How to Bring Mental Health Reform Over the Finish Line

With so many industries waiting for Team Trump to unveil a roadmap, it may seem arbitrary to zoom in on mental health. It’s not. Our nation’s deficiencies in this area add up to a crisis like no other. Before the presidential election, we were on the brink of addressing key aspects of this crisis through bipartisan legislation. A derailment at this juncture would be a tragedy.

Roughly one in five Americans will experience a mental health condition this year. Of adults with a mental illness, an estimated 56.5% receive no treatment at all, according to Mental Health America, an advocacy organization. It’s a grim number, but slightly better than the estimate of 59% in 2011.

In rural areas, access is even more complicated, as it is for veterans and children. There are simply not enough services and mental health professionals. Meanwhile, our suicide rate continues to rise and our criminal justice system too often defaults to incarceration over treatment.      

A Blueprint for Mental Health Reform

During the past few years, mental health stakeholders have debated, drafted, scrapped, rewritten, and finally gained consensus on a blueprint for mental health reform. Last July, the house passed The Helping Families in Mental Health Crisis Act of 2016 (H.R. 2646) with overwhelming support (422-2).

This legislation was not a panacea. It came after extensive bipartisan debate and inevitable concessions. Yet it succeeded in promoting evidence-based psychiatric care and outlined policies for coordinating federal mental health resources, addressing psychiatric workforce and bed shortages, providing HIPPA education, and enforcing mental health parity. Key elements of this bill were rolled into the 21st Century Cures Act, which President Obama signed into law on December 13.

21st Century Cures builds on other legislative milestones. Until 2008, insurance companies could discriminate against people with behavioral health disorders, imposing tougher limitations on benefits in this area than on other medical/surgical benefits.

In 2012, the Affordable Care Act required most individual and small employer insurance plans to cover mental health treatment and preventative services. It also expanded Medicaid and included mental health as an essential health benefit, while making it illegal to deny coverage due to pre-existing conditions, including mental illness.

President Donald Trump has provided few details about his stance on mental health.  And with the repeal of Obamacare, many initiatives that matter to the mental health community, including the expansion of Medicaid, are now in jeopardy.

The good news is, the same behavioral health groups that have promoted authentic mental health reform have offered to work alongside the Trump administration. Let’s hope the new administration is open to learning from those at the front lines.

To gain insight into reforms that matter most to patient advocacy groups and payers, my company, inVentiv Health, conducted extensive interviews with these organizations in the months leading up to and immediately following the November presidential election. In January, we published a whitepaper providing a detailed portrait of stakeholder views and recommendations, titled “An Advocacy Rx for Progress in Mental Health.”

For government, the wish list from mental health advocates comes down to three essential steps. First, Washington should provide financial support for advocacy organizations so that groups are not entirely dependent on industry partners and the families of patients. Second, policymakers should look closely at federal research allocations. What they’ll discover is that our budgets for mental health research are woefully inadequate when compared with budgets for research in cancer and other major disease areas.

The third imperative for Washington—and perhaps the most important—is to make sure the repeal of Obamacare does not lead to a contraction in state Medicaid programs designed to help low-and no-income individuals with mental health conditions. Health care reform is only meaningful if we assist people who experience the most urgent need.

  • Keri McDonough

    Keri McDonough is Senior Team Leader at Biosector 2, part of inVentiv Health. For 15 years, Keri has been providing counsel on complex, ever-changing healthcare dynamics and connecting mental health stakeholders in order to achieve shared goals.


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