Will you treat me?

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Jayme Nelson

Key note address given

Health & Medicine News & Politics

Will you Treat ME?
Funding Mental Health Care Treatment
Now and Under the Affordable Health Care Act
Jayme Xaris / Jayme Nelson
Associate Professor of Nursing
Luther COllege

Sketch of a shackled inmate at London's Bethlem Royal Hospital, known as
Bedlam. Photograph: Time & Life Pictures/Getty

Health Expenditure as a Share of GDP
in 2010
Organization for Economic Cooperation and Development (OECD)

Health Spending Per Capita by
Category of Care

Mental Health Expenditures by Type of
Service in 2005
0
5
10
15
20
25
30
35
Expenditure
Expenditure

Senator Paul Wellstone Addressing a
DC Crowd About Mental Health Parity

How will the Affordable Care Act
Impact Mental Health Care Coverage?
• Access, Access, Access….
• Extension of coverage of dependents to age
26
• Abolishment of pre-existing conditions
• Creation of health insurance exchanges
– Language that you will be able to understand
– Exchange must cover mental health services and
substance disorder services

Center on Budget and Policy Priorities http://www.cbpp.org/cms/index.cfm?fa=view&id=3819
Medicaid Expansion – April 21, 2013

ACA and Mental Health Parity Act
• This combination provides powerful mental
health coverage to millions of Americans
– Mental health care and substance abuse part of
10 essential services
– Mental Health Parity Act requires that services be
on par with all other services

Affordable Care Act
• Additional innovative options for those with
mental health conditions
– Community First Choice Option
– Health Homes

Why should we care about mental
health parity?
• Growing research indicates a physiologic
component to mental health illness
• Mental health related fatalities exceed those
of HIV/AIDS
• Increased costs would most likely be offset by
increased worker productivity and decreased
utilization of other costs (general medical
service utilization)

References
• Krisberg, K. (2012). Health Law Raising U.S.
Mental Health Parity to the Next Level. The
Nation’s Health. Sept. 2012.
• Mauldin, J. (2011). All Smoke and No Fire?
Analyzing the Potential Effects of the Mental
Health Parity and Addiction Equity Act of 2008.
Law and Psychology Review 35; 193-207.
• Mechanic, D. (2011). Behavioral Health and
Health Care Reform. Journal of Health
Politics, Policy & Law 36 (3): 527-531.

References
• Siegwarth, A. & Koyanagi, C. (2011). The New
Health Care Reform Act and Medicaid: New
Opportunities for Psychiatric Rehabilitation.
Psychiatric Rehabilitation Journal 34 (4); 277-
284.
• Smith, D., Lee, D. & Davidson, L. (2010).
Health Care Equality and Parity for Treatment
of Addictive Disease. Journal of Psychoactive
Drugs 42 (2); 121-126.

Helpful Websites
• http://www.healthcare.gov/law/
• http://www.healthcare.gov/using-
insurance/low-cost-care/medicaid/
• http://www.cbpp.org/cms/index.cfm?fa=view
&id=3819
• http://www.oecd.org/

Thank you!
• Questions? Please don’t hesitate to contact
me –
• Jayme Xaris in Second Life
• Jayme Nelson in Real Life
– nelsjaym@luther.edu

