11 Points For Mental Health Care Reform

Due to greater understanding of how many Americans live with mental illnesses and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges mental-health organizations across the U.S. are determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental-health and substance use disorders are properly addressed and integrated into healthcare reform.

In anticipation of parity and mental healthcare reform legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform..

MENTAL HEALTH SERVICE DELIVERY

1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.

2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.

3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.

4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of course, part of this initiative includes helping mental illness patients find a mental health clinic nearby.

MENTAL HEALTH SYSTEM MANAGEMENT

5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges.

6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.

7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.

MENTAL HEALTHCARE INFRASTRUCTURE

8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental-health and substance use performance measures that will be used to improve delivery of mental-health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.

9. Health Information Technology: Federal and state HIT initiatives need to reflect the importance of mental-health and substance use services and include mental-health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.

10. Healthcare Payment Reform: Payers and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.

11. Workforce Development: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors. Provider organizations will need to participate in these efforts and be ready to ramp up their workforce to meet unfolding demand.

GIRL POWER! Is Good Mental Health

GIRL POWER! is paving the way for girls to build confidence, competence, and pride in themselves, in other words, enhancing girls’ mental wellness. Girl Power! is also providing messages and materials to girls about the risks and consequences associated with substance abuse and with potential mental health concerns. For instance, did you know:

Girls are seven times more likely than boys to be depressed and twice as likely to attempt suicide.*

Girls are three times more likely than boys to have a negative body image (often reflected in eating disorders such as anorexia and bulimia).*

One in five girls in the U.S. between the ages of 12 and 17 drink alcohol and smoke cigarettes.*

Girls who develop positive interpersonal and social skills decrease their risk of substance abuse.*

Girls who have an interest and ability in areas such as academics, the arts, sports, and community activities are more likely to develop confidence and may be less likely to use drugs.*

On the other hand, this also is a time when girls may make decisions to try risky behaviors, including drinking, smoking, and using drugs.*

The Girl Power! Campaign, under the leadership of the Center for Substance Abuse Prevention (CSAP), Substance Abuse and Mental Health Services Administration (SAMHSA) is collaborating with the Center for Mental Health Services (CMHS) to provide this valuable mental health information.

* Girl Power! Hometown Media Kit, Center for Substance Abuse Prevention, 1997.

Substance Abuse and Mental Health

Results from a study of nearly 6,000 people aged 15 to 24 show that among young people with a history of both a mental disorder and an addictive disorder, the mental disorder is usually reported to have occurred first. The onset of mental health problems may occur about 5 to 10 years before the substance abuse disorders.**

This provides a “window of opportunity” for targeted substance abuse prevention interventions and needed mental health services.

** “National Comorbidity Survey,” Ronald C. Kessler, Ph.D., et al., American Journal of Orthopsychiatry, June 1996.

What Is Mental Health?

Mental health is how we think, feel, and act in order to face life’s situations. It is how we look at ourselves, our lives, and the people we know and care about. It also helps determine how we handle stress, relate to others, evaluate our options, and make choices. Everyone has mental health.

A young girl’s mental health affects her daily life and future. Schoolwork, relationships, and physical health can be affected by mental health. Like physical health, mental health is important at every stage of life. Caring for and protecting a child’s mental health is a major part of helping that child grow to become the best she can be.

Girls’ independence is usually encouraged in childhood, and their strengths nurtured. Most girls become emotionally, mentally, and physically healthy young adults. But sometimes, during the transition from childhood to adolescence, extra care is necessary, so that a girl’s self-esteem and coping skills are not diminished. For more information on teen mental health, call 1-800-789-2647 and ask for the brochure: “You and Mental Health: What’s the Deal?” (Order # CA-0002)

Nurturing Your Child’s Mental Health

Parents and other caregivers are responsible for children’s physical safety and emotional well-being. Parenting styles vary; there is no one right way to raise a child. Clear and consistent expectations for each child, by all caregivers, are important. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills. The following suggestions are not meant to be complete.

Do your best to provide a safe home and community for your child, as well as nutritious meals, regular health check-ups, immunizations, and exercise.

Be aware of stages in child development so you don’t expect too much or too little from your child.

Encourage your child to express her feelings; respect those feelings. Let your child know that everyone experiences pain, fear, anger, and anxiety.

Try to learn the source of these feelings. Help your child express anger positively, without resorting to violence.

Promote mutual respect and trust. Keep your voice level down–even when you don’t agree. Keep communication channels open.

Listen to your child. Use words and examples your child can understand. Encourage questions.

Provide comfort and assurance. Be honest. Focus on the positives. Express your willingness to talk about any subject.

Look at your own problem-solving and coping skills. Do you turn to alcohol or drugs? Are you setting a good example? Seek help if you are overwhelmed by your child’s feelings or behaviors or if you are unable to control your own frustration or anger.

Encourage your child’s talents and accept limitations.

Set goals based on the child’s abilities and interests–not someone else’s expectations. Celebrate accomplishments. Don’t compare your child’s abilities to those of other children; appreciate the uniqueness of your child. Spend time regularly with your child.

Foster your child’s independence and self-worth.

Help your child deal with life’s ups and downs. Show confidence in your child’s ability to handle problems and tackle new experiences.

Discipline constructively, fairly, and consistently. (Discipline is a form of teaching, not physical punishment.) All children and families are different; learn what is effective for your child. Show approval for positive behaviors. Help your child learn from her mistakes.

Love unconditionally. Teach the value of apologies, cooperation, patience, forgiveness, and consideration for others. Do not expect to be perfect; parenting is a difficult job. Many good books are available in libraries or at bookstores on child development, constructive problem-solving, discipline styles, and other parenting skills.
Mental Health Problems Many children experience mental health problems that are real and painful and can be severe.

Mental health problems affect at least one in every five young people, at any given time. At least 1 in 10 children may have a serious emotional disturbance that severely disrupts his or her ability to function.

Tragically an estimated two-thirds of all young people with mental health problems are not getting the help they need. Mental health problems can lead to school failure, alcohol or other drug abuse, family discord, violence, or even suicide.

A variety of signs may point to a possible mental health problem in a child or teenager. If you are concerned about a child or have any questions, seek help immediately. Talk to your doctor, a school counselor, or other mental health professionals who are trained to assess whether your child has a mental health problem. For a list of warning signs, call 1-800-789-2647 and ask for the brochure “Your Child’s Mental Health: What Every Family Should Know. (Order # CA-0001)

Available HELP

The National Mental Health Information Center, funded by the Center for Mental Health Services, can provide confidential information; free publications; and referrals to local, State, and national resources.

Call 1-800-789-2647