2010 DSM-IV & HIPAA

1880 Forms of Insanity

In 1880, there were six general categories of insanity: Mania, Melancholia, Paresis (General Paralysis), Dementia, Epilepsy, and Dipsomania. Puerperal Mania was not included with these six but is listed for one woman in the 1880 Defective, Dependent & Delinquent U.S. Federal Census of The Willard Asylum for the Insane under the heading “Form of Disease.”

 DSM-IV

In the year 2010, The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), lists seventeen Criteria for Mental Disorders as opposed to the six general forms of diseases that were presented in 1880. DSM-IV Complete Criteria for Mental Disorders are: Adjustment, Anxiety, Child, Cognitive, Dissociative, Eating, Factitious, Impulse, Mental GMC (Disorder due to Medical Condition), Mood, Other, Personality, Psychotic, Sexual, Sleep, Somatoform and Substance.
(SOURCE: from the website of Dr. James Morrison at http://www.neurosurvival.ca/ClinicalAssistant/scales/dsm_IV/dsm_index.html)

 The HIPAA Law

Health Information Privacy
The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety.

Understanding Health Information Privacy
The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes. The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information.

For Covered Entities
The Privacy and Security Rules apply only to covered entities. Individuals, organizations, and agencies that meet the definition of a covered entity under HIPAA must comply with the Rules’ requirements to protect the privacy and security of health information and must provide individuals with certain rights with respect to their health information. If an entity is not a covered entity, it does not have to comply with the Privacy Rule or the Security Rule.

A Covered Entity is one of the following:
A Health Care Provider
This includes providers such as: Doctors, Clinics, Psychologists, Dentists, Chiropractors, Nursing Homes, Pharmacies…but only if they transmit any information in an electronic form in connection with a transaction for which HHS has adopted a standard.

A Health Plan
This includes: Health insurance companies, HMOs, Company health plans, Government programs that pay for health care, such as Medicare, Medicaid, and the military and veterans health care programs.

A Health Care Clearinghouse
This includes entities that process nonstandard health information they receive from another entity into a standard (i.e., standard electronic format or data content), or vice versa.”

 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996
Public Law 104-191, 104th Congress

An Act
“To amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of health insurance, and for other purposes.

(4) HEALTH INFORMATION

(B) Relates to the past, present or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.

(6) INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION

(B) Relates to the past, present or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual, and —

(i) identifies the individual; or

(ii) with respect to which there is a reasonable basis to believe that the information can be used to identify the individual.

 WRONGFUL DISCLOSURE OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION

SEC. 1177.

(a) OFFENSE. – A person who knowingly and in violation of this part –

(1) uses or causes to be used a unique health identifier;

(2) obtains individually identifiable health information relating to an individual; or

(3) discloses individually identifiable health information to another person, shall be punished as provided in subsection (b).

(b) PENALTIES. – A person described in subsection (a) shall –

(1) be fined not more than $50,000, imprisoned not more than one year, or both;

(2) if the offense is committed under false pretenses, be fined not more than $100,000, imprisoned not more than 5 years, or both; and

(3) if the offense is committed with intent to sell, transfer, or use individually health identifiable information for commercial advantage, personal gain, or malicious harm, be fined not more than $250,000, imprisoned not more than 10 years, or both.”

(SOURCE: http://www.hhs.gov/ocr/privacy/)

1892 Hair of the Insane

A Dictionary of Psychological Medicine by Dr. Daniel Hack Tuke 1892

HAIR OF THE INSANE. – Dr. Bucknill has said that a lunatic is a lunatic to his finger ends; he might have added, writes Darwin, ‘and often to the extremity of each particular hair.’ Although this is true, the indications of insanity which the hair affords are not great importance. The prevailing colour of the hair of the insane, there are grounds for supposing, is different from that of sane people of the same class in the same district. Those possessing hair of a black, dark, or dark brown shade, have a greater tendency to become insane than those having hair of a fair or light brown hue, and those having brown hair, neither very light nor very dark, have the least tendency any…

