PUBLIC HEALTH SERVICE BERRY PLAN FOR UNDERSERVED MENTAL ILLNESS WITH AMUK CRISIS, EPIDEMIC AND EMERGENCY

“Mental health problems may actually start much earlier than previously thought. A toddler who is crying for hours and angrily stomping his feet may not be having a temper tantrum, but showing signs of depression.

“Research suggests 1 to 2 percent of children 2 to 5 years old have depression, said Dr. Joan Luby, director of the Early Emotional Development program at the Washington University School of Medicine in St. Louis and a pioneer in the study of the condition in preschoolers. Dr. Luby believes untreated depression in toddlers can lead to more depression later in life.

“Young children are more cognitively sophisticated, more emotionally sophisticated than we previously understood. They have complex emotions. They’re aware of emotions in their environment. They feel emotions like guilt,” she said. “They have all the prerequisites of what depressive symptoms are.”

“The Centers for Disease Control and Prevention (CDC) reports 1 in 5 American children, ages 3 through 17,  some 15 million, have a diagnosable mental, emotional or behavioral disorder in a given year.

“Only 20 % of these children are ever diagnosed and receive treatment; 80 %,  some 12 million are not receiving treatment. 300,000 preschool children 2 to 5 years have depression.

Recent research indicates serious depression is worsening in teens, especially girls and the suicide rate among girls reached a 40-year high in 2015, according to a CDC report released in August.

Early intervention rather than later offers more improvement in childrens’ outcomes.  [NBC Nightly News, Kate Snow, 6:30 pm ET, Dec 10, 2017]

Research has established that the United States is at war with an underserved mental illness epidemic, a mental illness crisis and public health emergency, which, acording to most authorities, has been responsible for many resent tragedies and atrocities to both children and adults.

“A 2017 report cited a study commissioned by the U.S. Department of Health and Human Services indicating that the current workforce of approximately 45,580 psychiatrists would need to increase by 2,800 to meet current demands for psychiatric care. In other words, there is currently a 6.4% shortage in the psychiatry workforce. Based on estimates of retirement and new entries into the workforce, the projected unmet need in 2025 will be 6,090 psychiatrists, or a deficit of 12% of the workforce.[Report Details National Shortage of Psychiatrists and Possible Solutions by Aaron Levin April 14, 2017, APA, Psychiatry News]

The Balanced Budget Act (BBA) of 1997 reduced direct GME (Graduate Medical Education) funding by 50% for subspecialty training beyond the primary specialty board eligibility. This is an additional funding cut to general psychiatry and child and adolescent psychiatry. [Workforce Issues, Feb 2016 AACAP, AM Acad child Adolescent Psych]

Federal law provides the U.S. President and other federal officials with authority to declare emergencies, like the Opioid Epidemic was declared, under specified conditions with access to federal technical, financial, logistical, and other assistance. The President of the United States has the authority to implement and complete a war on the underserved mental illness epidemic, a mental illness crisis and public health emergency.

“In times of emergency, the President can override Congress and issue executive orders with almost limitless power. Abraham Lincoln used an executive order in order to fight the Civil War, Woodrow Wilson issued numerous ones related to US involvement in World War I, and Franklin Roosevelt approved Japanese internment camps during World War II with an executive order.” [Legal Information Institute, Cornell Law]

The President has the authority to incentivize additional senior medical students to apply and be accepted to U.S. Psychiatry residency Programs.

The President has the authority to appoint graduating medical doctors, who are selecting residency training programs, to the U.S. Public Health Service, a uniformed service, as Commissioned active duty or ready reserve officers.

The President has the authority to assign new graduating M.D.s, who have been screened and approved by residency programs, but limited by position numbers due to limited funding, to Psychiatry residency programs, while receiving uniformed service pay scale of the U.S. Public Health Service Commissioned Corps, for the 3 years of residency training and 3 years employment as attending Psychiatry Physicians as payback for their training period.

The newly trained attending Psychiatrists and other newly trained healthcare personnel, who are included, will then examine and treat patients in underserved populations, including veterans, at a sizeable savings to incentivized university residency programs. The following presents additional information.

