More Leadership Needed In Response to MH Crises

In the first briefing held by the new Senate Caucus on Mental Health Reform, former Surgeon General David Satcher, M.D., Ph.D., called for federal leadership in the reconstruction of the mental health systems in areas affected by Hurricane Katrina, as well as other efforts.

Satcher told attendees at the September briefing on Capitol Hill that“ it was a breath of fresh air that the senators have come together around mental health.” Caucus members include influential law-makers such as Sens. Tom Harkin (D-Iowa), Edward Kennedy (D-Mass.), Pete Domenici (R-N.M.), and Gordon Smith (R-Ore.).

The first briefing by the caucus, titled “Mental Health: A Public Health Crisis,” aimed to raise awareness of mental heath issues among congressional staff.

The federal government has a responsibility, Satcher said, to rebuild the devastated mental health systems in areas affected by Hurricane Katrina. The federal government's mental health response to that and other 2005 Gulf Coast storms was limited to the provision of short-term crisis counseling and Medicaid waivers, a mental illness awareness campaign, and limited efforts to study the extent of mental illness among survivors of the nation's worst natural disaster (Psychiatric News, October 6).

Satcher pointed out that physicians have reported a “dramatic increase in mental illness among survivors” of the storms. He emphasized that he was especially concerned about the mental health of children who endured the storms and their aftermath. Preliminary data have indicated that many children have developed posttraumatic stress disorder, among other conditions, he noted.

“People are going to develop disorders when they go through something like that,” Satcher said. “We are dealing with people who will need long-term care, especially the children.”

Officials with the lead federal mental health services agency, the Substance Abuse and Mental Health Services Administration (SAMHSA), told Psychiatric News near the one-year anniversary of Hurricane Rita that the agency's assistance was “not targeted to long-term treatment.” Carol Rest-Mineberg, acting emergency administrator for SAMHSA, said that any long-term mental health assistance beyond crisis counseling requires additional funding from Congress.

Satcher said that private-sector treatment efforts for hurricane victims have provided federal officials with lessons they should heed on effective models of care, including efforts to integrate mental health care into primary care using volunteer physicians and nurses. Clinicians and nurses working at trailer parks where Katrina survivors are being housed have, for example, been able to screen large numbers of patients for mental illness using standardized tests, as part of their routine care of these individuals.

“We have done a lot of work to integrate mental health care into primary care,” Satcher said.

Senate staff members questioned Satcher and the other speaker, Howard Goldman, M.D., a professor of psychiatry at the University of Maryland School of Medicine and editor of the APA journal Psychiatric Services, about the kinds of support that various levels of government—local, state, and federal—are best suited to provide regarding mental health care.

Local governments can develop and implement systems to address mental illness stigma in public schools and among local police to improve the chances that those who need care will receive it, Satcher said.

“You can identify the key leaders in the community and have them all sit down together and agree on a message for how mental health will be approached.”

State governments can provide the most effective assistance by enacting laws that maximize the mental health coverage that private insurers are required to include in any health plan.

“All of the states have a responsibility for the care of those with mental illness,” Goldman said.

Thirty-eight states, he noted, require some level of mental health parity for workers whose health insurance is provided through their employer.

As for the federal government, it needs to implement the 2003 recommendations of the President's New Freedom Commission on Mental Health, Satcher said. The lack of action from either Congress or the White House on these recommendations means that mental health care advocates need to apply more pressure on federal legislators and policymakers if they want the recommendations enacted and the system changed.

Goldman said that Congress could help improve the mental health care system by acting to eliminate the exemption for self-insured health plans from state mental health mandates allowed under the Employee Retirement Income Security Act.

“If the federal government doesn't act” to reverse this exemption, millions of individuals will not have the protections that many state insurance laws now provide, Goldman said.

Information on the caucus hearing is posted at<http://harkin.senate.gov/news.cfm?id=263450>.▪