Category Access to Treatment

Case Study: Patient-Centric Mental Health Care Solutions

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

CarlucciOn 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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Health Reform and Access to Prescription Drugs

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

Andrew Sperling, J.D.
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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Highlights: National Conference on Mental Health

Official_portrait_of_Barack_ObamaWe 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?

 

“Too many Americans who struggle with mental health illnesses are still suffering in silence rather than seeking help, and we need to see it that men and women who would never hesitate to go see a doctor if they had a broken arm or came down with the flu, that they have that same attitude when it comes to their mental health.”
–President Barack Obama

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Locked Behind Door #3

BrandyDistance-Related Challenges
In Tuesday’s Expert Perspective, Ron Manderscheid outlined three common kinds of challenges to accessing mental health care: insurance-related, provider-related, and distance-related challenges. We’ve heard first-hand from Jennifer and Doug how these barriers have impeded their access to mental health care.

Today we hear from Brandy, whose distance-related and other challenges are not uncommon for people who live in rural areas and elsewhere.

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Locked Behind Door #2

stockvault-locked99163Provider-Related Challenges
In Tuesday’s Expert Perspective, Ron Manderscheid outlined three common kinds of challenges to accessing mental health care: insurance-related, provider-related, and distance-related challenges. Yesterday we heard from Jennifer, who experienced the first of these roadblocks, and tomorrow we’ll hear yet another story from someone who experienced these barriers first-hand.

Today’s story is from Doug. His provider-related challenges may sound familiar to you: he was denied access to quality care because a provider stopped seeing individuals on Medicare.

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Locked Behind Door #1

JenniferInsurance-Related Challenges
In yesterday’s Expert Perspective, Ron Manderscheid outlined three common kinds of challenges to accessing mental health care: insurance-related, provider-related, and distance-related challenges. Over the next three days, we’ll hear personal stories from individuals who’ve experienced these roadblocks first-hand.

Today, we hear from Jennifer, who, like many of you, experienced insurance-related challenges first-hand.

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Three Challenges to Accessing Care

Ron Mandersheid, Ph.D.
Executive Director, NACBHDD

Ron Manderscheid

On the May 1 “Access to Care” post, we asked, “If you or a family member needed care today for a mental health or substance use condition, would you be able to get it?”

Access to care can help prevent, delay, and treat mood disorders, other mental conditions, and co-occurring illnesses among the 45.6 million adults and 15.6 million children and youths who experience a mental health condition.

However, in reality:

  • Fewer than 40% of adults and youths with mental health conditions—including mood disorders—ever get any mental health services
  • Fewer than 7% of adults with co-occurring mental and substance use disorders get treatment for both.

Let’s explore access challenges to the prevention, diagnosis, and treatment of behavioral health conditions.

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What does Harry Potter have to do with accessing mental health care?

Do you remember the scene in Harry Potter and the Order of the Phoenix when Harry and his friends were trying to find their way to the Department of Mysteries in the Ministry of Magic?

Harry_Potter_and_the_Order_of_the_Phoenix_poster

The group arrived at a circular hall with several doors. The doors kept changing places, and the group’s progress was halted. Finding the right door was made almost impossible—aside from the fact that they weren’t entirely sure what they were looking for—by uncontrollable circumstances...

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