A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction
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Congress should appropriate federal funding to the Centers for Disease Control and Prevention to sponsor fetal alcohol syndrome disorder practice and implementation centers in every region.
INTEGRATION AND CLINICAL WORKFORCE
Congress should establish a grant program to assist states in developing tele-psychiatry and physician training programs for treating and referring individuals with mental health and substance use disorders.
Congress should increase funding for National Health Service Corps scholarship and loan repayments in order to increase the supply of behavioral and mental health professionals.
The Centers for Medicare and Medicaid Services should remove payment obstacles to and improve reimbursement for evidence-based approaches to integrating specialty behavioral care in primary care, including care management services, use of standardized outcomes measures, and the regular caseload review and consultation by a designated psychiatric consultant, done by phone or video.
The Department of Health and Human Services should work with Accountable Care Organizations to expand the implementation of collaborative care models for integrating care.
States should require interdisciplinary training in evidence-based integrated care for mental health specialists and primary care providers as part of Continuing Medical Education for state medical licensure.
Congress should require Federally Qualified Health Centers to integrate specialty behavioral healthcare using evidence-based collaborative care models and provide additional funding for technical assistance.
Congress should amend the HITECH Act and extend financial incentives for the meaningful use of electronic health records to mental health and addiction treatment providers and facilities.
The Centers for Medicare and Medicaid Services should extend Medicare and Medicaid reimbursement for use of electronic health records (EHRs) to mental health professional facilities.
The Department of Health and Human Services should identify for states and provide guidance on ways in which to expand the use of certified peer specialists, including Medicaid reimbursement options.
Congress should appropriate additional funding to the Department of Veterans Affairs to increase the number of behavioral and mental health professionals in the VA.
EDUCATION SYSTEM
Congress should provide federal grants for comprehensive school mental health programs that are culturally and linguistically appropriate, trauma-informed, and age appropriate.
The Department of Education, in coordination with other federal agencies, should assist colleges and universities in successfully attending to students’ growing mental health needs by improving access to mental and behavioral health services on campuses.
Congress should amend the Head Start Act to promote trauma-informed practices, age-appropriate, positive behavioral intervention and support, services for young children who have experienced trauma or toxic stress, and improved coordination between Head Start agencies and other programs that serve very young children.
The Department of Education should develop and disseminate guidance on the implementation of multitier systems of supports throughout our education system, using evidence-based instruction, screening, and research-based interventions to support the behavioral health needs of students.
States, in collaboration with local governments, should develop and implement state plans to improve collaboration between all child- and family-serving agencies, including state and local mental health systems; public and private schools; child welfare systems; and juvenile justice systems.
The Department of Education should integrate mental health screening, services, and support requirements into Early Start and Head Start to identify and address behavioral health problems early and appropriately.
The Department of Education, in coordination with other federal agencies, should define social and emotional learning (SEL) and SEL programming and identify core areas of social and emotional competency.
Congress should amend the Elementary and Secondary Education Act (ESEA) to allow funding for teacher and principal training and professional development to be used for social and emotional learning training.
States should integrate social and emotional learning into core curriculum to promote students’ skills in self-awareness, social awareness, relationship, and responsible decision-making, and improve student attitudes and beliefs about self, others, and school.
CRIMINAL JUSTICE
Congress should reauthorize the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) and improve outcomes for individuals with mental illness involved in the criminal justice system. Congress should also appropriate full funding for the Justice and Mental Health Collaboration Act.
States and counties should rapidly accelerate implementation of evidence-based pre-arrest, pre- and post-booking, pretrial, and presentencing diversion programs that target offenders with serious mental illnesses and/or substance use disorders and provide access to appropriate treatment and services.
States, in collaboration with local government, should develop and implement state plans to improve collaboration between their criminal justice and public mental health systems to ensure that people with mental health and substance use disorders receive appropriate treatment, services, and supports while in jail or prison and access to treatment and community-based services when released from jail or prison, including Medicaid coverage.
States should increase enrollment of the criminal justice population into Medicaid or private insurance to maximize health coverage, including mental health and substance use coverage, for this population and should not terminate individuals from Medicaid when they are incarcerated.
States should embrace the practices of the Mentally Ill Offender Community Transition Program in Washington State, implemented as a collaboration between the Department of Corrections and the Department of Mental Health to improve care for individuals with mental illness. By asking corrections and mental health staff to work together, the program provides coordinated services, including risk assessment and treatment planning, and has reduced recidivism among participants to 19 percent, from 42 percent before implementation.