The mental health illness crisis, epicemic and public health emergency are characterized by the following mental illnesses: ICD-10-CM Codes › Mental, Behavioral and Neurodevelopmental disorders include codes F01-F99:

F01-F09 Mental disorders due to known physiological conditions
F10-F19 Mental and behavioral disorders due to psychoactive substance use
F20-F29 Schizophrenia, schizotypal, delusional, and other non-mood psychotic disorders
F30-F39 Mood [affective] disorders
F40-F48 Anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders
F50-F59 Behavioral syndromes associated with physiological disturbances and physical factors
F60-F69 Disorders of adult personality and behavior
F70-F79 Intellectual disabilities
F80-F89 Pervasive and specific developmental disorders
F90-F98 Behavioral and emotional disorders with onset usually occurring in childhood and adolescence
F99-F99 Unspecified mental disorder

The underserved mental illness epidemic, mental illness crisis and public health emergency, are substantiated by massive amounts of research. Mental Health America concisely outlined the mental health illness crisis and public health emergency:

Mental Health America Key Findings:
• 1 in 5 Adults have a mental health condition. That’s over 40 million Americans; more than the populations of New York and Florida combined
• Nearly 50% have a co-occurring substance abuse disorder
• Youth mental health is worsening
• Rates of youth with severe depression increased from 5.9% in 2012 to 8.2% in 2015
• Even with severe depression, 76% of youth are left with no or insufficient treatment
• 9.6 million experience suicidal ideation
• Most Americans still lack access to care
• 56% of American adults with a mental illness do not receive treatment
• 7.7% of youth had no mental health services access with their private medical insurance
• Even in Maine, the state with the best access, 41.4% of adults with a mental illness do not receive treatment
• There is a serious mental health workforce shortage
• In states with the lowest workforce, there is up 6 times the individuals to only 1 mental health professional. This includes psychiatrists, psychologists, social workers, counselors, and psychiatric nurses combined.
[Mental Health Facts, Stats, and Data, Mental Health America 2017]

Unfortunately, the current underserved mental illness epidemic has been complicated and escalated with an additional layer of ‘acting out’ malbehavior called ‘Running Amok’ / ‘Attacking Amok’ which has intensified the public health psychopathological emergency and crisis in the U.S.

‘Running Amok’ is “sometimes referred to as simply amok or gone amok, also spelled amuk, from the Malay language, is ‘an episode of sudden mass assault against people or objects usually by a single individual’, which has traditionally been regarded as occurring especially in Malay culture, but is now increasingly viewed as psychopathological behavior”.

The syndrome of ‘Amok’ is found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV TR). The ICD-10 Code is F68.8 [Carr JE, Tan EK (November 1976). “In search of the true amok: amok as viewed with the Javanese culture”. Am J Psychiatry. 133 (11): 1295–9][“Origin of the Phrase “Run Amok””. Vacca Foeda Media. Retrieved 7 July 2013] [“amok”. Merriam-Webster, Incorporated. 2013. Retrieved 7 July 2013]

An innovative solution to our U.S. underserved mental illness epidemic, a mental illness crisis and public health emergency is the following as outlined:

  • The combination of a newly revamped ‘Berry Plan’ of deferred service, while in psychiatric residency or other associated mental health training discipline,
  • Combined, while receiving uniformed service pay scale
  • As uniformed mental health officer of the U.S. Public Health Service Commissioned Corps
  • for psychiatrists and other associated mental health officer, psychiatry nurse, certified nurse practioner, certified psychiatry technician
  • who upon graduateion become full-fledged mental health practitioners or associates with commensurate uniformed service pay
  • for the equivalent number of years in training i.e. 3 years practice for 3 years training
  • Potential residents are plentiful and residency  programs are hungry for more psychiatry residents but lack funding for more residents, its  about money.
  • The Balanced Budget Act (BBA) of 1997 reduced direct GME (Graduate Medical Education) funding by 50% for subspecialty training beyond the primary specialty board eligibility. This is an additional funding cut to general psychiatry and child and adolescent psychiatry. [Workforce Issues, Feb 2016 AACAP, AM Acad child Adolescent Psych]
  • Another similar option might possibly suffice, once details are fully analyzed.
  • The following is what that combination might look like.

THE STORY OF “THE BERRY PLAN” FRANK B. BERRY, M.D. New York. N.Y.

The story of the Berry Plan began in the winter of I931 at the Harvard Club of New York City during the annual midwinter dinner. The Berry Plan will be the model for impoving service.

The President of Harvard, A. Lawrence Lowell said to the group that although he knew there was no need to give any advice to the newly elected President of the United States, Franklin Delano Roosevelt, a loyal Harvard graduate, he was going to give him some anyway which he had always found most helpful in his own case. He said that any person entering upon a new job or into a new position should always have some plan ready to put into action.

