11 Points For Mental Health Care Reform

Due to greater understanding of how many Americans live with mental illnesses and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges mental-health organizations across the U.S. are determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental-health and substance use disorders are properly addressed and integrated into healthcare reform.

In anticipation of parity and mental healthcare reform legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform..

MENTAL HEALTH SERVICE DELIVERY

1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.

2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.

3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.

4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of course, part of this initiative includes helping mental illness patients find a mental health clinic nearby.

MENTAL HEALTH SYSTEM MANAGEMENT

5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges.

6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.

7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.

MENTAL HEALTHCARE INFRASTRUCTURE

8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental-health and substance use performance measures that will be used to improve delivery of mental-health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.

9. Health Information Technology: Federal and state HIT initiatives need to reflect the importance of mental-health and substance use services and include mental-health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.

10. Healthcare Payment Reform: Payers and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.

11. Workforce Development: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors. Provider organizations will need to participate in these efforts and be ready to ramp up their workforce to meet unfolding demand.

Mental Health Stigma

Despite the increase in publicity surrounding mental health and mental health issues, there is still a lack of understanding about mental health in general. For example, a research survey published by the government “Attitudes to Mental Illness 2007” reported that 63% of those surveyed described someone who is mentally ill as suffering from schizophrenia, and more than half believed that people with mental illness should be kept in a psychiatric ward or hospital. Overall the results showed that positive attitudes to people with mental health had actually decreased since 1994 which is worrying indeed.

Amazingly, many people still don’t understand that mental health problems affect most of us in one way or another, whether we are suffering from a mental illness ourselves or not. If we bear in mind that a quarter of the population are suffering from some kind of mental health problem at any one time, then the chances are, even if we personally don’t have a mental illness, we will know someone close to us who does, so it is our responsibility to understand what mental illness is and what can be done about it.

Many people with mental health problems will often feel isolated and rejected and too afraid to share their problems with others purely because of the way they might be perceived. This lack of understanding means they are less likely to get the kind of help and support they need and are in danger of slipping even further into depression and mental illness. People need to understand that mental illness need not be a barrier to a better quality of life and that help is available and that most people with a mental health problem can regain full control over their lives if they get the support they need.

A new guide to mental health

The Royal College of Psychiatrists has produced a new guide to mental health which was published in November 2007 and is aimed at informing the general public about what mental illness is and is a big step towards tackling the stigma that is still attached to mental illness.

The guide is written in an easy to understand format and over 60 mental health experts have contributed to it. The Mind: A User’s Guide contains chapters that cover a whole range of mental illnesses and includes a section on how the brain works, how mental illness is diagnosed, and how to cope with it.

A Scottish survey

In Scotland, a national survey of public attitudes to mental health Well? What Do You Think? (2006) was published in September 2007 and highlighted that although people living in socially deprived areas have a higher incidence of mental health, the level of stigmatisation is still no lower than in other areas. This suggests that being confronted with mental illness is not enough to change the attitudes towards it.

There are also gender differences too. According to the Scottish survey, men with a mental health problem were more likely to be treated with suspicion than women and were also more inclined to avoid social contact with someone else with a mental health problem. Even out of those who displayed a positive attitude towards people with mental health problems, many said they would be reluctant to tell anyone if they had a mental health problem themselves which just goes to show that there is still fear surrounding other peoples’ perceptions of mental health.

A CIPD Survey

A recent study conducted by the Chartered Institute of Personnel and Development and KPMG consultants surveyed over 600 employers and reported that doctors are not doing enough to help people with mental health problems return to work and that this is costing the business world billions of pounds. For example, only 3% of the participants rated doctor support as “very good”.

It may be that doctors really don’t know what else to offer someone suffering from depression and anxiety other than drugs and time off work. Even more worrying was the fact that 52% of employers maintained that they never hired anyone with a history of mental illness which serves to perpetuate the stigma. On a more positive note, of those that did hire someone with a mental health problem, more than half said the experience had been “positive”.

Changing attitudes

A lot is being done by governments and organisations to try to change public attitudes towards mental health but is it enough? Until we all recognise that mental illness doesn’t discriminate, it can affect any one of us at any time regardless of our age, gender or social background, the stigma attached to mental illness is likely to persist.

Mental illness doesn’t discriminate, it can affect any one of us at any time regardless of our age, gender or social background, and yet the stigma attached to mental illness still persists. Although a number of government initiatives, awareness campaigns and organisations have been set up specifically to tackle mental health stigma and change our attitudes towards mental health in general, there is still a long way to go.

It is therefore up to each and every one of us as individuals to make sure we are well informed and understand the issues involved because only when the public are fully aware of the facts will mental health stigma become a thing of the past.