Article, the challenges of deploying AI in mental health wards are examined by reference to AI surveillance systems, suicide prediction and hospital administration. The examination highlights risks surrounding patient privacy, informed consent, and data considerations. Overall, these risks indicate that AI should only be used in a psychiatric ward after careful deliberation, caution, and ongoing reappraisal.

This Article seeks to synthesize academic research on home healthcare workers during the COVID-19 pandemic to understand how their workplace challenges were magnified. Crisis communication researchers note that a crisis provides both opportunities and threats for growth. This Article argues that many of the issues that have impacted home healthcare workers have always been present, but the pandemic allows policy makers the ability to see them clearly because the pandemic brought a spotlight to the issues that home healthcare workers face on a daily basis. Consequently, the author employed a narrative analysis of the literature concerning home healthcare workers during the pandemic to understand how the pandemic exacerbated structural issues that led to an increase in mental health difficulties for this population. By understanding how the pandemic exacerbated mental health issues, policy makers can craft solutions that can withstand the next public health crisis which will undoubtedly impact the most disenfranchised.

In June 2022, in Dobbs v. Jackson Women's Health, the U.S. Supreme Court overturned the precedent set by the 1973 decision in Roe vs. Wade, leaving access to abortion to be regulated by each state, rather than a U.S. constitutional right. Some states are setting gestational age limits, beyond which point only under certain circumstances can an abortion be obtained. Other states are banning abortion outright (regardless of gestational age) unless an "exception" is met. Certain states include an exception for abortion when a woman's physical health is at risk if they continue the pregnancy, but, at the same time, do not provide an exception for women whose mental health is at risk (a "mental health exception").Mental health conditions that develop, continue, or are exacerbated during pregnancy may be manageable or treatable, and women may want to continue their pregnancy even while experiencing such conditions. However, the absence of a choice to terminate their pregnancy as a result of these mental health conditions means women who are unable to successfully manage or treat their mental health during pregnancy have no choice but to experience the impact on their mental health - and reconcile any resulting impact on the fetus.This article will discuss the role a mental health exception plays in state abortion statutes by analyzing the impact of pregnancy on mental health and resources available to support those who experience mental health impacts during pregnancy while, simultaneously, advocating for the inclusion of a mental health exception in state abortion laws.

Many people who experience opioid use disorder rely on Medicaid. The high penetration of managed care systems into Medicaid raises the importance of understanding states' expectations regarding coverage, access to care, and health system performance and effectively elevates agreements between states and plans into blueprints for coverage and care. Federal law broadly regulates these structured agreements while leaving a high degree of discretion to states and plans. In this study, researchers reviewed the provisions of 15 state Medicaid managed care contract related to substance use disorder (SUD) treatment to identify whether certain elements of SUD treatment were a stated expectation and the extent to which the details of those expectations varied across states in ways that ultimately could affect evaluation of performance and health outcomes. We found that while all states include SUD treatment as a stated contract expectation, discussions around coverage of specific services and nationally recognized guidelines varied. These variations reflect key state choices regarding how much deference to afford their plans in coverage design and plan administration and reveal important differences in purchasing expectations that could carry implications for efforts to examine similarities and differences in access, quality, and health outcomes within managed care across the states.

Many insurers exclude coverage for transgender individuals. Litigation challenging these exclusions has increased. Most of these cases successfully advance equality claims by arguing that trans exclusions discriminate based on sex. That is, procedures performed on patients for reasons unrelated to gender affirming care are being denied to transgender individuals. There are, however, limitations to this argument. First, some courts may construe care narrowly and hold that some procedures are unique to gender affirming care that have no analog in other contexts. Second, a court that is hostile to the sex discrimination argument might hold that the denial does not arise from sex discrimination, but rather, because of the kind of diagnosis at issue. Further, the sex discrimination argument might force transgender individuals into making claims based on a binarized gender identity which may not conform with their lived experience.Claims based on the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) can address these shortcomings. This Act prohibits insurers from discriminating against mental health diagnoses-for example, procedures that insurers cover because of medical or surgical diagnoses should also be covered if indicated for mental health diagnoses. Gender dysphoria is a recognized mental health diagnosis. Transgender individuals seeking gender affirming care arising from gender dysphoria can thus claim that exclusions of coverage violate the MHPAEA. Some transgender individuals might raise concerns that such an approach would lead to increased medicalization of trans identity. However, an MHPAEA claim would only appear in cases where a transgender individual is voluntarily submitting themselves to medical assistance in order to advance their own autonomy.