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Lesson 10: Integrated /mental health/healthcare and future of mental health services in public sector Readings: Schuffman, D., Druss, B.G., & Parks, J.J. (2009). Mending Missouri’s safety net: Transforming systems of care by integrating primary and behavioral health care. Psychiatric Services, 60(5), 585-588. Hogan MF, Sederer LI, Smith TE, & Nossel IR. (2010). Making room for mental health in the medical home. Prev. Chronic Dis. 7(6):A132 [Erratum appears in Prev Chronic Dis 2010;8(1). http://www.cdc.gov/pcd/issues/2011/jan/10_0249.htm.] Mechanic, D. (2012). Seizing opportunities under the Affordable Care Act for transforming the mental and behavioral health system. Health Affairs, 31(2), 376-382. http://content.healthaffairs.org/content/31/2/376.short View the short video on the Health Resources and Services Administration (HRSA) website about a primary care program in Tennessee. Available at: http://www.hrsa.gov/publichealth/clinical/BehavioralHealth/ Introduction Goal 1 of the President’s New Freedom Commission Report states that: “Americans understand that mental health is essential to overall health.” This seems like a simple enough goal. It is, however, not as easy to achieve as it appears. The link between mental and physical health has long been a subject of interest to theorists and practitioners and has been studied in the general population. For example, in a general population study, Sederer et al. (2006) found that those New Yorkers who reported nonspecific psychological distress suffered more physical health problems, were more likely to smoke, be inactive and have a poor diet than those who didn’t report distress. They noted that these individuals were much more likely to have hypertension, hyperlipidemia, obesity, asthma, and diabetes. The link with physical health is especially important for those suffering from serious mental illness. We learned in a previous lesson that persons with serious mental illness were likely to die 25 years earlier than adults in the general population (Colton & Manderscheid, 2006). Of those who die, 87% do so because of medical illnesses (Parks, Radke, & Mazade, 2008). These studies, results from Sederer et al. in a general population, and others show that physical and psychological problems not only co-exist, but also have a relationship. Treating one without addressing the other will result in inadequate care for the individual who suffers from both. Not much in terms of practice, however, has been done to address this issue until fairly recently. Why Integrate Care? Addressing the physical health needs of persons with mental illness has become increasingly important as more evidence becomes available of the link between them. An account of a recently held forum at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care noted: “For years, the prevailing notion in medicine held that the body is treated in a physician's office and the mind in a ...

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Lesson 6: Mental Healthcare Financing Readings: Frank, R, Glied, S. (2006). Changes in mental health financing since 1971: Implications for policymakers and patients. Health Affairs 25(3): 601-613. Garland, R.I., Lave, J.R. & Donohue, J.M. (2010). Health reform and the scope of benefits for mental health and substance use disorder services. Psychiatric Services 61(11): 1081 – 1086. Druss, B (2006). Rising mental health costs: What are we getting for our money? Health Affairs 25(3): 614-622. Scheffler, RM, Eisenberg, D (2004). How money makes its way through the mental health system. Family Therapy Magazine March/April 2004: 12-19. Insurance Market Reforms in the Patient Protection & Affordable Care Act and the Health Care & Education Reconciliation Act, Bazelon Mental Health Law Center http://www.bazelon.org/LinkClick.aspx?fileticket=rLF-G4_8dbw%3d&tabid=137. Scan: Barry, C.L., Huskamp, H.A. & Goldman, H.H. (2010). A Political History of Federal Mental Health and Addiction Insurance Parity. Milbank Quarterly 88(3): pp. 404-433. Readings also of interest: Honberg, R., Diehl, S., Kimball A., Gruttadaro, D., & Fitzpatrick, M. (2011). State mental health cuts: A national crisis. NAMI. http://www.nami.org/ContentManagement/ContentDisplay.cfm?ContentFileID=126233 Kliff, S. (December 17, 2012). Seven facts about America’s mental healthcare system. Washington Post. Retrieve at: http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/17/seven-facts-about-americas-mental-health-care-system/ Introduction There are many sources of financing for mental health care in both the private and public sectors. Private sector financing includes private insurance, out-of-pocket payment and a modest amount of charitable and philanthropic sources (Garfield, 2011). In addition, the Patient Protection and Affordable Care Act (ACA) passed in 2010, which was discussed last week, will have a substantial impact on behavioral health financing. The amount of funding for behavioral health care is substantial. Including those for the Affordable Care Act, private and public expenditures for mental health and substance abuse treatment are expected to be around $280.5 billion by 2020, an increase in spending from $171.7 billion in 2009. Growth in expenditures, however, will trail behind that of health care in general. This lesson will briefly discuss financing of the public mental health system. Public sector financing includes Medicaid, Medicare and other sources of funding support at the federal, state and local level. The largest amount of funding from other public sources is primarily from the federal level, the Community Mental Health Services Block Grant. On the substance abuse side, the Substance Abuse Prevention and Treatment Block Grant is also a large source of financing. Why examine the public mental health system? Garfield (2011) notes that there are differences in financing between general health and behavioral health in that “public s ...

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