Strengthening the Public Mental Health Addictions Safety Net

Much needs to be done to ensure that national healthcare reform and parity live up to their promise for persons with mental illness and addiction disorders, Congressmen and advocates pointed out during a recent policy briefing on mental health.

There is an unfortunate dual crisis of increased demand and service reduction. Coverage expansion under healthcare reform will result in 1.5 million new patients entering the public safety net for mental health and addictions treatment, which already struggles to care for 8 million+ children and adults. Approximately 2.5 million people with serious mental disorders, individuals with major addiction disorders and homeless persons will remain uninsured, relying on services delivered by the safety net. The economic recession has resulted in over $2 billion in cuts to public mental health services -with more cuts on the horizon - leading to the elimination of services for the uninsured.

Another public health emergency was highlighted during the policy briefing: Persons with schizophrenia, bipolar disorder and major depression die, on average, at the age of 53 -the highest death rate among any population served by any agency of the United States Public Health Service. Co-occurring chronic illnesses -asthma, diabetes, cancer, heart disease and cardio-pulmonary conditions -and lack of access to primary care and specialty medicine is a critical factor in these tragic outcomes.

The time has come for parity between community behavioral health and other parts of America's safety net including public hospitals and Community Health Centers. All of us (including Congress and regulators) must pay attention to three issues critical to the success of parity and healthcare reform:

Passage of HR 5636, the Community Mental Health and Addiction Safety Net Equity Act, that offers a new definition for Federally Qualified Behavioral Health Centers and identifies core services, creates nationwide cost based reimbursement, and establishes clearly-defined national accountability and reporting requirements.
Regulations to ensure that the healthcare reform's new Medicaid Health Home State Option requires mandatory subcontracts with behavioral health; and that behavioral health organizations serve as medical homes for people with serious mental illnesses and addictions to advance this population's overall health and improve life expectancy.
Passage of the HR 5040, the Health Information Technology Extension for Behavioral Health Services Act, to support the use of technology to create treatment transparency, eliminate errors and better coordinate care to improve the health outcomes of persons with serious mental illness.
Rep. Paul Tonko (D-NY), said there were four keys to a successful implementation of mentalhealthcarereform.org healthcare reform for people with mental and addiction disorders -a vigorous outreach and enrollment program by the Centers for Medicare and Medicaid Services; regulations that ensure parity in Medicaid state exchanges and parity in Medicare managed care plans, inclusion of intensive community based services and residential addiction services in the mandatory minimum benefits package offered through the new state exchanges, and inclusion of community mental health centers in every medical home funded via the law's Health Home State Option.
Rep. Tim Murphy (R-PA), pressed for passage of legislation that would extend federal health information technology incentives to behavioral health services. The legislation, introduced by Rep. Patrick Kennedy (D-RI), would make behavioral and mental health providers eligible for federal grants to acquire electronic health records that are interoperable, integrated, intelligent and easy to use. But bills improving access to mental health services "only matter if we make sure we integrate care together," Murphy said. "Mental health services are not stand-alone and that is something we need to continue to educate the community around."

Linda Rosenberg is the president and CEO of the National Council for Community Behavioral Healthcare. TNC specializes in lobbying for mental and behavioral healthcare reform. Lean more at thenationalcouncil.org thenationalcouncil.org.