Renewed focus on mental health comes at the right time
■ A message to all physicians from AMA President Jeremy A. Lazarus, MD, on the progress being made to provide mental health care for all those who need it.
Here are some difficult statistics:
According to the National Institute of Mental Health, 26% of adults have a diagnosable mental disorder in any given year.
Six percent of adults experience a seriously debilitating mental illness.
About a fifth of teenagers experience a severe emotional disturbance between the ages of 13 and 18.
When I began my term as president of the American Medical Association, I made it one of my priorities to push for better integration of mental health care into other aspects of medical care — and to provide more resources to treat more people.
As I said in my inaugural address, “You can no more separate the heart from the mind of a person any more than you can separate the heart from the lungs and expect them to still function.”
So lately, I have been pleased with all the attention that mental health care has been receiving — in two instances as part of the Affordable Care Act, in a third as a result of renewed public interest following the horrific gun murders in Connecticut, and on the needs of our returning members of the military.
A recent ruling by the U.S. Dept. of Health and Human Services authorized that mental health coverage would be one of 10 “essential benefits” offered by most health insurance plans next year under the Affordable Care Act.
This means that, beginning next year, federal law will require parity in mental health coverage with other medical services. That is, mental health coverage will have no more restrictions or higher cost than other kinds of medical care. This will be true for all new plans sold on health exchanges as well as nongrandfathered small-group and individual plans sold elsewhere.
So the new ACA rule means that those who already have some mental health coverage will see improvements in their benefits. And 32 million more people will gain access.
These policy changes will help close gaps that have existed in mental health coverage in the insurance market for a long time.
Up to now, even many people with health insurance have not had mental health coverage. According to a 2012 survey by the Society for Human Resource Management, 15% of employers offering health insurance provided no mental health coverage; the other 85% did offer at least some, but that left a lot of gaps. About a fifth of individually purchased policies did not include mental health coverage at all.
The second positive change will, hopefully, be in Medicaid coverage for hospitalized mental patients. Although Medicaid is the single-largest payer for mental health services, right now it does not pay for nonelderly adults (i.e., people between the ages of 21 and 64) to be hospitalized at freestanding private or governmental psychiatric institutions.
Under the ACA, $75 million in matching funds were designated for a three-year “demonstration” to determine the value of Medicaid paying for inpatient psychiatric care of nonelderly adults. Twenty-eight private psychiatric hospitals in 11 states and the District of Columbia are taking part in this demonstration project. Ultimately, the various states will evaluate whether placing Medicaid patients in private hospitals will improve care for mental health patients and help lower Medicaid costs. If their conclusions are affirmative, then the HHS secretary will recommend that the demonstrations be expanded nationally.
The AMA is watching this study with interest. AMA policy has long supported psychiatrist-supervised mental health homes. We also have encouraged states to place more emphasis on community-based outpatient psychiatric services, which also are lacking.
As a practicing psychiatrist, I am gratified to see American laws begin to catch up with the need that is out there among our population. I also am also glad to see the new attention being paid generally to mental health needs, although it is unfortunate that it took a series of horrendous shootings to bring this about. Early in the year, a member of the American Psychiatric Assn. visited the White House with members of Vice President Joe Biden's Task Force on Gun Violence to discuss changes in the country's mental health system. It is a positive step that the president has called for expanded services to combat mental illness. We need better mental health care for many more people.
However, my colleague cautioned, as I do, that while making improvements in our mental health system will be important to our society as a whole, focusing on mental health alone will not stop gun violence. In the vast majority of cases, mental health patients are not a threat to society. In fact, research shows that less than 5% of all violent acts of any kind are carried out by people with mental illness.
On the other hand, research does show that patients with mental illness who are involved in regular treatment are far less likely to commit violent acts than those who need mental health care but are not receiving it. So expanding mental health care and coverage are important, and the president's attention can only help.
The AMA also has joined a coalition led by the American Psychiatric Assn. to examine the issues related to gun violence and mental illness.
One other important facet of mental health care has gained national attention over the past year, and that is posttraumatic stress disorder, traumatic brain injury and postcombat depression that afflict so many members of the military returning from war duty.
The AMA supports Joining Forces, a national initiative that seeks to mobilize all sectors of society to ensure that service members and their families get the opportunities and support they have earned. As part of this important program, the AMA is committed to connecting physicians with information, tools and training materials to help assess and treat our nation's veterans and their families, those with PTSD, TBI, postcombat depression and other mental illnesses, as well as those with physical issues.
I am still not satisfied that all Americans who need mental health care will be able to receive it, but the country seems to have awakened to the great need that exists, and we are beginning to take important steps forward.