Oquendo Urges Senate Passage of Mental Health Reform Bill
Abstract
The bill will benefit patients and their families for generations to come, say senators and psychiatrists.
APA President Maria A. Oquendo, M.D., and other mental health experts went to Capitol Hill in late May to generate support for passage of the bipartisan Mental Health Reform Act of 2016 (S 2680).
“As a nation, we have failed to meet the needs of Americans with mental illness,” Oquendo told senators and advocates gathered for the event in the Hart Senate Office Building. “We have a fragmented delivery and reimbursement system, we deal with workforce shortages and obsolete regulations, and we face the enduring stigma surrounding mental illness. We must do better, and we can do better.”
The Mental Health Reform Act would improve access to care by increasing the number of providers, disseminating the best scientific research, integrating physical and mental health care, and bolstering coordination among federal mental health agencies, said bill coauthor Sen. Bill Cassidy, M.D. (R-La.).
His colleague and coauthor from across the aisle, Sen. Chris Murphy (D-Conn.), described the step-by-step process of gathering support among fellow senators, including eight Democratic and eight Republican cosponsors, to move the bill closer to passage.
“The act is the first attempt in the House and the Senate to take a holistic look at a broken system,” said Murphy. “We assessed the problem as being threefold: a lack of resources, a lack of coordination, and a lack of focus on continuing stigma.”
Spending in Medicare, Medicaid, and private insurance is highly concentrated, and all citizens pay for it, directly or indirectly, said Ashish Jha, M.D., M.P.H., director of the Harvard Global Health Institute and a professor of medicine at Harvard Medical School and the Harvard T. H. Chan School of Public Health.
“About 21 percent of the Medicare population had a mental health diagnosis, but 49 percent of the high-cost patients had such a diagnosis, primarily depression, anxiety, or schizophrenia,” said Jha. “However, we can’t point to any one mental health diagnosis as the problem.”
Five critical components were needed for meaningful mental health reform, said Oquendo.
First, all federal mental health initiatives must be overseen by physicians with expertise in psychiatric conditions, she said. “Because psychiatric and substance use disorders are fundamentally brain disorders, leadership with the appropriate biological training is key.”
She also called for more research support at the National Institute of Mental Health, National Institute on Drug Abuse, and National Institute on Alcohol Abuse and Alcoholism, as well as more resources for training psychiatrists and other mental health clinicians. Greater emphasis on preventing mental illness is also essential, she said, along with stronger federal enforcement of the Mental Health Parity and Addiction Equity Act.
In thanking the senators for their efforts, Oquendo said, “APA is very encouraged that the components of meaningful mental health reform are addressed in the bill.”
Child and adolescent psychiatrists face additional problems as they seek to help solve the problems addressed by the bill, said Gregory Fritz, M.D., a professor of psychiatry at Brown University School of Medicine and president of the American Academy of Child and Adolescent Psychiatry.
Medical school loan repayment plans don’t include child and adolescent psychiatrists, an oversight rendering them ineligible for such programs, said Fritz. Also, National Health Service Corps loan relief is available only within two years of completion of a “primary residency,” again leaving out child psychiatrists, who must complete a two-year fellowship. Amendments covering changes to eliminate these restrictions have been proposed, he noted.
“Let’s not leave the children out,” said Fritz. “We need to get the details right.”
“Ignoring mental health is hugely costly to our health system, our treasury, and our own pockets,” said Jha. “If we get it right, we will be fiscally more prudent and provide better care for our patients.”
Cassidy and Murphy emphasized the importance of grassroots support of mental health reform in the months ahead.
“Even in this election year, we can still pass the Mental Health Reform Act and get it signed by the president,” said Cassidy. ■
In a blog post on APA’s website, Oquendo urged her fellow psychiatrists to contact their representatives in Congress and ask them to support comprehensive mental health reform.