When federal district court Judge Carlton Reeves penned his opinion in U.S. v. Mississippi,¹ the case that seemed poised to overhaul Mississippi's suffering mental health system, he began with the story of Ms. Melanie Worsham, a mental health patient, also a certified peer support specialist. Ms. Worsham works to help those like herself who suffer with lifelong serious mental illness (SMI) to "overcome the obstacles that might be getting in their way of living the life they want to live." She also assists those with SMI by aiding in "navigating the system, to find resources, and then just being moral support."².

This Article focuses on unifying the protocol for state competency evaluations, but with special concerns about undiagnosed FASD and developmental immaturity in adolescents. States do not mandate any process whereby psychometric tests are first performed prior to psychiatric mental status evaluations, often causing disparities in evaluations which might easily be avoided in court proceedings. Adding to the complications in current competency evaluations are recent studies from Canada and Australia identifying exceptionally high rates of FASD in incarcerated adolescents following multi-disciplinary teams' studies directed at identifying FASD. If these studies' rates of FASD turn out to be similar for children in the U.S. juvenile justice system, then systemic reform is called for as we are failing to identify this congenital condition when adolescents enter the system and then continue on into the adult criminal system without recognition of their prenatal exposure to alcohol.

Treatment of mental illness in the United States is woefully inadequate. One-third of adults report having a mental health condition or substance use disorder, but less than half receive treatment for their condition.Access is the problem. The U.S. is short on mental health professionals: more psychiatrists are needed and psychologists and social workers are overextended. Proposed solutions are to (1) increase reimbursement rates for psychiatrists and other mental health practitioners, and (2) use a wider range of providers, including nurses and family support specialists-all good ideas. My focus however is on two other forces that are moving into the behavioral health area, offering both financing and technologies to extend the reach of mental health services-private equity and telemental health.First, private equity firms see high demand in this market. Behavioral health is desperately needed but is highly fragmented and lacking in innovation. Private equity is attracted to outpatient programs that target specific conditions that have evidence-based clinical models-programs aimed at addiction, eating disorders, and autism; these areas require less capital. Federal and state reimbursement is available, some regulations have been relaxed to allow remote prescribing of medicine; and innovative telehealth tools can be used. The problem is that private equity has a poor track record in both nursing home care and behavioral care for teens. The private equity model and its financial incentives are at odds with good care.Second, telemental health tools, already in use because of the need during the pandemic, appear attractive. These tools require less capital to treat a higher volume of patients and promise much improved access to mental health treatment for populations that could not get such care because of travel distance, costs, and time limitations. The problem is that the telemental health tools have yet to be subjected to evidence-based testing.My goal in this article is to test whether these two developments - private equity and telemental health -can improve access for patients at an acceptable level of quality. I conclude that both have substantial problems and I offer a range of regulatory approaches to control patient abuses and poor quality.

Dementia within the criminal system, from arrest through incarceration, has been largely ignored. While the health system has begun grappling with the chronic conditions that will accompany an aging society, the criminal system has yet to meaningfully respond. Dementia is a clinical syndrome characterized by impairment in cognitive domains (memory, executive function, visuospatial). Additionally, dementia often includes behavioral symptoms that increase the likelihood that an individual's actions may violate social norms and in some circumstances be deemed criminal. Prior studies have established criminal behavior as a trend among individuals living with dementia. Yet, the criminal system has yet to establish protections for individuals who commit a crime while impaired by dementia. This paper will report on an empirical study to evaluate the treatment of persons with dementia within the criminal justice system. We will report on interviews with attorneys (n=15) regarding their experience and perspective on the treatment of persons with dementia post-arrest. In the paper, we will explore topics identified through these interviews including pre-trial release, competency, placement (housing), criminal liability determination, sentencing, and post-conviction release. We will highlight key findings including the lack of a systematic screening process for dementia post-arrest, placement is a significant challenge, attorneys' lack of training on dementia to be able to understand how the disease could impact decision-making, and the two legal mechanisms available to divert miss the mark given their focus on psychiatric populations. We will use these data and findings to argue for a research and policy agenda to address a gap in legal policies to appropriately manage persons with dementia post-arrest.