During World War II Frank B. Berry, M.D. served in the army from the spring of I942 until January 1946, the last six or seven months as deputy to Maj. Gen. Morrison Clay Stayer, who was in charge of health, education, and welfare and served on the staff of Gen. Lucius Clay.

He was assigned to the Office of the Surgeon General of the Army.

The fall of 1953, Berry received a telephone call came from Dr. Melvin A. Casberg, who in the reorganization of the Department of Defense in June and July 1953, had been appointed Assistant Secretary of Defense, Health and Medical. He said that he was going to resign his position, go into private practice, and return to his home in California. And asked Berry if he would be interested in accepting his position? He would recommend me. Berry accepted. Eventually Berry received notice of his appointment by President Eisenhower.

Dr. Berry had been in Korea as a consultant to the army in the winter of i95i and 1952, and knew the great dissatisfaction on the part of a large number of medical officers who thought they were not being treated fairly. They felt that those doctors who had not served in World War II should also be eligible to serve, even without volunteering. It was often asked “why not have a draft of such young doctors?”

Berry began to devise a doctors’ military draft with fairness to all, including the medical schools, the hospitals, and the greater organizations which were objecting to the drafting of doctors-the American Medical Association, the Association of American Medical Colleges, and the American Hospital Association.

The objection of these organizations was natural. The draft was depriving them of a large group of young men needed to staff their hospitals. There was also the obligation to provide good sound training for these young men after their internships.

The Berry Plan would give the hospitals a group of men to continue their training and would provide the military services with men of different status and in different states of training. We offered three choices: doctors could choose full residency training in civilian hospitals in a specialty of their choice.

This plan was accepted by the Assistant Secretary of Personnel, John A. Hannah and also by the Secretary of Defense and approved by General Hershey, who headed the whole draft mechanism in Washington.

General Hershey was very interested and it was a novel idea. He did not know whether it would work, but he directed me to go ahead with it. I assured him that I could easily gain the sympathy of the 3 Surgeons General -Army, Navy and Air Force-who agreed and wanted the plan expedited, immediately.
Notification of the medical schools and the printing of instructions and circulars, were immediately prepared and the schools had in hand the full plan with its three subdivisions and could submit it to the senior classes of U.S. medical schools.

The dean of one school objected, saying that it amounted practically to indenture of the senior students into the services, but Berry pointed out-and soon had legal agreement to this effect-that inasmuch as these young students were all over 21, it was an open-ended contract for them, free and voluntary on their part.

The plan was endorsed by the students, who, of course, all wanted full residency postponed as long as possible without thoughts of entering the military service.

Some knew that they would have to enter the service eventually and signed up at once. Gen. Hershey and his medical adviser, Col. R. H. Eanes, were gratified with the way the plan had gone into operation and the enthusiasm with which it was greeted by the students and the medical services.

All students sought further help were referred back to the service of their choice to work out their own private deals with the Surgeons General, who appreciated my fairness in dealing with them and with the students; every one knew exactly where he stood at all times.

The Department of Defense did not interfere; it referred all these young medical officers back to the service to make their own arrangements with the offices of the Surgeons General.

Both the services and the young medical officers saw that both sides were playing fair, and as long as there was fair play they would have full cooperation from the Department of Defense.
During the nine years that Berry served as Assistant Secretary of Defense, Health and Medical, he made many visits to hospitals of the armed forces all over the world and found satisfaction with the number of medical officers on duty; almost no shortages were evident.

By the time Berry left the Department of Defense in i963 the plan, well known throughout the country under the name of the “Berry Plan,” was giving good results for both
• hospitals and
• schools in the United States and
• the armed forces.
• It proved to be so effective that it was not discontinued until I974.

Even then the services wished to continue it, because it would save them much trouble. It had filled their needs extremely well, providing all the specialists they needed and giving them a good group of medical officers. Since its termination there has been talk of starting a similar plan to fulfill the needs of the services.

This is the only time in any of our wars that such a plan was found to be necessary and that the proper medical officers more or less were put into their proper places and were doing the work for which they were qualified.

In none of our other wars has an attempt been made to keep the medical schools and hospitals in the United States moderately well staffed and at the same time to keep the military hospitals moderately well staffed.

