What Washington Should Do To Implement True Mental Health Reform
by Harvey Rosenthal Mental Health Weekly September 24, 2019
We only talk about true and substantive mental health policy reforms after a gun-related tragedy, but the focus inevitably is about control and confinement and not recovery and rehabilitation.
True mental health reform has nothing to do with mass shootings and providing an alternative to meaningful gun control measures. The federal government must take the lead here, recognizing that mental health policy should fundamentally be around public health, not public safety.
Here’s a list of common-sense measures the federal government can take to truly advance the lives of people diagnosed with the most “serious” conditions.
1. Incentivize Recovery
Current National Committee for Quality Assurance and state outcome measures reward connecting people with treatment and medication but ignore the fundamental impact of the social determinants of health (e.g., some of us might want and need medication, but all of us need stable housing and finances).
The National Institute of Mental Health (NIMH) should conduct or fund research into these areas, especially as we move to a value-focused environment where outcomes drive reimbursement.
2. Focus on the True Causes of Gun Violence
The president and many congressional leaders must stop the shameful practice of unjustly blaming Americans with mental health conditions for gun violence and remove restrictions on the Centers for Disease Control and Prevention on conducting research into the nature, causes and remedies to reduce gun violence in America.
3. Address Victimization
While there are clear findings that Americans with mental health conditions are 11 times more likely to be victims of violence, nothing is being done to evaluate and address this issue. NIMH should fund, if not conduct, research as to why this occurs and what we can do about this.
4. Validate the Value of Peer Support
Peer-delivered services are being widely sought by governments, health plans and providers across the nation, yet the Substance Abuse and Mental Health Services Administration (SAMHSA) does not list them as an evidence-based practice. SAMHSA should fund research that conclusively looks at the impact of peer services, especially on individuals with major mental health conditions.
5. Expand Alternatives to Coercive Treatment
SAMHSA is devoting considerable resources to expanding the use of court-mandated assisted outpatient treatment services. SAMHSA must explore and fund voluntary strategies to engage people with major mental health conditions who currently receive or reject services and support. There will come a time when folks will look back and wonder how it was that we prioritized coercion over skilled engagement.
6. Overhaul Prison and Jail Discharge Policies
Reforming such policies would substantively reduce extremely high rates of recidivism, reincarceration, homelessness and suicide for those leaving prisons and jails who re-enter their communities without access to health care. The Centers for Medicare and Medicaid Services (CMS) should actively encourage and incentivize states to restore Medicaid 30 days before release.
7. Fight Homelessness and Expand Housing Access and Retention
There is no recovery without stable housing. To support more people with disabilities to get and keep decent housing, the Department of Housing and Urban Development should increase the number and funding level for Section 8 Housing Choice Vouchers.
8. Address Poverty and Work Disincentives
While the nation’s employment rate is at record lows, upwards of 85% of Americans with psychiatric disabilities are not working and live on the margins of society out of fears they will lose essential health care and money to support their basic needs.
CMS and state Medicaid authorities must ensure full access to Medicaid Buy-In “Work and Wellness” programs. The Social Security Administration should allow Supplemental Security Income recipients to keep these entitlements fully in place for a full year after employment, to encourage people with disabilities to get back into and stay in the workforce.
9. Address Overrepresentation of People Of Color in Criminal Justice Systems
The U.S. Department of Health and Human Services and Department of Justice should combine forces to educate and incentivize communities and local providers for effective culturally and linguistically competent engagement, diversion and support programs for people of color, both in the community and in prisons and jails, with special attention to eliminating the use of the torture of solitary confinement to our entire community.
10. Maintain Current Privacy Protections
Encourage more people to seek, trust and disclose in treatment. SAMHSA must support state-of-the-art engagement efforts that touch the lives of all Americans with major mental health and addiction-related challenges in place of federal proposals to weaken Health Insurance Portability and Accountability Act protections (HIPAA).
11. Expand Community Not Hospital Care
We now know how to help even the most distressed individuals in the community, but those policies and that funding are not remotely close to being available to all those in need. Instead of encouraging states to use Medicaid to expand inpatient beds, CMS should strongly encourage and incentivize states to create or expand home- and community based services options — most notably, peer-delivered outreach and engagement, crisis respite and a broad range of preventive and diversionary community services.
Harvey Rosenthal is CEO of the New York Association of Psychiatric Rehabilitation Services Inc.