mental health tagged posts

Sequestration Update: Feeling the Pain

Care for Your Mind Update


capitol3Two months ago, we shifted from discussing the importance of access and barriers to access to examining how a specific governmental policy, sequestration, was impacting the delivery of mental health services across the country. Even then, we could already point to examples of sequestration’s impact: the closing of a residential treatment center in Alaska, the reduced availability of civilian mental health professionals to military personnel, and the increased wait to receive residential treatment in Utah—not to mention the potentially devastating long-term impact of spending cuts on research, both in terms of treating people during clinical studies and finding effective treatments to mental health conditions.

It is unsettling, though perhaps not surprising, that the most-reported impacts of sequestration have been airport travel delays and the cancellation of air shows at Military bases for the July 4 celebrations. Because these cause discomfort for the general population, they are easy topics for media coverage. However, this does not appropriately reflect the level of real suffering happening as a result of sequestration across the country. This under representation of suffering is probably due to the fact that the populations arguably suffering the most severe consequences from sequestration are in fact underrepresented in general—the poor, people in the military, and minorities (an ironic realization as we reach the end of National Minority Mental Health Awareness Month, which draws attention to the need for mental health awareness, better utilization of services, and the development of culturally competent care for the nation’s racial and ethnic minorities).

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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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Congress Should Provide for Students’ Mental Health

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

Friendly Teens

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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How the Federal Government Sequestration Impacts Mental Health Services

Care for Your Mind

Due to Congress’ stalemate in reducing the federal deficit, automatic, across-the-board spending cuts, known as sequestration, are taking effect on federal government programs. Medicaid and Social Security are practically the only programs unaffected, and the Congress has begun scrambling to address the high-profile, high-impact cuts as they arise, such as providing relief for air traffic control. With spending being cut on a broad scale, what will sequestration mean in practical terms for people dealing with mental health conditions? Will the cuts affect you?

(For background information, read What is Sequestration? at USA.gov.)

The overriding concern about sequestration is that it has absolutely no precision: sequestration was designed to cut wide swaths through government, sparing no agency or program. This means that spending in every federal agency—from the National Institutes of Health and Centers for Disease Control and Prevention to the FBI—and on every federal program—like the national parks, disaster relief, food safety inspection, and airport security—will be cut by 5 percent this year, and even more each year for the next nine years. And because of the delay in implementing sequestration, the cuts are more severe as reductions that would have been spread over 12 months are now crammed into 7 months instead.

(This interactive chart from the Washington Post provides estimates of the state-by-state impact of sequestration by category, based on White House estimates. Click on “Public Health” for the most relevant information.)

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