Category Mental Health Reform

What Role Do Patients Play in Improving Quality of Care? A Big One.

Editor’s note: Please enjoy this article from the CFYM archive, first published March 24, 2014. Look for the upcoming series which will focus on the collaboration between the patient and the clinical team around shared-decision making.

David Katzelnick, M.D.
Chair, Division of Integrated Behavioral Health, Mayo Clinic
We acknowledge the collaboration of 
National Network of Depression Centers in developing this series.

With a world of health information literally at our fingertips, patients are more informed and engaged than ever. Research indicates that patients who are actively involved in their own healthcare receive higher quality care and achieve better health outcomes.

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Is the “Helping Families in Mental Health Crisis Act” Ready for Prime Time?

Things can move very quickly in DC when the right people are motivated. Case in point: Speaker of the House Paul Ryan (R-WI) signaled that he wanted mental health legislation to reach a floor vote this year. So while H.R. 2646, sometimes known as the Murphy bill, seemed to be languishing, the leadership of the Energy and Commerce Committee worked to bring the bill to mark-up last Wednesday, June 15.

Some people opine that our democracy intends for citizens to advocate hard for their principles while accepting that competing points of views must also be acknowledged when moving legislation. Others believe that people should hold tight to their principles, never relenting.

Depending on your own philosophy, last week’s committee mark-up outcome is cause for celebration, acceptance of the inevitable, or reason to keep up the fight. Following is an overview of the bill that was voted out of committee. Insiders are saying that Speaker Ryan wants a full chamber vote later this summer.

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BCBS North Carolina Isn’t Paying Claims. People Are Suffering. What to Do?

Rhonda Karg, Ph.D.
New Leaf Psychotherapy, Asheville, NC

Imagine being a small business owner. You’re passionate about what you do, you serve your community, and your main purpose is to help people in need. But suddenly your biggest client withholds payment for six months or more. Would you find this unacceptable, illegal, infuriating? How would you keep your doors open or pay your car insurance, phone bill, or mortgage?

For many behavioral health providers who’ve contracted with Blue Cross Blue Shield of North Carolina (BCBSNC), that’s the situation they’ve faced since January.

Citing a software problem, the insurance giant is now months behind on paying 9-15% of its claims from providers. In addition to the outrageous financial toll this is taking on clinicians—some of whom rely on BCBSNC for 90% of their income— thousands of patients statewide have lost their access to care.

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How Communities Can Fund Mental Health Services

Funding local mental health and substance use disorder programs and services is an ongoing challenge. Although the federal government allocates money to support mental health care in the states, federal spending on public health has been eroded through funding cuts and budget caps. State governments haven’t done any better. However, over the past couple of decades, state legislatures have been empowering counties and municipalities to create their own revenue, whether through a local sales tax or property tax.

Sales tax in Washington State
Like many other counties in Washington State, Snohomish County adopted a 1/10th of 1% sales tax to support mental health and substance use disorders services. Since 2010, these funds have been used to support a range of direct and wrap-around services for six target populations: youth, families with children, veterans and their families, the aging population, the most vulnerable, and the most costly (i.e., high utilizers).

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A Success Story from Snohomish County

Families for Depression Awareness

In the post above, we used the example of Snohomish County, Washington, of using a designated sales tax to fund mental health services. Here is an example of how funds are used and how they made the difference in one case.

Among many programs, the Snohomish County sales tax funds the Student Support Advocate Program, which provides “intensive case management services to at-risk middle and high school students to connect and engage students and their families with needed resources (mental health and substance use disorder treatment, housing resources and homeless prevention services, food and other basic needs, etc.).” In 2015, the results included the following:

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Is Your State Participating in Medicaid Expansion?

Let’s look at Sarah, who lives in Tennessee, and Elizabeth, who lives in Kentucky. Both have major depressive disorder, but both are working the maximum number of hours allowed at a mega-store. Even so, they barely stay afloat financially. Their employer does not provide health insurance to them, although if the company made it available, Sarah and Elizabeth would not be able to cover the premiums and deductibles. But Elizabeth can get subsidized health insurance–and mental health care–while Sarah cannot. Why? Read about it in this third post in our series on funding mental health care.

Depression and bipolar disorder—the two most prevalent mental health conditions—affect more than 21 million Americans. Untreated, these and other mental health conditions can exact a huge toll on the American economy:

  • Loss of productivity from mental health disorders costs $63 billion each year
  • Unemployment rate for adults living with mental health conditions is 3-5 times higher than for those without a mental health condition
  • Major Depressive Disorder is the leading cause of disability in the U.S.

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It’s Time to Stop Cutting Public Health Funding

Tiffany Kaszuba

Tiffany Kaszuba, Vice President Cavarocchi Ruscio Dennis Associates
Manager to the Coalition for Health Funding

CFYM continues the series on mental health funding with a look at how the sequestration is affecting access to care in local communities and shares ways your voice can make a difference.

In our last post, we took note of the federal agencies that make up the public health continuum and their contributions to mental health specifically. Together, these agencies work to prevent illness and promote wellness, provide care for the afflicted, make sure that health professionals are there when we need them, monitor the threats facing Americans, and put in place policies and procedures to protect their health. However, despite the critical work of keeping Americans both physically and mentally healthy, these agencies have scarce resources that continue to disappear as austerity maintains its hold on the federal budget.

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Who Is Making the Rules for Our Mental Health Care?

Tiffany Kaszuba

Tiffany Kaszuba, Vice President Cavarocchi Ruscio Dennis Associates
Manager to the Coalition for Health Funding

We advocate for our own medical care, we advocate to our senators and representatives for laws to improve mental health care, but are we reaching everyone who has a say in mental health care policy and delivery? In fact, most policy is developed, implemented, and enforced by regulatory agencies; there are at least a half-dozen federal agencies charged with aspects of addressing mental health.

Over the next few weeks, we’ll explain the structure and roles of some of these agencies and their programs, including how they are funded. After all, if we are advocating for improvement in the mental health care system, we need to understand what works (and what doesn’t) and what it costs.

Public health is the science and art of protecting and promoting health in communities where we live, work, and learn. Federal investment in public health dates back to 1798 when Congress first authorized the Marine Hospital Service to deliver care to the merchant seamen who were disproportionately affected by disease. Today, the Public Health Service is led by the Office of the Secretary and comprised of 11 operating divisions—including the eight agencies authorized by the Public Health Service Act and three human services agencies.

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