Yet it all seems simple as we look back upon it. The problem was one of direct communication-getting a few people together to see what could be done to solve a difficult problem. [Berry FB. The story of “the Berry Plan”. Bulletin of the New York Academy of Medicine. 1976;52(3):278-282.]

“The Public Health Service Act of 1944 structured the United States Public Health Service (PHS), founded in 1798, as the primary division of the U.S. Department of Health, Education and Welfare (HEW; which was established in 1953), which later became the United States Department of Health and Human Services in 1979–1980 (when the Education agencies were separated into their own U.S. Department of Education). The Office of the Surgeon General was created in 1871. The PHS comprises all Agency Divisions of Health and Human Services and the Commissioned Corps. The Assistant Secretary for Health (ASH) oversees the PHS and the United States Public Health Service Commissioned Corps.” [Organizational Chart of Health & Human Services, 2007] [US Department of Health and Human Services. Office of the Assistant Secretary for Health (ASH)]

“United States Public Health Services has duty stations in over 20 federal departments and agencies. The commissioned corps provides officers the ability to pursue and fulfill their chosen careers. For example, CDC, Homeland Security, Department of Justice, Indian Health, NIH, Department of Defense.

“More than 6,500 Commissioned Corps officers currently work on the front lines of public health – fighting disease, conducting research, and caring for patients in underserved communities.

“Corps officers serve in 15 careers in a wide range of specialties within Federal agencies such as the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC).

The following USPHS Ready Reserve, Former Commissioned Officers, Active Duty Commissioned Corps and Inter-service Transfers, uniformed officers, are currently serving in the following disciplines: physicians, dentists, optometry, pharmacists, nurse, nurse practitioner, physician assistants, physical therapists, occupational therapists, speech language pathology, respiratory therapists, science and research, dietician, veterinary medicine, and former JRCOSTEPs,

Medical officers in the U.S. Public Health Service (USPHS) Commissioned Corps train and serve on the front lines of public health: developing national health policies, treating patients in underserved communities, and responding to public health emergencies.

Any valid license allows the professional to work in any one of our Federal facilities. The Commissioned Corps allows a variety of multidisciplinary experiences. As a part of a national team of committed health care professionals, officers enjoy leadership opportunities, excellent benefits, and work/life balance, all while improving the health of the Nation.

“U.S. Public Health Service Commissioned Corps. The uniformed service pay scale is used for determining base salaries for Commissioned Corps officers.”

The U.S. Public Health Service (USPHS) Commissioned Corps offers excellent opportunities for students to serve their country while completing or continuing their education: Junior Commissioned Officer Student Training and Extern Program (JRCOSTEP), Senior Commissioned Officer Student Training and Extern Program (SRCOSTEP), Student Opportunities through Other Agencies

In addition to the above opportunities offered by the Commissioned Corps, students can take advantage of programs offered through other agencies:
USU School of Medicine, National Health Services Corps, IHS Loan Repayment Program, Additional Student Opportunities, Officer Training Opportunities

Officers in the US PHS Commissioned Corps, have the opportunity to continue specialized training and education.

Already in place is the DOD-USPHS PARTNERSHIP FOR PSYCHOLOGICAL HEALTH
To address behavioral health issues associated with combat deployments, the Department of Defense and the U.S. Public Health Service signed a memorandum of agreement in 2008 establishing the “DoD-USPHS Partnership for Psychological Health” initiative. The initiative was designed to ensure that service members, their families, and veterans receive the resources they need by increasing the availability of behavioral health services such as psychiatric counseling, family and group therapy, and preventive and resiliency building services.

Behavioral health officers in the Commissioned Corps of the U.S. Public Health Service are detailed to military medical treatment facilities across the Nation to treat service members who are returning from overseas deployment with conditions such as post-traumatic stress disorder (PTSD), insomnia, anxiety, flashbacks, and depression.

With every possible professional discipline, management structure, facility and experience necessary already in place, the USPHS is an excellent uniformed service for centering the war on the ‘underserved mental illness epidemic, crisis, and public health emergency’ in the United States, while incorporating the professional discipline, management structure, facility and experience of the Berry Plan, already in place.

Combining the know-how, experience and philosophies of both the USPHS and Berry Plan, the war on the epidemic and crisis of ‘Underserved Mental Health Illness and Public Health Emergency’ in the United States, will be simplified and facilitated.

