Plan to “Decimate” Mental Health Care

Leading mental health advocates are strongly condemning the Senate Republican health care bill proposed on June 22 for cutting Medicaid programs that provide vital lifelines to Americans struggling with mental illness.

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The criticism follows the harsh reaction voiced earlier this year to the American Health Care Act proposed by House Republicans to replace the Obama administration’s Patient Protection and Affordable Care Act, or Obamacare.

The National Alliance on Mental Illness, the nation’s largest grassroots mental health organization, said this week that the Senate Republicans’ Better Care Reconciliation Act “will slash Medicaid benefits for critical mental health services millions of Americans need to lead productive lives. NAMI opposes this effort to decimate our nation’s already struggling mental health system.”

NAMI explained the importance of Medicaid to mental health care:

“Medicaid is the largest source of funding for public mental health services in our nation. One-third of people covered by Medicaid expansion lives with a mental health or substance use condition and Medicaid serves as a lifeline for people with mental illness who typically fall through the cracks. It provides critical coverage so people have access and receive the mental health treatment they need to finish school, get back to work and contribute to their communities.”

NAMI said that the Senate and House proposals to convert Medicaid to a “per capita cap” for states will result in “devastating cuts to mental health services.”

“NAMI is deeply concerned that the Better Care Reconciliation Act will force people with mental illness out of the health care coverage they need and on to the streets and into costly emergency rooms, hospitals and jails. We encourage Senators to reject this harmful bill, and instead, ensure that Americans have receive the mental health care they need to lead healthy and productive lives.”

Paul Gionfriddo, president and CEO of Mental Health America, echoed NAMI’s concerns. He said the Senate Republican legislation would “do significant harm to people with all chronic conditions, including mental illnesses.” He said the proposal “replaces much of both the core and expanded Medicaid program—lifelines to people with serious and persistent mental illnesses.”

Gionfriddo called for changes to Obamacare to be made “in the context of rational health policy. We would all be well served if Congress were to go back to the drawing board and get this right. Too many lives depend on it.”

Similar to the House legislation, the Senate version would cut health care coverage to 22 million people, according to the Congressional Budget Office. “Repealing and replacing” Obamacare was a major campaign promise made by President Donald Trump. Trump’s Republican Party controls both houses of Congress.

NAMI is organizing a “Virtual Hill Day” on Thursday June 29 to lobby Congress against cuts in mental health coverage, demanding: “We need more mental health care, not less.”

The organization says that 1,000 mental health advocates will meet face-to-face with members of Congress; it encourages others to voice their opposition to cuts by phoning, emailing, or tweeting at their congressional representatives.

Risky Business

May is Mental Health Awareness Month and #riskybusiness is Mental Health America’s theme this year. The Sophie Fund will be sharing materials from the #riskybusiness awareness campaign throughout the month.

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As MHA’s awareness campaign explains:

“When you or someone you love is dealing with a mental health concern, sometimes it’s a lot to handle. It’s important to remember that mental health is essential to everyone’s overall health and well-being, and mental illnesses are common and treatable.

“Yet, people experience symptoms of mental illnesses differently—and some engage in potentially dangerous or risky behaviors to avoid or cover up symptoms of a potential mental health problem.

“That is why this year’s theme for May is Mental Health Month—Risky Business—is a call to educate ourselves and others about habits and behaviors that increase the risk of developing or exacerbating mental illnesses, or could be signs of mental health problems themselves.

“Activities like compulsive sex, recreational drug use, obsessive internet use, excessive spending, or disordered exercise patterns can all be behaviors that can disrupt someone’s mental health and potentially lead them down a path towards crisis.”

Click here to take MHA’s interactive quiz about when you think behaviors or habits go from being acceptable to unhealthy.

Click here to download MHA’s toolkit and spread the word about #riskybusiness yourself.