ADDICTION AND RECOVERY
States should reimburse for Screening, Brief Intervention, and Referral to Treatment (SBIRT), an approach where primary care staff assess patients’ substance use risk and refer to appropriate treatment under Medicaid.
Congress should expand prevention and educational efforts to prevent the abuse of opioids and heroin and to promote treatment and recovery, and expand the availability of naloxone to law enforcement agencies and other first responders to help in the reversal of overdoses to save lives.
Congress should expand resources to identify and treat incarcerated individuals suffering from addiction disorders promptly by collaborating with criminal justice stakeholders and by providing evidence-based treatment, and expand disposal sites for unwanted prescription medications to keep them out of the hands of our children and adolescents.
Congress should authorize and fund an evidence-based opioid and heroin treatment and intervention program for states, local governments, and nonprofits.
Congress should strengthen prescription drug monitoring programs, with additional funding and supports to help states monitor and track prescription drug diversion and to help at-risk individuals access services.
Congress should expand the ability of trained medical professionals to provide lifesaving medication-assisted therapies for patients with substance use disorders.
The Department of Health and Human Services should amend 42 CFR Part 2 to remove barriers to patient care coordination and promote improved quality of care in integrated care settings.
ACCESS AND OUTCOMES
The federal government and state insurance commissioners should develop, implement, and enfo
rce strong network adequacy requirements for all types of health insurance plans to ensure patients have timely access to covered mental health and substance use services in a service area.
The federal government and state insurance commissioners should require all types of health insurance plans to make publicly available detailed and understandable information so that consumers can make informed decisions about their health insurance coverage.
Congress should pass legislation to clarify that the Mental Health Parity and Addiction Equity Act (MHPAEA) requires coverage for residential treatment of eating disorders.
States should revise their Medicaid payment policies to allow for billing for behavioral health and primary care services provided on the same day to remove barriers to care and facilitate behavioral health integration.
Congress should eliminate the 190-day lifetime limit on inpatient psychiatric hospital care under Medicare.
Congress should revise the IMD exclusion for Medicaid beneficiaries between ages twenty-one and sixty-four for nonhospital residential care and hospital-based care. Congress should expand the Medicaid home and community-based services waiver to include youth in need of services provided in a psychiatric residential treatment facility.
The Centers for Medicare and Medicaid Services should use existing authority to reform the IMD exclusion under Medicaid managed care.
The Centers for Medicare and Medicaid Services should require the use of measurement-based care for behavioral health providers by 2018, beginning with incentivizing patient-reported outcome measurement assessments within the fee-for-services framework and integrating measurement-based care into pay-for-performance.
The Department of Health and Human Services should develop objective, quantifiable performance measures for healthcare systems, managed care organizations, and health insurance companies that support the adoption of measurement-based care.
States should require training in measurement-based care as part of Continuing Medical Education for state medical licensure.
Congress should expand and extend Section 223, the demonstration program for certified community behavioral health clinics included in the Protecting Access to Medicare Act.
RESEARCH
Congress should appropriate federal funding to the National Institute of Mental Health for the purpose of conducting and supporting research on the determinants of self-directed violence associated with mental illness, including studies designed to reduce the risk of self-harm, suicide, and interpersonal violence, especially in rural communities with a shortage of mental health services.
Congress should increase funding to CDC to allow for the complete expansion of the National Violent Death Reporting System to all fifty states and coordination between states.
Congress should expand funding for the NIMH RAISE program to continue to develop effective specialty care programs that target youth and young adults in a variety of urban and rural communities to treat psychosis at the first sign of symptoms and promote recovery.
Congress should increase funding for the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative to further the knowledge base for researchers seeking new ways to treat, cure, and even prevent brain disorders.
Congress should increase funding for the NIMH Early Psychosis Prediction and Prevention (EP3) initiative to accelerate research on detecting risk states for psychotic disorders, preventing the onset of psychosis in high-risk individuals, and reducing the duration of untreated psychosis in people who have experienced first episode psychosis.
Federal and state funding should encourage research institutes to adopt open science to support collaboration, accelerate data replication and integration, and promote the translation of research to clinical use.
PARITY IMPLEMENTATION AND ENFORCEMENT
The Departments of Labor and Health and Human Services and states should require all health plans covered under MHPAEA to disclose their medical management criteria, documents, and analyses used to approve and deny care for both mental health and substance use benefits and medical and surgical benefits and issue additional guidance to this effect.