The secretary of Health and Human Services (HHS) has broad authority under Sections 301 and 311 of the Public Health Service Act to provide assistance to states and localities.

Federal law also provides the U.S. President and other federal officials with authority to declare emergencies under specified conditions.

The Number of Accredited Psychiatry Residency Programs, training medical docctors to becom board certified psychiatrists for the Academic Year 2015-2016 United States follows:

Totals are subject to change during current academic year

Specialty Code Specialty No. of Programs No. On-Duty Residents
400 Psychiatry 226 5,932
401 Addiction psychiatry 47 83
405 Child and adolescent psychiatry 134 889
406 Forensic psychiatry 46 81
407 Geriatric psychiatry 59 60
409 Psychosomatic medicine 58 87

[PDF- Number of Accredited Programs Academic Year 2015-2016 … – acgme
https://apps.acgme.org/ads/Public/Reports/ReportRun?ReportId=3…2015]

The Boy Scout Moto, ‘Be Prepared’ should be standard operating policy and procedure, which requires implementation, management and funding.

The following abstract, ‘Funding Public Health Emergency Preparedness in the United States’ reveals some preparedness research.

“Emergency preparedness and response start at the local level, with the city and county officials, state governors, and tribal leaders who are the first to respond to any disaster. Authorities over emergency management functions are historically delegated to state and local governments.

“Responsibilities for biological threats rest with state and local public health departments, emergency response agencies, and public and private health care institutions—organizations that often lack clear funding mechanisms or well-defined authorities for sustained preparedness activities, with no shortage of competing priorities.1 Large-scale events, however, often exceed local management capacities, leading to federal interventions.”

“In 2016 alone, the federal government made assistance available to state governments for 103 declared disasters and emergencies, including fires, natural disasters, and one public health crisis caused by manmade water contamination.2

“We outline legal and funding mechanisms in the United States to clarify federal policies, regulations, and resources that affect coordinated responses at all levels of government to infectious disease outbreaks and other biological health crises.

“In the last 15 years, the federal government reframed the roles and responsibilities for emergency preparedness and response, particularly for biological events. After the terrorist attacks of September 11, 2001, Congress approved the creation of the Department of Homeland Security (DHS) to act “as a focal point regarding natural and manmade crises and emergency planning” for the federal government.3

“Following the 2001 anthrax assaults, Congress also granted new resources and authorities to the Department of Health and Human Services (HHS) and its operating divisions, including the Centers for Disease Control and Prevention (CDC), to coordinate preparedness and response for bioterrorism and other events. 4

“Widespread coordination failures during Hurricane Katrina in 2005, including in the federal response to complex public health challenges that followed the storm, underscored the limited capabilities of the DHS to organize federal response activities as well as ambiguities in national guidance for “all-hazards” emergency preparedness and response. The Katrina experience, coupled with concerns over the emergence of potentially pandemic influenza, prompted Congress to establish the office of Assistant Secretary for Preparedness and Response within the HHS and to strengthen federal programs to mobilize assistance to states for immediate and extraordinary action to protect public health.5

“In addition to the establishment of new offices, the federal government created a series of planning and guidance documents to better coordinate preparedness and response efforts. The National Response Framework defines the general roles, responsibilities, and coordination structures for federal, state, and local entities during all types of disasters or emergencies. 6

“The Emergency Support Function and Support Annexes to the National Response Framework outline how federal agencies will provide coordinated assistance in core areas commonly required for disaster response. The Incident Annexes to the Federal Interagency Operational Plan similarly address coordination of the federal response to specific risks and threats. Both the Public Health and Medical Services Annex (Emergency Support Function #8) and the Biological Index Annex designate the HHS the coordinating agency for federal preparedness and coordination regarding public health events. 7

“Under section 319 of the Public Health Service Act, the HHS secretary may declare a disease, disorder, outbreak, or bioterrorist attack a public health emergency (PHE).17 The HHS secretary declared a PHE for H1N1 influenza in the United States in 2009 and for Zika virus in Puerto Rico in 2016.18

PHE declarations allow the HHS to waive certain federal regulatory and reporting requirements (in some cases, only after the concomitant declaration of a national emergency or major disaster); enter into grants and contracts as needed; allow states to temporarily reassign personnel supported with federal funds; and mobilize federal resources (directly and through assistance to states) to support disease surveillance, investigations, and control measures. A PHE declaration also authorizes the secretary to access federal funds from the Public Health Emergency Fund.19,20

