It’s time for mental health reform in the United States. And at the Senate Summit on Mental Health, a bipartisan meeting organized by Senators Bill Cassidy (R-LA) and Chris Murphy (D-CT), we learned exactly what is propelling the need for action.
This is important stuff in the U.S. — really important — on par with the parity efforts that made headlines years ago. (Parity was the legislation needed to ensure that insurance companies stopped discriminating against mental illness, which they had regularly done since the 1990s.)
“It’s not the end… [but] it’s a great next step,” said Sen. Cassidy, speaking at the Summit on the latest revision of the bill.
The Mental Health Reform Act of 2016
Unlike a separate House bill that was trying to gain traction (HR 2646), the Senate version has no controversial provisions or attempts at remaking (or significantly expanding) the federal bureaucracy. It simply expands the money provided to states for treatment of mental illness and mental health issues and fixes some long-standing problems in how mental health care is defined and can be treated.
“We focused on three specific issue: A lack of resources, lack of coordination, lack of focus on continuing stigma,” said Sen. Murphy. The highlights of the Senate bill are:
- Intends to improve coordination between federal agencies and departments that provide services for individuals with mental illness, and will improve accountability and evaluation of mental health programs.
- Will help ensure that federal dollars support states in providing quality mental health care for individuals suffering from mental illness by updating block grants given to states.
- Ensures people incorporate the most up-to-date approaches for treating mental illness, and requires that agency leadership include mental health professionals who have practical clinical experience.
- Increases access to care for individuals including veterans, homeless individuals, women, and children. It also helps improve the training for those who care for those with mental illnesses. It promotes better enforcement of existing mental health parity laws.
- Continues to help the effort to move people from jails and prisons into appropriate mental health treatment programs.
The latest markup of the bill also:
- Helps improve mental health programs targeting children and teens.
- Reauthorizes money for suicide resources.
- Fights opioid addiction and the growing epidemic of opioids.
- Provides grant money to help fight mental illness on university campuses.
“What we’ve got is a pretty good consensus in dealing with the mental health crisis,” said Sen. Lamar Alexander, who is helping to move the bill through the sometimes-tortured Senate legislative process.
Mental Health Treatment Today: A Patchwork of Care
Sen. Patty Murray (D-WA) told the story about a friend who compared the health care she received while pregnant versus the care she got while seeking mental health treatment.
“[She was just taken aback by] the difference between the coordinated care she got for her pregnancy and the disjointed patchwork of care in the mental health system.” said Sen. Murray. “The mental health crisis in this country is a challenge that we cannot afford to ignore.”
“We need better coordination, better discharge planning, and a closer link between families and providers,” she noted.
Research The Price of Inaction
One presentation made by the director of the Harvard Global Health Institute, Dr. Ashish Jha, noted that we end up spending way more in Medicare costs when we ignore the impact of mental illness on physical health and disease.
The upshot from that presentation was that:
- Spending in Medicare is highly concentrated.
- Mental health issues are especially common in the “high cost” patient groups.
- There are three complex, interlinked issues: how much of spending is directly related to mental health; does mental health issues affect spending for other diseases; how much do mental health issues remain under-diagnosed.
- Ignoring mental health issues is hugely costly to us.
“If we do not address mental health in a comprehensive way, we pay more,” notes Dr. Ben Miller, who was also on the panel.
What is the entry point for mental health treatment? It seems to be primary care. In one study, 49 percent of patients see only their primary care physician for a mental health condition, while 18 percent saw no one.
Dr. Peter Jacoby, head of emergency medicine in a Connecticut hospital, had one of the more eye-opening statistics of the day: “21 out of 32 beds in my ER right now in Waterbury, CT are being taken up by psychiatric patients. [… And] five of them are children or adolescents.”
At the end of the summit, NAMI, Sandy Hook Promise, the American Foundation for Suicide Prevention, and the Eating Disorders Coalition presented 200,000 signatures in support of this legislation.
Here’s hoping to its eventual passage. Psych Central supports the Mental Health Reform Act of 2016 (S. 2680) because it is a smart, thoughtful, incremental step forward.