Congress should require the Department of Health and Human Services to issue an annual, public report identifying federal investigations conducted or completed during the preceding twelve-month period regarding compliance with MHPAEA and summarizing the results of any investigations.
The Department of Health and Human Services should immediately begin enforcement of parity for Medicaid coverage through Alternative Benefit Plans and the Children’s Health Insurance Program and issue strong final regulations on Medicaid parity.
The Departments of Labor and Health and Human Services and state insurance commissioners should work together to strongly enforce MHPAEA, publicly report incidents of noncompliance, including summaries of all investigations and their results, and publish health insurance plan denial rates for outpatient and inpatient behavioral health care compared to medical and surgical care.
The Department of Health and Human Services, in coordination with other federal agencies and state insurance commissioners, should develop a public education campaign to educate consumers, family members, and service providers about rights under MHPAEA.
The Departments of Labor and Health and Human Services, in coordination with state insurance commissioners, should develop a central online tool for consumers and providers to report incidents of noncompliance with the federal parity law.
The Department of Labor should, at a minimum, conduct audits of any plan that generates three or more parity complaints of the same type by consumers and providers and use its current authority to conduct randomized MHPAEA compliance audits of no fewer than twelve health plans on an annual basis.
The Department of Health and Human Services, in coordination with state insurance commissioners, should develop a model state law for implementing the MHPAEA that should include guidance on disclosure, what constitutes MHPAEA compliance, and fines for noncompliance.
Federal leaders should work to ensure the United Nations incorporates mental health, substance use disorders, and intellectual developmental disabilities into the Post-2015 Sustainable Development Goals, as well as key indicators to measure progress, including suicide rates and severe mental illness treatment coverage.
FOR MORE INFORMATION ABOUT OUR PROGRAMS
Policy incubator and convener for the entire community of mental health and addiction
Gathers experts from across the spectrum of behavioral health to discuss and promote best practices and policy solutions in areas requiring collaborative leadership, including parity implementation, outcomes-based care, integration, technology, and brain fitness
Holds Kennedy Forum national issues conference in Boston, including dinner at JFK Presidential Library, and the annual “State of the Union in Mental Health and Addiction” with Dr. David Satcher at the National Press Club in Washington
Launched the NOW Campaign, a nationwide movement to engage political candidates and the public to drive solutions for mental health and addiction
To join the Kennedy Forum and get regular updates on legal, medical and scientific news, go to www.thekennedyforum.org.
International forum for open science, sharing of big data, and advanced collaboration in brain research, which will accelerate replication and validation of results, allow increased data integration and power for statistical analysis, and accelerate the translation of basic research to clinical use so patients receive improved diagnostics and treatments
Built open data portal with open science principles that will greatly accelerate the discovery of better diagnostics, treatments and, someday, cures for diseases and injuries of the brain
Creates global public-private partnerships among governmental, corporate, scientific, and philanthropic communities
Holds annual summit of international brain research community to share innovation and best practices, and take on new research challenges that will benefit a broad range of brain diseases
To join the One Mind effort and get regular updates on its brain science efforts, go to www.onemind.org.
Partnership between Kennedy Forum and former Surgeon General Dr. David Satcher and his Satcher Health Leadership Institute at the Morehouse School of Medicine (MSM) in Atlanta, Georgia
Annual live-streamed event at National Press Club that holds our nation and its leaders accountable for the real cost and impact of mental illness and addiction on many sectors of American society; event also serves to rally policymakers, thought leaders, and advocates around a shared vision for progress
For more information, and to watch last year’s State of the Union, go to https://www.thekennedyforum.org/events/stateoftheunion.
Collaboration between the Kennedy Forum, the Thomas Scattergood Foundation, and the Treatment Research Institute that has created a live, interactive map providing actionable information on a state-by-state basis, about the implementation and enforcement of the 2008 Mental Health Parity and Addiction Equity Act
Aggregates critical information related to state legislation, regulations, and litigation that is related to parity; long-term goal is to help consumers understand their rights under the law, and to help them to exercise those rights
In addition to the in-depth state reports, outlines common parity violations, to help better educate consumers on a host of issues that might arise when seeking or accessing treatment
Debuted in the spring of 2015 with five crucial states, and more are being added until all fifty will be fully operational
For more information, visit www.paritytrack.org.
In late 2015 we will be launching the Mental Health Leadership Roundtable, which will provide a forum for select visionary corporate leaders and thought leaders committed to improving American behavioral health through the workplace