“Federal public health preparedness programs are generally funded through routine congressional appropriations. Appropriations for domestic health security fluctuate from year to year and do not necessarily include contingency funds to respond to biological events. When an emergency or crisis arises, additional funds may be mobilized through special contingency funds or through congressional supplemental appropriations. Since 2003, Congress has approved emergency supplemental appropriations for SARS, H5N1, H1N1, Ebola, and Zika. During the West African Ebola crisis in 2014 and 2015, for example, Congress appropriated $5.4 billion through emergency supplemental funding for preparedness and response, 69% of which was dedicated to the international response; the remainder went toward domestic efforts ($1.1 billion) and research and development ($515 million).21

“The Disaster Relief Fund (DRF), managed by FEMA, is the primary source of funds for federal assistance to states following the declaration of a major disaster or emergency under the Stafford Act. The DRF receives congressional appropriations annually; funds remain available until used and are carried over at the end of the fiscal year.22 In FY2016, Congress allocated $661 million in base funding to the DRF, in addition to its carryover balance.23

“The Public Health Emergency Fund (PHEF; Figure 1), created in 1983, falls under the authority of the HHS. The HHS secretary is authorized to access PHEP funds following the declaration of a PHE. Like the DRF, the PHEF was established as a “no year” account, with an initial appropriation of $30 million.21

However, no appropriations to the PHEF since FY1999 have been noted; the account maintains a zero balance since at least 2012.19 Neither Congress nor recent administrations have explicitly addressed the steady exhaustion of funding in the PHEF as a deliberate policy decision
{The U.S. underserved mental illness epidemic, a mental illness crisis and public health emergency, is an example of a urgent federal intervention]

The following are bullets for a Declaration of an Emergency by the Executive Branch of Government, 42 U.S.C. §§ 5121–5207
• “The Stafford Act authorizes the U.S. President to declare a “major disaster” or “emergency” in response to an event (or threat) that overwhelms state or local governments. A declaration under the act triggers access to federal technical, financial, logistical, and other assistance to state and local governments.
• The Act directs the Federal Emergency Management Agency (FEMA) to coordinate administration of disaster relief to the states.
• The governor of an affected state must first respond to the disaster and execute the state’s emergency plan before requesting that
• the president declare a major disaster or emergency, and the governor must certify that the magnitude of the emergency
• exceeds the state’s capability.
• The president may declare an emergency without the request
• of a governor or tribal leader if the emergency involves “federal primary responsibility” (such as an event occurring on federal property, for example the bombing of the Murrah Federal Building in 1995).

Title VI of the act provides for a national system for all-hazards emergency preparedness, with authority located at both the federal and state levels.”
Deployment of the Public Health Service (PHS), Executive Branch, 42 USC 6A Part A §217:

Use of Service in time of war or emergency
• In time of war, or of emergency proclaimed by the U.S. President, he may utilize the PHS to promote the public interest.
• The president may by executive order declare the
• commissioned corps of the PHS to be a military service.
• Upon such declaration, the commissioned corps (a) will constitute a branch of the land and naval forces of the U.S., (b) will, to the extent prescribed by regulations of the president, be subject to the Uniform Code of Military Justice [10 U.S.C. 801 et seq.],
•and (c) will continue to operate as part of the PHS
• except to the extent that the president may direct as Commander in Chief.

1135, Waivers, Secretary of Health & Human Services, 42 U.S.C. § 1320b-5:
Authority to Waive Requirements During National Emergencies. Section 1135 of the Social Security Act (SSA) authorizes the secretary of HHS to waive or modify certain requirements of Medicare, Medicaid, and the State Children’s Health Insurance Program during certain emergencies.

Section 1135 waivers require both:
1) a declaration of national emergency or disaster by the U.S. President under the National Emergencies Act or the Stafford Act and
2) a public health emergency determination by the secretary under the PHS Act. Waivers may be requested by affected healthcare providers in the emergency area during the emergency period.
• The secretary may make a waiver retroactive to the beginning of the emergency period or any subsequent date thereafter.
• In addition, the secretary may specify that the waivers terminate 60 days from publication, which may be extended, provided that neither the original 60-day period nor any extension extends beyond termination of the applicable declaration or determination.
• Waivers related to the Emergency Medical Treatment and Active Labor Act (EMTALA) and the Health Information Portability and Accountability (HIPAA) Privacy Rule are subject to different requirements and may terminate after 72 hours.

