Beyond the ACA, Part Two: Change the Culture of Care

Ron Manderscheid, Ph.D.
Executive Director, National Association of County Behavioral Health and Developmental Disabilities Directors

Ron ManderscheidPreviously on Care for Your Mind, I 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?” We’ve explored obstacles that stand in the way of accessing mental health care, and we explored how the Affordable Care Act improves access and quality for people with conditions like depression and other mood disorders.

In yesterday’s post, we explored three ways to change the structure of community-based mental health care. Today, we look at how we can change the processes and attitudes through which community-based mental health care is delivered.

Changing the Culture of Care

Improving access to behavioral health care isn’t only about making changes in how care is structured. It’s also a matter of the content and quality of the care.

Professionals should be able to identify people who need care early. Consumers should be engaged in their care. And consumers need to know that the care they seek is going to be effective. That’s why we need change—and advocacy—regarding processes of care.

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Beyond the ACA, Part One: Make Mental Health Part of Overall Health

Ron Manderscheid, Ph.D.
Executive Director, National Association of County Behavioral Health and Developmental Disabilities Directors

Without access to care, sustained recovery is not possible.Ron Manderscheid

That’s why each opportunity to break through barriers to access is critically important. When access to care becomes universal, millions of people with mental conditions who don’t get care today will get care. That care will be grounded in evidence-based practices and focused on the whole person, not a diagnosis.

Problems will be caught early; symptoms will be mitigated early in their course. And, ultimately, we can help make recovery not a potential outcome, but rather the expectation.

But change doesn’t happen overnight. Overcoming barriers to behavioral health care access requires persistent action and effort to target and sustain new ways of framing, delivering, and sustaining services and supports.

Behavioral health is part of overall health.

Slowly but surely, policy makers and researchers are reuniting brain and body in their thinking. That reunion has begun to help break down barriers to access, reduce the stigma that still surrounds mental health problems, and promote prevention and early opportunities for intervention. And it’s about time!

But to create an environment in which access is open to all, that policy and research reunion needs to be matched by a comparable reunion in program and practice. A number of structural changes—each an opportunity for our action and advocacy—can become the building blocks for full access to behavioral health care as part of overall health care.

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Happy Fourth of July

As we celebrate the history, government, and traditions of the United States of America this Independence Day, we are grateful for the freedoms and power afforded individuals in the U.S.A.

Among those freedoms and power, we count the ability to voice our thoughts, ideas, and
opinions about policy decisions. We have the power to make policy personal, to share our experiences, and to promote change.

Thank you for joining us at Care for Your Mind to exercise these powers. We encourage you to comment on the blog and continue sharing your thoughts and ideas...

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Older Adults Need Specialized Mental Health Care

David Steffens, M.D., M.H.S.
President, American Association for Geriatric Psychiatry

steffens.August2008

Just as a family with a child suffering from depression, anxiety, or any other illness would want a clinician who specializes in helping children, older adults deserve care from clinicians trained and experienced in diagnosing and treating older patients.

The mental health needs of the elderly differ from the rest of the population.

Why?

In general, older adults have more medical illnesses than younger people and may have cognitive problems that can worsen with depression and other health issues. Older individuals often suffer more losses—such as the loss of a spouse, friends, or independence—and these losses can lead to depression. Older adults may also be reluctant to discuss mental health issues, particularly concerns about memory and Alzheimer’s disease.

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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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Six Resources for Workplace Mental Health

young businessman under stress, fatigue and headacheIn 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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Policy in Practice: How Companies Can Address Mental Health

Clare Miller

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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