Health reform proponents are urging those pushing to improve the mental
health care system in particular to implore Congress to include several key
provisions in evolving national reform plans.
Among the issues that general health reform advocates have urged mental
health care supporters to highlight are the need for parity insurance
provisions, integrating psychiatric care into primary care, and including
psychiatric illnesses under the final plan's definitions of chronic
Many of the health reformers' comments were addressed to attendees of the
Mental Health America Centennial Conference in Washington, D.C., in June.
Among the critical provisions in congressional reform plans are protections
for people with chronic illnesses. The major health reform bills under
consideration in Congress would bar private insurers—either individually
or as members of new government-created insurance marketplaces—from
denying coverage to applicants based on preexisting, chronic health
conditions. But not all of the legislative proposals include mental illness
among these chronic conditions (see
Questions Arise About Parity in Health Reform Plans).
That is a disparity that could fundamentally drive whether access to
coverage is expanded for people with mental illness, said reform
Chris Jennings, a Washington, D.C.-based health consultant and former
senior health policy advisor to President Clinton, said mental health
supporters should ensure that every legislative reference to chronic illness
in health reform explicitly includes mental illness. Inextricably linking
psychiatric illness and chronic disease will ensure that robust mental health
care is included in any health care overhaul.
Designating mental illness a chronic illness also would ensure that its
assessments and screenings would be included in the reform measures' plans for
greatly expanded "prevention and wellness" programs.
Mental health advocates could bolster their case to Congress by
highlighting recent research documenting the pervasiveness and costs of mental
illness, said Michael Hogan, Ph.D., commissioner of the New York State Office
of Mental Health. For example, a study released by the Institute of Medicine
in February found that up to 20 percent of children will have a mental illness
in any year and that such untreated illnesses cost the nation $247 billion
David Shern, Ph.D., president and CEO of Mental Health America, agreed on
the primacy of including mental illness among the new federal definitions of
chronic disorders because it frequently co-occurs with nonpsychiatric chronic
"Improving the health care system means more effective management of
chronic illnesses," Shern told Psychiatric News.
Mental health advocates also need to emphasize that insurance parity needs
to be part of the foundation of national health reform, reform advocates
"We will have [health care] reform, and hopefully parity will be
included," said Hogan.
The inclusion of broad mental health care coverage in all insurance plans
can produce large savings in other areas, noted Hogan, who cited statistics
that about 40 percent of the people who seek Social Security Disability Income
(SSDI) have a mental illness. "Many wouldn't need to be on SSDI if their
mental illness was treated," he said.
Parity coverage also will require federal health officials to develop plans
expanding the availability of mental health care; otherwise, a huge infusion
of previously uninsured people seeking such care into the system will result
in long delays for everyone.
"Having insurance doesn't necessarily mean you have a place to go get
care," Hogan said.
Another improvement that should be included in health reform is increased
integration of mental health care into primary care, according to reform
advocates. Hogan noted that insurance parity mandates cannot be depended upon
to get people needed care for psychiatric conditions because most people never
see a mental health professional and never know that they have such an
illness. Increased integration would help address that situation.
JoAnn Volk, a legislative representative of the AFL-CIO, said that a
reformed health care system should include psychiatrists and mental health
workers within so-called medical home programs and patient-centered-care
models, which use a single clinician to coordinate all of a patient's care.
Medicare has traditionally excluded psychiatrists from demonstration projects
of these types of care approaches.
Information on the Institute of Medicine report is posted at<www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12480>.▪