Additional Resources
• NCSL State Quarantine and Isolation Statutes
• Federal and State Quarantine and Isolation

Authority (CRC)
• Office of the Assistant Secretary for Preparedness and Response (ASPR)
1. Legal Authorities, Policies, and Committees
2. ASPR Public Health Declarations Questions & Answers
• CDC Public Health Law Program
1. Selected Federal Legal Authorities Pertinent to Public Health Emergencies
2. Public Health Preparedness Capabilities: National Standards for State and Local Planning
3. State, Tribal, Local, and Territorial Public Health Professionals Gateway
4. Funding and Guidance for State and Local Health Departments
5. CDC Ebola Resources
[RESPONSIBILITIES IN A PUBLIC HEALTH EMERGENCY 10/29/2014, National Conference of State Legislatures 2017]

The President of the United States has the executive authority to implement multiple action plans to alleviate, and possibly eradicate, the public health emergency, the current mental illness underservice, psychiatry research and training crises.

Developing and employing a civilian, Berry Plan Model, wherein the military draft is not enforce, the Mental Health Berry Plan would increase the number of U.S.
• students mental healthcare programs in training
• doctors, psychiatrists, psychologists in training
• mental healthcare nurses, social workers in training
• trained, employed licensed above professional types mental healthcare personnel in hospitals, clinics and rural outreach clinics
• Professional senior students who volunteer for the Mental Health Public Health Service would be commissioned in the Active Duty Mental Health Public Health Corps or Ready Reserve Corps Mental Health Public Health Corps and pay grade
• Doctors, professionals and other personnel would be salaried according to their pay grade with different status and in different states of training.
• The Mental Health Berry Planan open-ended contract for them, free and voluntary on their part
• SEC. 203. ø204¿ COMMISSIONED CORPS AND READY RESERVE CORPS. (a) ESTABLISHMENT.

(1) IN GENERAL.—There shall be in the Service a commissioned Regular Corps and a Ready Reserve Corps for service in time of national emergency.
(2) REQUIREMENT.—All commissioned officers shall be citizens of the United States and shall be appointed without regard to the civil-service laws and compensated without regard to the Classification Act of 1923, 3 as amended.
(3) APPOINTMENT.—Commissioned officers of the Ready Reserve Corps shall be appointed by the U.S. President and commissioned officers of the Regular Corps shall be appointed by the President.
(4) ACTIVE DUTY.—Commissioned officers of the Ready Reserve Corps shall at all times be subject to call to active duty by the Surgeon General, including active duty for the purpose of training.
(5) WARRANT OFFICERS.—Warrant officers may be appointed to the Service for the purpose of providing support to the health and delivery systems maintained by the Service and any warrant officer appointed to the Service shall be considered for purposes of this Act and title 37, United States Code, to be a commissioned officer within the Commissioned Corps of the Service. (b) ASSIMILATING RESERVE CORP OFFICERS INTO THE REGULAR CORPS.—Effective on the date of enactment of the Patient Protection and Affordable Care Act, all individuals classified as officers in the Reserve Corps under this section (as such section existed on the day before the date of enactment of such Act) and serving on active duty shall be deemed to be commissioned officers of the Regular Corps

SEC. 203A. ø204a¿ DEPLOYMENT READINESS. (a) READINESS REQUIREMENTS FOR COMMISSIONED CORPS OFFICERS.—
(1) IN GENERAL.—The Secretary, with respect to members of the following Corps components, shall establish requirements, including training and medical examinations, to ensure the readiness of such components to respond to urgent or emergency public health care needs that cannot otherwise be met at the Federal, State, and local levels: (A) Active duty Regular Corps. (B) Active Reserves

