Monthly Archives June 2013

Senator David Carlucci
Chair, Committee on Mental Health and Developmental Disabilities
New York State Senate

On this blog a few days ago, Andrew Sperling of the National Alliance on Mental Illness raised questions about access to mental health treatments under the Affordable Care Act (ACA); and he voiced concerns about people being able to receive the specific mental health drugs they require once the health reform law is implemented.

As Mr. Sperling pointed out, restricting access to a full class of drugs and limiting prescribers’ option to one drug per class—which health plans can opt to do under ACA—can be short-sighted from an economics standpoint and disastrous from a health perspective. Without access to clinically appropriate medication, individuals with mental illness have higher rates of emergency room visits, hospitalization and other health services.

As Chair of the New York State (NYS) Senate Committee on Mental Health and Developmental Disabilities, I understand that in order to manage the health of people living with serious mental illness, patients need guaranteed access to the full range of drugs and services that are most likely to improve their health. Even more important, I recognize that no one understands a patient’s needs better than his or her healthcare provider; and it’s presumptuous—if not irresponsible—to remove decision-making authority from that provider.

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Andrew Sperling, Director of Legislative Advocacy
National Alliance on Mental Illness (NAMI)

The Patient Protection and Affordable Care Act (ACA) offers new choices for quality, reliable, low cost private health insurance and opens Medicaid to more people living with mental illness.

Under the law, all health plans are required to provide certain categories of benefits and services—so-called Essential Health Benefits (EHB). One of these is prescription drugs.

A question mark as to prescription drug coverage
While plans will be required to cover a minimum number of prescription drugs used to treat mental health conditions in a therapeutic class, each plan may choose to cover different medications; and the number of covered drugs will vary by state and by plan.  Most significant, the law does not require plans to cover all drugs in a particular therapeutic class.  As a result, medical and behavioral health plans can avoid covering specific drugs that, in your physician’s judgment, best address your needs.

This poses serious challenges for individuals who are in need of multiple drugs per class, particularly people with serious and persistent mental illness, chronic conditions and disabilities. Antipsychotic medications, for example, are not clinically interchangeable, and providers must be able to select the most appropriate, clinically indicated medication for their patients.  What’s more, physicians may need to change medications over the course of an illness as patients suffer side-effects or their illness is less responsive to a particular drug, and patients requiring multiple medications may need access to alternatives to avoid harmful interactions.

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In this week’s posts, Clare Miller of Partnership for Workplace Mental Health outlined why employers should pay attention to mental health in the workplace and offered some examples for how businesses can address mental health with their employees.

Today we offer some other ideas, programs, and information sources for employers who want to address mental health in their workplace.

1.  Cost of Mental Health Training is a free webinar for human resources and employee assistance program professionals from Families for Depression Awareness
2. Families for Depression Awareness also participates in the Massachusetts Workplace Mental Health Initiative, which offers company-specific workplace mental health programs to Massachusetts businesses at no charge. These include the Coping with Stress and Depression workshop for employees, online mental health screening from Screening for Mental Health, and training for managers from CMG Associates

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Clare Miller
Director, Partnership for Workplace Mental Health

Employers who seek to address mental health issues in the workplace have a daunting task. After all, a comprehensive mental health workplace program could include the following:

• developing a mental health policy that complies with federal and state law
• implementing an employee assistance program
• training managers to recognize mental illness and make referrals
• offering mental health wellness programs, such as stress reduction and mental health awareness trainings and mental health screening tools
• supporting employees’ health care needs, including providing adequate health insurance and allowing treatment-related time off
• addressing employees’ concerns about their co-workers, including providing support services in the event of a mental health-related emergency or death (e.g., attempted or completed suicide)
• communicating with employees about mental health to allay their concerns about job loss, stigma, etc., and encourage them to get help

The good news is that there are a number of programs and resources to help employers address their workplace mental health needs. Today, we look at two companies that have successfully introduced mental health programs, and Clare Miller shares information about Right Direction, a new program from The Partnership for Workplace Mental Health and Employers Health.

