NYAPRS Note: Last week, an especially timely briefing was held at DC’s Capitol Visitor Center to highlight the critical role that counties play in implementing the unprecedented changes our behavioral health, health, criminal justice and social service systems currently face. The briefing emphasized that “750 [county level] behavioral health authorities in 23 states cover more than 75 percent of the U.S. population.”
The briefing included Representatives Tim Murphy, Paul Tonko and Grace Matsui, county leaders and our own Harvey Rosenthal, who emphasized that counties are at ‘ground zero’ for how change happens. He also described how peer support has transformed our local, state and federal behavioral health systems, and how counties should be supported to grow those indispensable services.
County Officials, Policymakers Tout Importance of BH support
Mental Health Weekly November 3, 2015
The National Association of Counties (NACo) and the National Association of County Behavioral Health & Developmental Disability Directors (NACBHDD) on October 28 hosted a bipartisan group of congressional leaders and county officials to demonstrate how integral counties are to this country’s behavioral health system. The briefing was also streamed live.
Rep. Paul Tonko (D-N.Y.), one of the presenters, told attendees it’s important to make “certain that parity is woven into the regulations of this country.” He added, “We cannot ‘stepchild’ the audience of health care consumers that are mentally ill or living with mental health disorders.” About 1 in 5 people have a mental illness, 1 in 25 have a serious mental illness and 1 in 10 have a substance abuse disorder in this country, he said. The Substance Abuse and Mental Health Services Administration should not be underfunded, said Tonko. “It is important for us to have those preventative programs,” he said.
The work that needs to be done can be accomplished with “our partners in county government,” he said. “You need to remind us of which services work and how to best fund those services.”
Rep. Doris Matsui (D-Calif.) noted that counties play a pivotal role in implementing state and federal programs. She told attendees that one of her top priorities in Congress is to be sure that mental health care and physical health care are addressed on the same plane. “It’s very important that we take a comprehensive, proactive approach to mental health reform,” she told attendees.
“It’s really important that we work together to ensure that reforms improve patient outcomes,” Matsui said. “We must connect patients with care teams as soon as possible, making services available early, before they get to the crisis stage.” She pointed to the work her county, Sacramento County, has done with four major hospitals in her district to ensure there is a plan for taking patients out of emergency rooms and into crisis centers and identifying their need early.
Matsui, who co-sponsored the Mental Health First Aid Act with Rep. Lynn Jenkins (R-Kansas), noted that establishing mental health literacy and awareness is an important step.
Matsui also discussed her efforts to implement demo programs based on the Excellence in Mental Health Act, which she co-led. It provides new Medicaid funding for certified behavioral health clinics to provide counseling services and peer and family support.
Recently, 23 states were awarded planning grants to make this happen, she said. “We need to help providers better understand the mental health information-sharing process,” said Matsui, explaining the reason for her sponsorship of H.R. 2690, the “Including Families in Mental Health Recovery Act.” The legislation ensures patients’ right to privacy while encouraging providers to share information with family members and caregivers when appropriate and when it’s in the patient’s best interest.
Behavioral health
“Behavioral health matters to counties,” Ron Manderscheid, Ph.D., executive director of the NACBHDD, told MHW in an interview following the congressional briefing. Approximately 3,069 counties spend $70 billion per year in health care, including county behavioral health services, he said. Counties operate more than 750 behavioral health authorities, he noted.
The NACBHDD also presented to policymakers that those 750 behavioral health authorities in 23 states cover more than 75 percent of the U.S. population, Manderscheid noted. Additionally, many counties help finance Medicaid, which is considered a major source of funding for county behavioral health services. It is important that congressional members and staff understand “that counties are a fundamental part of our infrastructure and our safety net,” said Manderscheid. “When someone has no insurance, is homeless or has no family support, where do they turn?” he noted. “Not the federal government or state government. You go to your local county, the safety net of last resort. It’s important to pay attention to how well counties are fulfilling that role.”
Other attendees at the briefing included Cherryl Ramirez, president of the NACBHDD and executive director of the Association of Oregon Community Mental Health Programs; Rep. Tim Murphy (R-Pa.); Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services; Robert Sheehan, incoming chief executive officer of the Michigan Association of Community Mental Health Boards; and Matthew Chase, NACo executive director.
“We view this as the first of many briefings,” said Manderscheid, who said he was pleased with the good attendance.
County priorities
County priorities for behavioral health reform include:
Fully fund SAMHSA’s block grants.
Fully implement and expand mental health parity.
Ease Medicaid’s Institutions of Mental Disease exclusion.
Enhance Medicaid flexibility.
Expand access to health information technology.
Develop and expand the workforce.
Simplify health privacy provisions.
Reauthorize and fully appropriate the Mentally Ill Offender Treatment and Crime Reduction Act.
Respond to the needs of veterans.
Fully implement services across the life cycle.