Bipartisan Action On Mental Health

Major mental health legislation is finally advancing in Congress, albeit somewhat stripped down to achieve a broad consensus. On June 15, the House Energy and Commerce Committee voted 53-0 to send the Helping Families in Mental Health Crisis Act to the House floor. The full House will probably consider the bill in the fall. It was introduced by Republican Representative Tim Murphy of Pennsylvania, a licensed psychologist, and Democratic Representative Eddie Bernice Johnson of Texas, a psychiatric nurse.

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The Hill has a good roundup of the committee’s work here. Chairman Fred Upton of Michigan said: “Today, this Committee takes a monumental step by advancing a bill that makes real reforms and offers evidence-based treatment for families in mental health crisis. Today we are taking a stand. We affirm that mental illness is not a crime. Mental illness is not a moral defect, it is not a choice, and it is not a joke. Mental illness is just that: an illness.”

Sarah Chamberlain, president of the Republican Main Street Partnership, had a strong piece in The Hill supporting the legislation:

America is in the midst of a national mental health crisis. Over 40 million Americans have a mental illness. Nearly 10 million have a serious psychiatric disorder such as schizophrenia, bipolar disorder or major depression. Millions of people who experience mental illness go without care, and many of them end up in prison or on the streets—or dead. Each year, 41,000 Americans die from suicide and 44,000 from drug overdoses, a number equal to all U.S. combat deaths in Korea, Vietnam, Afghanistan and Iraq combined. Women are particularly impacted by mental illness because they make up two-thirds of all caregivers.

Mental Health America (MHA), which has 950 affiliates across the country, applauded the committee’s passage of the bill. It is one of a number of non-profit advocates that support the legislation.

MHA’s “Top 10 Facts About The Mental Health Reform Legislation in the 114th Congress”:

Myths and Facts About H.R. 2646 (The Helping Families in Mental Health Crisis Act) and S. 1945 (The Mental Health Reform Act)

1. The bills are not the same as earlier ones, and there are some important differences.

While much of the debate on both sides appears similar to a year ago, the underlying legislation has changed, and this session’s proposals take a more balanced approach to mental health reform than did past proposals, emphasizing both stage 4 crisis response, as well as prevention, early intervention, and care integration.

2. The bills do not mandate forced treatment.

While H.R. 2646 offers an incentive and funding for states to implement Assisted Outpatient Treatment (AOT), it does not mandate any additional AOT.  It also does not change any existing state laws that do not penalize people if they refuse AOT.  States will continue to be free to spend their current block grant dollars as they wish, and also be free to choose any evidence-based programs to support with their new federal demonstration grant dollars, and any promising programs to support with their new federal innovation grant dollars.

3. Nothing in either bill will prevent mass shootings.  But they will prevent tragic outcomes and the progression of mental illnesses from Stage 1 to Stage 4.

That should be our top “prevention” priority.  Mental health care is not a solution to gun violence, because the correlation between mental health conditions and gun violence is modest.  But people with mental illnesses do lose 25 years of life expectancy for a variety of reasons – violence, suicide, and complications from other diseases among them.  Early identification and intervention is the way to prevent many of these tragedies, and these proposals move us in that direction.

4. These proposals do not diminish SAMHSA, but elevate mental health in the federal bureaucracy.

That should be our top “systems” priority.  SAMHSA has done a great job promoting recovery and the innovative services that make it possible during the 23 years since the agency was created.  But SAMHSA has never been given the authority it needs to make sure other federal agencies are really addressing mental health.  In their present form, neither bill cuts funding to SAMHSA, or repeals any of its statutory authority to promote recovery.1  Instead, both bills add in a new Assistant Secretary and an Interagency Serious Mental Illness Coordinating Committee, and leave federal law guiding SAMHSA in effect.  In one approach, SAMHSA as an agency will report to the Assistant Secretary.  In the other, the people of SAMHSA will be led by the Assistant Secretary.  But a fair reading of both bills is that they ensure that in the future SAMHSA will play an even bigger role in helping the rest of the federal government better serve individuals with mental health conditions.

5. For those whose mental illnesses have already reach crisis stages, the bills will move mental health treatment and services (and maybe even dollars) out of our jails and into treatment and service programs in our communities.

