NYAPRS Note: Mental health reform in the US become a subject of even greater discussion in 2015 in the nation’s capital.
- This past Tuesday, former Congressman Patrick Kennedy and former US Surgeon General David Satcher announced the formation of a partnership between the Kennedy Foundation and the Morehouse School of Medicine to pursue several strategies to improve mental health service access and performance in the US. Their piece below in USA Today suggests that their focus will be on promoting mental health parity policies, greater access to clinicians, brain research and healthcare integration. There currently is no mention of strategies that extend beyond a medical focus like recovery supports and the need to address the social determinants of health (housing and economic status, social and peer support, cultural and linguistic competence).
- The federal Government Accountability Office released a report recently that pointed to a lack of coordination and accountability across federal behavioral health related programs. The evaluation comes in the form of a “Report to the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, House of Representatives.” See below for some excerpts.
- Congressman Tim Murphy is holding a hearing next week to discuss the report’s findings. The Congressman is also expected to release a new version of mental health policy legislation in the coming few weeks.
- A new coalition entitled ‘Recovery Now!’ is forming that will be focused on ensuring that mental health policy discussions, coverage and actions are informed by recovery-focused approaches that have helped millions of Americans and their families to move beyond major distress, avoidable homelessness, incarcerations and repeat or long term hospital use. Stay tuned for more details!
Satcher-Kennedy: How To Fix Mental Health System
David Satcher and Patrick J. Kennedy USA Today February 4, 2015
Since JFK’s speech, progress has been made. Four steps today would help solve crisis.
What if we told you there was an issue that virtually everyone — Democrat, Republican and Independents — agreed on? Would it further surprise you that it’s a subject on which we’ve been silent for generations?
But now, an overwhelming majority (96%) of the public agrees that mental health conditions, such as depression, anxiety and alcohol or drug abuse are serious public health problems, according to a new poll by Public Opinion Strategies. Almost as many (93%) believe that the current way we are handling mental health needs to change.
This call to action reflects the fact that virtually every American family has a personal connection with an individual impacted by mental health disorders. If you do not have someone in your immediate household who is battling depression or struggling with alcohol, then you work or go to school with people who are. Our prisons hold 10 times more people with mental illness than our state hospitals. We can no longer afford to look at these as others’ problems. They impinge on our happiness, our productivity, and our health, whoever we are, and we all must take responsibility for finding a new approach.
Fifty-two years ago this week, President John Kennedy gave a special address to Congress on mental health, a major step toward removing the stigma that continues to surround brain diseases. Later that year, President Kennedy signed the Community Mental Health Act of 1963, which ended the warehousing of people with mental illness in institutions and enabled many Americans to receive treatment while working and living at home.
Just over 15 years ago, the Surgeon General of the United States issued a comprehensive report that again put mental health on the front burner. The report documented that half of all Americans had mental disorders at some time in their lives, but most of them did not seek treatment. By putting the weight of the federal government behind the issue, just as the Surgeon General’s report on smoking once had, barriers to treatment started to come down.
One of the key recommendations of “Mental Health: A Report of the Surgeon General” was that insurance companies should be required to treat mental illness and addictions like any other disease. In 2008, Congress passed the Mental Health Parity and Addiction Equity Act to prohibit discrimination in insurance coverage. The Affordable Care Act went even further and insurance companies are now required to cover treatment for mental health issues and substance abuse.
Today, we have more potential to solve the crisis in mental health, and care for our loved ones struggling with mental illness and addictions, than ever before. Even so, we are still far away from where we ought to be.
That is why we are announcing a partnership between the Kennedy Forum and Morehouse School of Medicine that will fulfill President Kennedy’s vision of ensuring the best possible mental well-being for every American. Here is how we will get there:
First, we need greater equality so that everyone has access to the care they need, without bias. The first step will be full implementation of the Parity Act, especially holding payers accountable. Insurance companies must be compelled to disclose how they make coverage decisions. With greater transparency, we will learn whether they are complying with the Parity Law and treating illnesses of the mind, like depression, the same as diseases of the body, like diabetes.
Second, we need to focus on greater innovation to expand research and further our knowledge of the brain. President Obama’s $100 million brain research initiative is a step in the right direction, but we lag behind investments made in Europe and China. Of course, some breakthroughs come not because of more funding, but more collaboration. Research organizations such as One Mind have shown that we can accelerate advances in diagnostics, treatments and cures with open science and data-sharing among scientists around the world.
