MH Care Called Integral to Health System Reform

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 conditions.

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 Original article: 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 advocates.

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 annually.

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 illness.

“Improving the health care system means more effective management of chronic illnesses,” Shern told Psychiatric News.

Parity Will Produce Savings

Mental health advocates also need to emphasize that insurance parity needs to be part of the foundation of national health reform, reform advocates suggested.

“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.

Integrated Care Needed

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>.▪