That should be our top “treatment” priority.  In fact, in its current form, H.R. 2646 calls on the federal government to create a plan to end the incarceration of nonviolent offenders with mental illness within ten years and use the savings to support community services for people with mental illnesses.  That alone could finally empty our 21st century asylums (jails and prisons), echoing the efforts of our founder, Clifford Beers, a century ago.  Even more importantly, both proposals call for millions of dollars of additional federal spending on a wide range of community-based programs – where new infusions of dollars are badly needed.

6. The bills are grounded in a sound public health approach.

In public health policy, we recognize the importance of the prevention, early intervention, services integration, and recovery.  We work to prevent premature disability and death from chronic disease.  And we focus on making communities, as well as individuals, healthier.  These bills are not “wellness only” or “non-medical” responses to mental illnesses.  On the contrary, they move in the direction of treating mental illnesses as health, not safety, concerns, the same way we treat other chronic diseases, and focus on the causes, not just the effects, of mental illnesses – and provide money in innovation and demonstration grants for this work.

7. If these bills pass, people will get more than just triage when they go to the hospital, but not held for years.

Some people think the bills – by opening up more funding for hospitals, too – will return individuals with mental health conditions to asylums.  The bills do allow for some additional inpatient stays, which are often necessary for proper diagnosis and treatment plan development.  But they do not allow for lengthy custodial institutionalization.  Recovery must be the goal of all treatment and services, and we should support efforts – even modest ones – to make sure that people get the amount of inpatient care they need at the time, and afterwards they get access to the community services they need to prevent another hospitalization and thrive in the community.

8. Integrating health records as proposed in these bills will not let the police or your employer access your health information or diminish the legal rights of individuals.

The bills allow for the sharing of substance use information in integrated health care systems.  This sharing will not allow employers and police to see your health information and use it against you – the privacy rule in HIPAA already protects against this.  Allowing information sharing is essential for safety and ensuring that individuals can get access to the care they need.
9. The bills will not force peers to be supervised by clinicians.
The bills contain a report that examines best practices in training and credentialing peer support specialists who work in clinical settings.  This report will be an important first step in ensuring that health plans will reimburse for peer services.  Nothing about either bill forces peers outside of clinical settings to work under clinicians.

10. The bills will not be the end of mental health reform, but they do represent an important beginning to addressing structural issues and building out a continuum of care.

The mental health system is deeply broken and underfunded.  While these bills lay a foundation for reform, they are still only a beginning.  Congress will need to build on them with subsequent legislation to ensure that our mental health system is most effective.  It will still need to look at education and employment supports, for example.  While it can be argued by both sides that the bills do not go far enough, we need to acknowledge that they go further toward large-scale reform than other bills have in a generation, and that “starting over” from here is just a euphemism for “doing nothing,” yet again.

Read a contrary perspective in Truthout from Oryx Cohen, co-producer of the recent documentary, Healing Voices. He is a member of the National Coalition for Mental Health Recovery and the Campaign for Real Change in Mental Health Policy.

Mental Health Awareness Month 2016

The first day of May is the start of National Mental Health Awareness Month in the United States. Today is also the start of Children’s Mental Health Awareness Week.

Mental Health America (MHA) and its local affiliates around the country have led an annual observance of Mental Health Month since 1949. The observance seeks to reach millions of people through the media, local events, and screenings. Check out the toolkits on the MHA website aiding organizations and individuals who wish to engage with Mental Health Awareness Month.

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This year’s theme is “Life with a Mental Illness.” It encourages individuals to share what life with a mental illness feels like for them in words, pictures, and video by tagging their social media posts with #mentalillnessfeelslike (or submitting to MHA anonymously). Posts are being collected and displayed at mentalhealthamerica.net/feelslike.

Mental Health America, founded in 1909, is the nation’s leading community-based nonprofit dedicated to addressing the needs of those living with mental illness and to promoting the overall mental health of all Americans. It promotes mental health as a critical part of overall wellness, including prevention services for all, early identification and intervention for those at risk, and integrated care and treatment for those who need it, with recovery as the goal. Much of its current work is guided by the Before Stage 4 (#B4Stage4) philosophy—that mental health conditions should be treated long before they reach the most critical points in the disease process.

