Looking ahead to 2016, mental health field leaders and advocates are buoyed by the prospect of achieving comprehensive mental health reform, which they say is long overdue. The push for comprehensive reform legislation by bipartisan lawmakers has held center stage for some time now. Both House and Senate bills are gradually drawing more support from both Democrats and Republicans.
Rep. Tim Murphy’s (R-Pa.) “Helping Families in Mental Health Crisis Act” and Sens. Chris Murphy (D-Conn.) and Bill Cassidy’s (R-La.) “Mental Health Reform Act of 2015” are pending. Murphy’s bill cleared a subcommittee hearing last November.
Other priorities for the field this new year include parity enforcement, workforce development and the decriminalization of people with mental illness in the nation’s jails and prisons.
“For 2016, I’m optimistic that more states will move forward to meeting their Olmstead obligations,” Robert Bernstein, Ph.D., executive director at the Bazelon Center for Mental Health Law, told MHW. “In this regard, I see great opportunities as the Affordable Care Act (ACA) gains wider acceptance. Not only will more individuals have access to mental health care through their insurance, but more states will see how the ACA helps them with funding for the community-based services they should be providing in order to comply with Olmstead.”
Bernstein added, “Also, Congress has the opportunity to come back and work on real reform of the mental health care system. I hope to see proposals that focus on making sure that supports and services are available to people in their communities.”
The quest for comprehensive reform has received the most attention from the mental health community and lawmakers by far in 2015. Both bills represent historic legislation for the first time in decades, said Renée Binder, M.D., president of the American Psychiatric Association. “A comprehensive mental health reform bill is one of the huge things we’re looking forward to,” Binder told MHW. The legislation, Binder noted, would bring systemwide reform and improvements to care for patients and access to psychiatric treatment.
“As to be expected, there are minor policy differences between the two,” Binder said. “Although the bills are remarkably similar, there is considerable overlap.” The quest for reform has become a bipartisan issue in Congress as people are recognizing the need to do something to improve access to mental health care, she said.
“Our top priority continues to be getting comprehensive mental health legislation passed and hopefully signed by the president,” Mark Covall, president and CEO of the National Association of Psychiatric Health Systems, told MHW. “We see comprehensive mental health reform as way overdue. The time is now to move forward and hopefully work with the mental health community as we continue to look at the details and work with Congress to make reform a reality.”
Although more than five years have passed since the passing of the Mental Health Parity and Addiction Equity Act, there has been only minimal enforcement on both the state and federal levels.
“We continue to support further clarity in the mental health law so that there’s more transparency,” Covall said. An important step in complying with the mental health parity law is for health insurers to fully disclose how they’re complying with the law, he said.
The American Psychiatric Association has made some efforts to educate consumers about what they can do about health care plans that are not in compliance with the parity law, said Binder. The APA has created the “Fair Insurance Coverage: It’s the Law” document that can be posted in such places as physicians’ offices and break rooms at workplaces. It’s also available on the APA website. “We’ve been doing that in 2015 and are continuing to do it in 2016,” she said.
Additionally, the APA has embarked on other efforts when health plans are not complying with “the spirit of the parity law,” said Binder, including support of Rep. Joe Kennedy’s (D-Mass.) bill, “The Behavioral Health Coverage Transparency Act of 2015.” The legislation will hold health insurers accountable for providing adequate mental health benefits and increase transparency for consumers seeking coverage for mental illness and substance use disorders.
The APA is encouraging consumers to let them know about insurers who are not complying with the parity law, and encouraging psychiatrists and other mental health providers to do the same, said Binder. “We hope to make great strides in 2016 in the enforcement of mental health parity,” she said.
Binder noted that the APA will co-host, with the National Association of Counties and the Council of State Governments Justice Center, the Stepping Up National Summit in Washington, D.C., on April 17–19. The goal will be to train communities on how to decrease the number of people who are in jails and prisons, she said.
During the event, the APA will present the APEX (American Psychiatric Excellence) Awards to individuals who are advancing the cause of mental health and using public platforms to raise attention to the issue.
Ron Honberg, J.D., national director of policy and legal affairs at the National Alliance on Mental Illness, told MHW that NAMI is also looking forward to the summit. “It’s going to be a very intensive three-to-four-day summit,” he said. “The best solutions get forged at the local level,” Honberg said.