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Clare Miller
Director, Partnership for Workplace Mental Health

Organizations like the Partnership for Workplace Mental Health and Families for Depression Awareness have long advocated for employers to address mental health in the workplace, citing both visible (e.g., disability payments) and hidden (e.g., lost productivity) costs of depression among employees. As we have previously discussed on this blog, the Affordable Care Act (ACA) requires that mental health care be included in health care coverage. As the ACA carries an affirmative obligation for certain employers  (50 or more employees) to provide health insurance, employers now have the opportunity to impact employees’ mental health broadly through proactive wellness programs and individually through their employee assistance plans and ultimately their health insurance programs.

In this post, Clare Miller explains the essential role of employers in advancing mental health and—even apart from the ACA—the critical reasons for employers to address the mental health needs of their employees.

Employers are an important constituency to engage in advancing mental health in the United States given their power in affecting how much and what kind of care employees and dependents actually receive. Indeed, about 157 million Americans receive coverage through employer-sponsored health insurance.

Employers are getting more involved in healthcare because many realize that employees are their most important asset—their human capital. They’re also focused on healthcare because it is such an enormous expense, as evidenced by the oft-quoted fact that General Motors spends more on healthcare than on steel.

Many employers realize that they can use their purchasing dollars to leverage the healthcare system to demand better quality. And demanding it they are; employers are pushing strategies such as value-based purchasing and outcomes-based contracting. They are aligning incentives to produce better outcomes, as in the case of value-based benefit designs, where copayments might be lowered or eliminated to encourage people to access care and services to manage chronic illnesses.

One of the first examples of this approach was focused on diabetes management. A large employer eliminated the copayments associated with diabetes medication after realizing that high cost-sharing was leading workers to forgo medication, which led to increased hospitalization costs. In response, the employer aligned incentives to be sure that workers could afford the treatment to appropriately manage their condition. Importantly, they married this strategy with others, such as patient education about diabetes management.

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Jessica Eagle, M.A.Ed., N.C.C.
Legislative Representative, American Counseling Association

Since the Newtown tragedy, a spotlight has been placed on the mental health of our country’s youth, creating an expectation among many Americans that we would come together as a nation and respond to the need for improved school safety and mental health access. Indeed, dozens of bills were introduced in the Congress, and numerous Congressional hearings on mental health were held. In the Senate, 95 Senators voted in favor of the Mental Health Awareness and Improvement Act, which would have reduced youth suicide and mental health barriers to academic and social success.

Unfortunately, the effort to pass comprehensive mental health reform legislation has lost its momentum, leaving our schools and communities in a dire situation due to a one-two punch of funding cuts by state and local governments, and a polarized Congress’ inability to agree on a budget to fund essential community-based programs that support our country’s most vulnerable populations.

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It’s estimated that one in five U.S. youth experience mental illness. Yet less than half of kids with a diagnosable mental health disorder receive mental health treatment. (Some studies put this number as high as 80%.)

The consequences of undiagnosed and untreated mental illness in children are tragic. Over the past two decades, suicide rates have doubled among kids ages 10 to 14, and suicide is now the second-leading cause of death for young people ages 15 to 24.

What’s more, half of the high school students with mental health issues end up dropping out. Children with mental illness are also at higher risk for developing substance abuse problems in adolescence.

We know that children do better in school when they are well fed and well rested. Good mental health is just as important to kids’ school success, and children who have access to mental health treatment do better academically and socially.

Yet we don’t do a very good job of meeting the mental health needs of school-age children. The Mental Health in Schools Act, introduced by Sen. Al Franken (D-MN) in the Senate and Rep. Grace Napolitano (D-CA) in the House, hopes to correct that. It would expand access to mental health services in schools and give kids experiencing mental illness a fair shot at success.

“Addressing the mental and emotional needs of our kids is just as important as keeping them safe from physical injury and illness,” Sen. Franken said, in prepared remarks. “Healthy kids grow into healthy adults, and if we’re able to catch and address mental health issues early, we can help kids become productive members of society.”

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We don’t want to close out the week without acknowledging the National Conference on Mental Health held at the White House this past Monday. Attended by high-ranking government officials, Members of Congress, mental health advocates, educators, medical professionals, veterans, faith leaders, local officials, and people living with mental health conditions and their family members, the Conference focused on two questions:

• How can we reduce the social misperceptions associated with mental health conditions?
• How can we support people with mental health conditions to get help?

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