A Vision for Getting Mental Health Care Right
There's a lot that state policymakers could do to move us toward treating it the same as physical health.
Deaths from suicides in the United States rose faster between 2016 and 2017 than in previous years, increasing by 4 percent to more than 47,000, according to a new analysis of data from the National Center for Health Statistics. It was the largest increase since data collection began in 1999.
If deaths from a type of cancer were at such 20-year highs, there'd be a public clamor for action -- for more treatment, clinicians and health systems stepping up to turn the tide. But this marshalling of resources hasn't happened for mental health, whether it be the opioid crisis, substance misuse, loneliness, despair or suicide.
It's not for lack of trying. More than a decade ago, Congress attempted to address some of the problems specific to health insurance coverage and the egregious discrimination between benefits for mental and physical health. But enforcement of the Mental Health Parity and Addiction Equity Act never really happened, and equal access to mental health services remains elusive for too many.
We're long overdue to bring forward a more comprehensive vision for mental health. To start, we have laid out a list of 10 options that states could employ to make access to mental health care easier and more affordable for everyone.
The foundation for these recommendations moves away from the traditional method of seeing mental health solely as a specialty service -- a fractured historical framework that has only perpetuated ongoing fragmentation. Instead, the solutions require ensuring that mental health services are more seamlessly integrated into general health care. Here are some common-sense examples of what policymakers can do right now:
• There should be no wrong door for accessing mental health care. Any policy that limits where a person can be identified for care or treated is a policy that should be reexamined.
• Too often mental health conditions are not identified as consistently as physical health conditions. An easy fix for this is for states to define, in policy, mental illnesses to include all disorders in the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases' listing of mental and behavioral disorders. Policymakers ought to lead the effort to create consistent standards for identifying and treating mental health and substance misuse disorders.
• While co-pays of any amount can be a barrier, it should go without saying that co-pays and other out-of-pocket costs should be the same for mental health services as they are for physical health services. That's often not the case today, but it's a policy fix that we believe all lawmakers could agree on.
• States should empower regulatory agencies to enforce their parity laws; update and step up enforcement efforts by requiring health plans to submit detailed compliance analyses; and designate a "parity lead" armed with adequate resources to enforce the law. At the community level, states ought to establish and fund advocacy offices staffed by experts who can help patients understand, file and process claims and appeals.
• And as a nation, we must redesign how we pay for mental health and substance misuse treatment. The current state of fragmented financing keeps mental health services siloed. Just as we have with physical illnesses such as diabetes and cancer, we should ensure that funding prioritizes preventive care, ensures team-based care and focuses on quality.
States can and should lead the way. With this roadmap, we can take steps to be more comprehensive in addressing mental health. Such small steps as enforcing mental health parity can help save lives. Progress on the mental health front will also benefit state budgets: Encouraging commercial insurers to pay for treatment to which people are entitled will reduce costly late interventions and preclude cost shifts to government payers such as Medicaid.
Diagnoses of mental health illnesses are on the rise, as are the number of Americans seeking mental health services. For those reasons alone, mental health ought to be on the agenda in every state capitol. Let's bring forward a new vision for mental health -- one that is integrated and reconnects the mind and body in practice, policy and payment.