Regarding criminal justice, NAMI is also supportive of Sen. John Cornyn’s (R-Texas) bill, “The Mental Health and Safe Communities Act of 2015” (S. 2002).
“The bill tries to establish resources for people with mental illness and co-occurring substance use disorders,” said Honberg. Additionally, the legislation offers jail diversion programs, law enforcement training, discharge planning and re-entry services, he said. The Cornyn bill “is a good bill,” noted Honberg, although there is some controversy around a provision that seeks to clarify mental health reporting requirements, he said.
“The whole gun issue is very divisive,” Honberg said. “I believe Sen. Cornyn is trying to clarify what is already in the law.” Cornyn is faced with criticism by gun control groups, he noted. “Getting the bill passed is one of our priorities,” Honberg said.
“We really need to figure out how to make mental health an issue in the 2016 election,” said Honberg. The over-incarceration of people with mental illnesses in jails and parity enforcement are just some of the examples of issues NAMI would like to see candidates address, Honberg said.
NAMI and a host of other organizations are partnering with the Kennedy Forum to engage presidential candidates to address mental health– and addiction-related issues.
The Kennedy Forum’s NOW Campaign is a nationwide movement to find solutions to educate the candidates on issues important to the mental health and addictions fields. “It’s really critical that we’ve got NAMI as a partner to launch this campaign with us,” Lauren Alfred, policy director at the Kennedy Forum, told MHW.
“Having any 2016 candidate hear from NAMI through this coordinated effort is a big priority,” said Alfred. This is a coalition that is speaking with one voice, she said. “We want to hear from candidates about specific solutions [regarding] access, innovation, research efforts and what they plan to do for veterans,” said Alfred.
Current partners of the NOW Campaign also include the National Council for Behavioral Health, Faces and Voices of Recovery, Mental Health America, the American Foundation for Suicide Prevention and the Legal Action Center. For more information, visit www.nowcampaign.org.
Another priority for NAMI is engagement, said Honberg. Over the last few months, NAMI has looked at what the best practices are in getting people engaged in services, he noted. “Why are people reluctant to receive services?” Honberg said. “The question is what can be done? We convened a group of stakeholders of very diverse people” to address these issues, he said. A report is expected in early spring on what can be done to improve engagement.
Some tension already exists in the field between those who support involuntary treatment and those who oppose it, said Honberg. He also noted that he’s heard some stories about the mistreatment of people in hospitals and how the experience has added to their trauma. Their opinions about their own health have not been valued, he noted.
Young people in particular are reluctant to access treatment, said Honberg. Some feel ostracism from their peers, loss of friends, and missed opportunities for employment and the fear of negative impact on relationships, he said. “We have to figure out a way to make the system more user-friendly and humanistic, and try to [involve] people in their own care the way we see in other disciplines,” Honberg said.
Another key point for NAPHS in 2016 is reform of the Substance Abuse and Mental Health Services Administration, said Covall. “We want to see changes and enhancement and build upon it,” he said. NAPHS would like to see a medical treatment component within the federal agency, Covall said.
Additionally, NAPHS wants to support change in the Health Insurance Portability and Accountability Act privacy rule so that patients and families can get the kind of information needed to help individuals get access to the services they need, he said.
“We support changes in the IMD [Institution for Mental Diseases] exclusion, except regarding short-term hospitalization,” he said. Much is needed, noted Covall, particularly because of the limits in accessing inpatient care, and the limited number of beds.
Workforce development is also a priority. “We need more clinicians,” he said. “We have to find ways to encourage physicians and other professionals to come into the field.”
health care marketplace, including behavioral health, will continue to change, said
Linda Rosenberg, president and CEO of the National Council for Behavioral
Health. “We see insurance companies consolidated to actually become providers
in some cases,” she said. Behavioral health organizations will be partnering
with insurance organizations, hospitals, businesses and managed care companies
to forge new relationships, she said. “You need strong partners,” Rosenberg
said. “Health care as a commodity is really intensifying. Private investors are
entering the marketplace.”
not all of the field’s problems will be solved in one year, said Rosenberg.
“There will be incremental progress,” she said. “We don’t want Congress to
think their job is done.”
A major summit in April to address the incarceration of individuals with mental health and a campaign to inform presidential candidates about behavioral priorities are high on the agenda for many in 2016.