National Children’s Mental Health Awareness Week is an annual event sponsored by the National Federation of Families for Children’s Mental Health. This year’s theme is “Healthy Families, Resilient Children: Mental Health is a Family Affair!”

President Obama proclaimed May to be National Mental Health Awareness Month, stating in part: “This month, we renew our commitment to ridding our society of the stigma associated with mental illness, encourage those living with mental health conditions to get the help they need, and reaffirm our pledge to ensure those who need help have access to the support, acceptance, and resources they deserve.”

The full text of the presidential proclamation:

Nearly 44 million American adults, and millions of children, experience mental health conditions each year, including depression, anxiety, bipolar disorder, schizophrenia, and post-traumatic stress. Although we have made progress expanding mental health coverage and elevating the conversation about mental health, too many people still do not get the help they need. Our Nation is founded on the belief that we must look out for one another—and whether it affects our family members, friends, co-workers, or those unknown to us—we do a service for each other when we reach out and help those struggling with mental health issues. This month, we renew our commitment to ridding our society of the stigma associated with mental illness, encourage those living with mental health conditions to get the help they need, and reaffirm our pledge to ensure those who need help have access to the support, acceptance, and resources they deserve.

In the last 7 years, our country has made extraordinary progress in expanding mental health coverage for more people across America. The Affordable Care Act prohibits insurance companies from discriminating against people based on pre-existing conditions, requires coverage of mental health and substance use disorder services in individual and small group markets, and expands mental health and substance use disorder parity policies, which are estimated to help more than 60 million Americans. Nearly 15 million more Americans have gained Medicaid coverage since October 2013, significantly improving access to mental health care. And because of more than $100 million in funding from the Affordable Care Act, community health centers have expanded behavioral health services for nearly 900,000 people nationwide over the past 2 years. Still, far too few Americans experiencing mental illnesses do not receive the care and treatment they need. That is why my most recent Budget proposal includes a new half-billion dollar investment to improve access to mental health care, engage individuals with serious mental illness in care, and help ensure behavioral health care systems work for everyone.

Our Nation has made strong advances in improving prevention, increasing early intervention, and expanding treatment of mental illnesses. Earlier this year, I established a Mental Health and Substance Use Disorder Parity Task Force, which aims to ensure that coverage for mental health benefits is comparable to coverage for medical and surgical care, improve understanding of the requirements of the law, and expand compliance with it. Mental health should be treated as part of a person’s overall health, and we must ensure individuals living with mental health conditions can get the treatment they need. My Administration also continues to invest in science and research through the BRAIN initiative to enhance our understanding of the complexities of the human brain and to make it easier to diagnose and treat mental health disorders early.

One of our most profound obligations as a Nation is to support the men and women in uniform who return home and continue fighting battles against mental illness. Last year, I signed the Clay Hunt SAV Act, which fills critical gaps in serving veterans with post-traumatic stress and other illnesses, increases peer support and outreach, and recruits more talented individuals to work on mental health issues at the Department of Veterans Affairs. This law will make it easier for veterans to get the care they need when they need it. All Americans, including service members, can get immediate assistance by calling the National Suicide Prevention Lifeline at 1-800-273-TALK or by calling 1-800-662-HELP.

During National Mental Health Awareness Month, we recognize those Americans who live with mental illness and substance use disorders, and we pledge solidarity with their families who need our support as well. Let us strive to ensure people living with mental health conditions know that they are not alone, that hope exists, and that the possibility of healing and thriving is real. Together, we can help everyone get the support they need to recover as they continue along the journey to get well.

Now, therefore, I, Barack Obama, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 2016 as National Mental Health Awareness Month. I call upon citizens, government agencies, organizations, health care providers, and research institutions to raise mental health awareness and continue helping Americans live longer, healthier lives.