(6) URGENT OR EMERGENCY PUBLIC HEALTH CARE NEED.— For purposes of this section and section 214, the term ‘‘urgent or emergency public health care need’’ means a health care need, as determined by the Secretary, arising as the result of— (A) a national emergency declared by the U.S. President under the National Emergencies Act (50 U.S.C. 1601 et seq.); (B) an emergency or major disaster declared by the U.S. President under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5121 et seq.); (C) a public health emergency declared by the Secretary under section 319 of this Act; or (D) any emergency that, in the judgment of the Secretary, is appropriate for the deployment of members of the Corps. (b) CORPS MANAGEMENT FOR DEPLOYMENT.—The Secretary shall— (1) organize members of the Corps into units for rapid deployment by the Secretary to respond to urgent or emergency public health care needs; (2) establish appropriate procedures for the command and control of units or individual members of the Corps that are deployed at the direction of the President or the Secretary in response to an urgent or emergency public health care need of national, State or local significance; (3) ensure that members of the Corps are trained, equipped and otherwise prepared to fulfill their public health and emergency response roles; and (4) ensure that deployment planning takes into account— (A) any deployment exemptions that may be granted by the Secretary based on the unique requirements of an agency and an individual’s functional role in such agency; and (B) the nature of the urgent or emergency public health care need. (c) DEPLOYMENT OF DETAILED OR ASSIGNED OFFICERS.—For purposes of pay, allowances, and benefits of a Commissioned Corps officer who is detailed or assigned to a Federal entity, the deployment of such officer by the Secretary in response to an urgent or emergency public health care need shall be deemed to be an authorized activity of the Federal entity to which the officer is detailed or assigned. S

GRADES, RANKS, AND TITLES OF THE COMMISSIONED CORPS SEC. 206. ø207¿ (a) (c) The U.S. President is authorized to prescribe titles, appropriate to the several grades, for commissioned officers of the Service other than medical officers. All titles of the officers of the Reserve Corps shall have the suffix ‘‘Reserve’’
(7) APPOINTMENT OF PERSONNEL SEC. 207. ø209¿ (a)(1) Except as provided in subsections (b) and (e) of this section, original appointments to the Regular Corps may be made only in the warrant officer (W–1), chief warrant officer (W–2), chief warrant officer (W–3), chief warrant officer (W–4), junior assistant, assistant, and senior assistant grades and original appointments to a grade above junior assistant shall be made only after passage of an examination, given in accordance with regulations of the President, in one or more of the several branches of medicine, dentistry, hygiene, sanitary engineering, pharmacy, psychology, nursing, or related scientific specialties in the field of public health. (2) Original appointments to the Reserve Corps may be made to any grade up to and including the director grade but only after passage of an examination given in accordance with regulations of the President. Reserve commissions shall be for an indefinite period and may be terminated at any time, as the President may direct. (3) No individual who has attained the age of forty-four shall be appointed to the Regular Corps, or called to active duty in the Reserve Corps for a period in excess of one year, unless (A) he has had a number of years of active service (as defined in section 211(d)) equal to the number of years by which his age exceeds forty-four, or (B) the Surgeon General determines that he possesses exceptional qualifications, not readily available elsewhere in the Commissioned Corps of the Public Health Service, for the performance of special duties with the Service, or (C) in the case of an officer of the Reserve Corps, the Commissioned Corps of the Service has been declared by the U.S. President to be a military service. (b)(1) Not more than 10 per centum of the original appointments to the Regular Corps authorized to be made during any fiscal year may be made to grades above that of senior assistant, but VerDate Nov 24 2008 17:29 Oct 24, 2017 Jkt 000000 PO 00000 Frm 00008 Fmt 9001 Sfmt 9001 G:\COMP\PHSA\PHSA.BEL HOLCPC October 24, 2017 G:\COMP\PHSA\PHSA-MERGED.XML As Amended Through P.L. 115-71, Enacted October 18, 2017 etc. in accordance with the U.S. Codes and Regulaltions

(7) All resident and to be trained personnel shall be attached and serve the already U.S. academic residency program in which they match in the residency matching program.
(8)After completion of the residency program each licensed personnel shall become a member of the academic program where they were trained for the same number of years they received training.
(9) Previously trained and licensed personnel can apply for employment at an established academic program and be commissioned and compensated accordingly.
(10) All employment, duration and compensation Information and questions shall be managed, arranged and addressed with the U.S. Secretary of Health and Human Services, individually.
(11) All mental health training and provider services funding will be remunerated from government funding in accordance with the Public Health Service
(12) All training policies and procedures are under the direction of the faculty and staff of the academic programs, where the individual has assigned or attached duty status.

The above is a cursory review of the 2017 mental illness epidemic, a mental illness crisis and public health emergency, the Berry Plan and the US PHS. The U.S. Department of Health and Human Services and US PHS shall implement and manage and distribute the detailed, complete duty code with rules and regulations, with this proposed plan, should a definitive war on the U.S. underserved mental illness epidemic, a mental illness crisis and public health emergency, be legitimately commenced.

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