Third, we need to improve access to high quality care to provide the best outcomes for our brothers and sisters seeking recovery from mental illness and substance abuse. More than half our nation’s counties do not have a practicing psychiatrist, psychologist or social worker. We must increase the number of mental health professionals across the country, but we must also encourage primary care providers to make mental health part of their charge. Family practitioners are often in the best position to intervene early and improve mental health outcomes before conditions become worse.
Fourth, we need better integration to bring mental health into the mainstream of American medicine. Descartes’ concept of a mind-body split in the 17th century has left us with a fragmented health system in the 21st century. With today’s technology, we can break down the silos in payment and service delivery systems. The result will be improved outcomes for patients and lower costs for everyone.
In his speech 52 years ago, President Kennedy called for an end to the “tradition of neglect” of people with mental illness. Ending that tradition — once and for all — is the responsibility of the entire American family. Those of us who suffer from mental illness or addictions must seek care. Health care providers must be as concerned about a patient’s brain functioning as her blood work. Insurance companies must become partners in helping people get better, rather than focusing solely on profits. Having passed the Parity Act and the Affordable Care Act, policymakers cannot move on, but must make sure the laws are enforced and implemented.
Above all, each of us must do our part to elevate the dignity of individuals impacted by mental health and substance use disorders. Rather than blaming these issues on moral failing, we must take responsible action to ensure that effective treatments are made available to those who need them, ending the tradition of neglect and replacing it with a “whole health” culture of respect.
David Satcher, M.D., Ph.D. is director of The Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta and former U.S. surgeon general. Patrick J. Kennedy is founder of the Kennedy Forum and former Democratic U.S. representative from Rhode Island.
http://www.usatoday.com/story/opinion/2015/02/04/mental-health-satcher-kennedy/22764289/
———
What GAO Found
Agencies identified 112 federal programs that generally supported individuals with serious mental illness in fiscal year 2013. The majority of these programs addressed broad issues, such as homelessness, that can include individuals with serious mental illness. The programs were spread across eight federal agencies: Department of Defense (DOD), Department of Education, Department of Health and Human Services (HHS), Department of Housing and Urban Development, Department of Justice (DOJ), Department of Labor, Department of Veterans Affairs (VA), and the Social Security Administration. Thirty of the 112 programs
were identified by the agencies as specifically targeting individuals with serious mental illness. Four agencies—DOD, HHS, DOJ, and VA—reported that they obligated about $5.7 billion for programs that specifically targeted individuals with serious mental illness in fiscal year 2013. Agencies had difficulty identifying all programs supporting individuals with serious mental illness because they did not always track whether or not such individuals were among those served by the program. Agencies also varied in which programs they identified because they had different definitions of what such a program might be. Such inconsistency limits the potential comparability across programs.
Interagency coordination for programs supporting individuals with serious mental illness is lacking. HHS is charged with leading the federal government’s public health efforts related to mental health, and the Substance Abuse and Mental Health Services Administration is required to promote coordination of programs relating to mental illness throughout the federal government. In the past, HHS led the Federal Executive Steering Committee for Mental Health, with members from across the federal government. However, the steering committee has not met since 2009. HHS officials told us that the Behavioral Health Coordinating Council (BHCC) performs some functions previously carried out by the steering committee. The BHCC, however, is limited to HHS and is not an interagency committee. Other interagency committees were broad in scope and did not target
individuals with serious mental illness. Staff for the majority of the programs targeting serious mental illness reported taking steps to coordinate with staff in other agencies. While coordination at the program level is important, it does not
take the place of, or achieve the level of, leadership that GAO has previously found to be key to successful coordination and that is essential to identifying whether there are gaps in services and if agencies have the necessary information to assess the reach and effectiveness of their programs.
Agencies completed few evaluations of the programs specifically targeting individuals with serious mental illness. Of the 30 programs specifically targeting individuals with serious mental illness, 9 programs had a completed program evaluation, 4 programs had an evaluation underway, and 17 programs had no evaluation completed and none planned. However, agency officials said they engaged in other efforts—such as drawing on evidence in published literature— to ensure their programs were effective. GAO’s prior work has shown the significance of both performance monitoring activities and program evaluations
and noted the importance of formal program evaluations to inform program managers about the overall design and operation of the program.