It is commonly believed that people with certain colours of hair are more prone to certain forms of insanity than others. It has long been recognised that black hair very often accompanies a melancholic temperament, and there is an impression that black-haired people are more liable to melancholia than light-haired, and that the latter are more subject to attacks of mania. Though our statistics confirm this impression the difference is not of a very striking nature. Esquirol believed that some people with dark hair and eyes became violently maniacal, and we have found that the percentage of dark-haired among the acutely maniacal is above the average. He also believed that the illness in the dark-haired terminated more frequently in a marked crisis, and that the fair haired fell more readily into chronic disease.

Grey hair is less common among the chronically insane who have become insane when young, and among the demented, owing partly to the fact that the cares and worries of life fall on them less, and are less felt. If, however, a person above middle age be attacked by insanity, greyness of hair rather tends to develop, whether recovery takes place or not, and in this respect insanity does not differ from many other diseases. Grief and fear are well known to turn the hair grey, and it is found that melancholia has a greater tendency to produce greyness than mania. Dr. Hack Tuke reports a case of recurrent insanity in which the hair turned grey during each attack, and recovered its healthy brown colour when the patient was well. Grey hair in the insane is very frequently found patchy.”

Reprinted from Tuke, D. Hack, A Dictionary of Psychological Medicine Giving The Definition, Etymology, And Synonyms Of The Terms Used In Medical Psychology,  with the Symptoms, Treatment, And Pathology Of Insanity And The Law Of Lunacy In Great Britain And Ireland.  (Edited by D. Hack Tuke, M.D., LL.D., Examiner in Mental Physiology in the University of London; Lecturer on Psychological Medicine At The Charing Cross Hospital Medical School; Co-Editor Of The “Journal Of Mental Science”), Volume I, London, J. & A. Churchill, 11 New Burlington Street, 1892, Pages 562, 563.

1906-1907 Elopements, Suicides & Accidents at New York State Hospitals

“The Commission is pleased to report an unusually small number of untoward occurrences at the State hospitals during the year. At the Utica State Hospital a somewhat unusual case was that of a woman patient who, escaping from the institution, found means to reach Albany where she obtained employment as a clerk in a department store. Here her peculiarities were noticed after a few days and her services were discontinued. She also received notice from the mistress of the boarding-house in which she had found domicile that she must look for quarters elsewhere. The excitement which followed these events brought on an attack of considerable violence necessitating her commitment to a local institution for safe keeping. When she became quieter efforts were made to send her to the home of her husband but she declined to consider this, alleging that he was, in the first instance, responsible for her unjustifiable commitment to a hospital for the insane. Through the good offices of a local attorney she consented to return to the Utica State Hospital, upon condition that she would be granted a parole within a short time. As she was able to exhibit considerable self-control she was discharged upon the hospital books within a short time afterward and has not, up to the close of is report, required recommitment. A woman patient at this hospital was paroled by the authorities for the purpose of spending Thanksgiving with her husband at home. Although she had not at any time previously exhibited suicidal tendencies she seized the opportunity thus afforded her to swallow a powerful drug, and although prompt measures were applied she died in a short time.

At the Willard State Hospital a patient secreted binding twine about her clothing and seizing a favorable opportunity hanged herself from the door of a room. At the same institution a male patient died from asphyxiation due to the lodgment of meat in the larynx.

At the Hudson River State Hospital a male patient left the grounds without permission, and was afterward found dead on the railway tracks near the hospital pumping station, his skull having been fractured evidently by contact with the locomotive or cars.

At the Middletown State Hospital a male patient committed suicide by drowning. It appears that he carried a pail of water to his room and held his head far enough in the pail to become asphyxiated. At the same hospital a male patient left the institution without permission or notice and remained for some months about the neighboring counties enlivening the situation at different times by transmitting to the authorities of the institution souvenir postal cards. At the same institution a male patient committed suicide by wading out into a small ice pond in the rear of the institution and lying down in the shallow water until this reached over his head.

