NYAPRS Note: While the articles below provide some of the telling points make yesterday in a Senate hearing on our mental health service systems, please do take a look and listen to the actual testimonies. Both Mike Hogan and Larry Fricks went ‘off script’ and provided some very strong, insightful and inspiring comments, as did SAMHSA Administrator Pam Hyde. Watch it at:
U.S. Mental Health Experts Urge Focus on Early Treatment
By David Morgan, Reuters January 24, 2013
WASHINGTON – The U.S. mental health system has huge gaps that prevent millions of people with psychological problems, including children and teens, from receiving effective treatment that could prevent tragic consequences, experts told U.S. lawmakers on Thursday.
Just over a month after the shooting rampage in Newtown, Connecticut, experts told a Senate hearing that three-quarters of mental illnesses emerge by age 24, but fewer than one in five youths with diagnosable problems receive treatment that could avoid later problems including violence and suicide.
Overall, experts said as many of 45 million Americans experience mental illnesses such as depression, eating disorders, post-traumatic stress disorder and drug abuse each year. But only 38 percent get treatment.
“These are the chronic disorders of young people,” said Dr. Thomas Insel, director of the National Institute of Mental Health.
The hearing, before the Senate Health, Education, Labor and Pensions Committee, was held in response to the shootings at Newtown’s Sandy Hook Elementary School, where a young 20-year-old man described as having mental issues gunned down 26 people including 20 young children with assault rifle on December 14. It was the first time the committee has addressed the issue of mental health since 2007.
The Newtown tragedy and other mass shootings in recent years have ignited a debate about gun control and mental health, including a push by President Barack Obama for stronger gun controls and better mental health training for schools and communities.
But the committee’s Democratic chairman, Tom Harkin, warned against drawing a bold parallel between mental illness and violence against others.
“One of the most insidious stereotypes about people with mental illness is that they are inherently violent,” said the Iowa senator. “People with mental illness are much more likely to be the victims of violent crimes than they are to be perpetrators of acts of violence.”
Insel said a relatively small number of mentally ill people, who suffer from symptoms such as paranoia and hallucinations, are violent. “Far more common than homicide is violence against the self,” he said, pointing out that 90 percent of the 38,000 suicides each year involved mentally ill people.
All told, he said, the risk of violence, including suicide, among people who develop mental illness is 15 times greater without treatment.
Experts cautioned that treatment should avoid powerful drugs for children who are often vulnerable to side-effects and recommended extra care to ensure that the normal behavioral problems of childhood and adolescence not be mislabeled as mental illness.
In response to the Newtown tragedy, Obama has announced a series of initiatives intended to help teachers and other adults identify children, adolescents and young adults with mental illness and ensure they receive treatment.
Experts said Obama’s healthcare reform law is expected to lead to the biggest increase in mental health access in a generation. After January 1, 2014, it is scheduled to extend health coverage to millions of Americans currently locked out of the $2.8 trillion U.S. healthcare system because of a lack of insurance.
Pamela Hyde, administrator of the U.S. Substance Abuse and Mental Health Services Administration, said that as many of 10 million people with mental illnesses could gain access to care as a result of the Patient Protection and Affordable Care Act. “Prevention works. Treatment is effective. And people recover,” she said.
But Senator Patty Murray, a Democrat from Washington state, expressed concern that the Obama administration is not moving fast enough to produce detailed rules on how mental health access should be made available through new state-based online health insurance marketplaces being set up under the law.
“It’s really essential that we see a final rule before April,” Murray told Hyde. “Our states are working on the exchanges and they need that clarity. I can’t urge you strongly enough.”
Hyde said a final rule on essential benefits is due next month. But she could not say whether a separate rule on mental health parity would meet Murray’s deadline.
Mental health: Will It Fall Between The Insurance Cracks?
By Allison Bell Life Health Pro January 24, 2013
Regulators have to do more to make sure that two major federal laws already on the books really improve access to mental health care insurance benefits.
Witnesses delivered that message today in Washington at a hearing on the state of the U.S. mental health care system that was organized by the Senate Health, Education, Labor and Pensions Committee.
The committee organized the hearing in response to the mass shooting in Newtown, Conn., to look at how the United States might be able to improve the way it manages psychological problems that lead to violence.
Pamela Hyde, the administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), noted at the hearing that “most people who are violent do not have a mental disorder, and most people with a mental disorder are not violent.”
“Demographic variables such as age, gender and socioeconomic status are more reliable predictors of violence than mental illness,” Hyde testified, according to a written version of her remarks posted on the committee website. ” These facts are important, because misconceptions about mental illness can cause discrimination.”
Patients and their families now get 69 percent of the cash used to pay for mental health care from state and federal government programs, 12 percent from their own personal resources, and 27 percent fromprivate insurance plans, Hyde said.
One of the major laws governing private health insurance benefits for mental health care, the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), affects insured and self-insured group health benefits.
The MHPAEA does not require an employer to offer coverage for mental health or substance use disorders.
If an employer with 50 or more employees does offer mental health or substance abuse benefits, then the financial requirements and treatment limits for the behavioral health benefits can be no more restrictive than the typical requirements for benefits for other types of disorders.
The federal departments in charge of implementing the MHPAEA – the U.S. Department of Health and Human Services, the U.S. Labor Department and the U.S. Treasury Department – put the law into effect with temporary regulations in July 2010. A lack of final regulations interferes with efforts to enforce the law, critics say.
Another law, the Patient Protection and Affordable Care Act of 2010 (PPACA), is set to require all non-grandfathered individual and small group plans to offer an “essential health benefits” (EHB) package that includes coverage for mental health and substance use disorder services starting Oct. 1.
The Obama administration intends to move forward by issuing a final rule on the EHB package and PPACA mental health benefits parity requirements in February, Hyde said.
The administration also intends to put out an MHPAEA final rule, Hyde said.
Michael Hogan, a former New York state mental health office commissioner and the chairman of the President’s New Freedom Commission on Mental Health, said improving the mental health system “must begin with a realization that we have begun to take big steps away from an approach that was both separate and unequal.”
Going forward, to get the most out of the new, expanded access to mental health care benefits, mental health care providers should be providing “collaborative care” in primary care office settings, Hogan said.
“Station a mental health practitioner in the practice,” Hogan said. “Screen for mental health problems, measure progress, allow billing for basic mental health services like educating patients about managing their depression, and ensure that a psychiatrist or other specialist is available for consultation.”
The country also needs better programs to help people who are showing signs of having psychotic disorders find and stay on effective medications, and get and keep jobs, Hogan said.
Dr. Bob Vero, chief executive officer of Centerstone, a community mental health center in Tennessee, testified that the Obama administration needs to ensure that “behavioral health has a seat at the table” in new, PPACA-driven efforts, such as the Medicare “accountable care organization” (ACO) pilot program, to improve coordination of care.
Hogan said he has concerns about having the people who manage general health care take over managing care for people who are dealing with serious mental illness.
Although the idea of integrating behavioral care with general primary health care is a good one, “we do not yet have national standards for the quality of care for people with serious mental illness, so the transition away from expert leadership is risky,” Hogan said. “We failed to maintain focus during an earlier era of deinstitutionalization; we must not make this mistake again.”
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