At the Rochester State Hospital a woman patient committed suicide by suspension, using a bed sheet, one end of which was attached to the window guard. At the same institution a male patient committed suicide by drowning subsequent to an unsuccessful effort to persuade his wife to remove him from the institution.

At the Kings Park State Hospital a male patient met his death under somewhat unusual circumstances, and the hospital authorities called upon the local coroner to make the usual investigation. The patient’s relatives, not being satisfied with his report, requested the Commissioners to make a special inquiry which was done. Physicians and attendants were placed under oath, and all testimony that could throw light upon the patient’s death was adduced, but nothing was found to contradict the findings of the coroner.

At the Long Island State Hospital a woman patient, while on parole and in the charge of her friends, was accidentally killed by a trolley car.

At the Manhattan State Hospital a woman patient after leaving a dining-room started straight for the river. A nurse went in immediate pursuit and a hospital watchman also tried to intercept the patient, but she outstripped her pursuers and plunged into the river. No trace of her body was afterward discovered. At this same institution a male patient becoming very noisy in a small dormitory to which he had been assigned was attacked by a fellow patient whose rest he had disturbed and struck on the head with a small serving table. The patient died in a few days as a result of the injury. At the same institution a woman patient secured a poisonous drug, died, and upon investigation by the coroner evidences of mercurial poisoning were found. At this institution a male patient was found hanging in the closet in which are usually stored the brooms, polishers, etc., of the ward. The patient had placed a broom handle across the top of two shelves, and with the girdle of his dressing gown about his neck had produced asphyxiation. At this institution a male patient succeeded in throwing himself into the river. His body was taken to the Fordham Hospital, and afterward identified by the institution clothing. Another male patient committed suicide in the same way. At the same institution a woman patient eluded observation while patients were preparing for bed. The premises of the institution were searched throughout the night and the following day, but no traces of her was found. It was supposed she was drowned while attempting to swim the river. A Russian patient, while walking about the exercising court with other patients, eluded observation and rushing to the point of the grounds opposite Hell Gate plunged into the river, and after swimming a few strokes was carried away by the strong tide and soon disappeared. A second patient who had observed the first one escape attempted to throw himself into the river at the same time, but was prevented by the nurse who had started out to overtake the Russian patient.

Owing to the situation of the Manhattan State Hospital on Ward’s Island, it is at all times necessary to detail several attendants to specially guard the river banks and an attendant is also detailed to patrol the river near the shore in a row boat. Almost daily attempts are made to break through this line, but the escapes are relatively few in number. Owing to the proximity of this hospital to the city of New York, and the fact that all occurrences of an unusual character in an institution for the insane are seized upon eagerly by metropolitan dailies, occurrences of this kind are frequently exaggerated as are also injuries received by patients though these may not be actually serious. Charges were made against the Manhattan State Hospital in connection with the somewhat sudden death of a patient named Rodesky. Allegations of cruelty and maltreatment were made by the relatives of this patient, and the managers and the coroner made an investigation of the circumstances attending his death. It appears that he was a bed-ridden paretic and a few days prior to his death, on the thirtieth of July, was found to be suffering from a fracture of the sternum and three fractured ribs. The coroner reported the cause of death as septic poisoning from several large abscesses owing to the patient’s general septic condition. The managers at the close of their special inquiry reported that the patient was not handled in any rough manner.

At the Central Islip State Hospital a male patient who had been given parole of the grounds and was in the habit of taking long walks about the premises was found hanging by the neck in the woods some three miles distant.

At the Gowanda State Hospital two women patients committed suicide by hanging.”

SOURCE: Reprinted from State Commission in Lunacy, Nineteenth Annual Report, October 1, 1906 – September 30, 1907, Albany: J.B. Lyon Company, State Printers, 1908, Pages 39-42.  http://books.google.com/