Mental Heath Comes To The Fore

Recent acts of violence across the nation have brought the issue of mental healthcare to the fore. News pundits have repeatedly made calls for reforming the mental health system in this nation as one way to reduce future episodes of violence. 

But in recent years, state mental health systems have only seen cuts, and it doesn’t look like that trend is going to change. There are some things that can be done, however, to strengthen the system. 

Joel Miller, senior director of policy and healthcare reform at the National Association of State Mental Health Program Directors, said the numbers look bleak. Between 2009 and 2012, state mental health budgets were cut by nearly $5 billion total. This is the largest combined cut in mental health since the 1970s, he said. 

And this is on top of a relatively lean system to begin with. Miller said $5 billion is “a significant portion” of mental healthcare’s nationwide allocations which is $38 billion.

“At the same time we’ve seen these budget cuts, state public mental health systems saw a 10% increase in demand for public behavioral health treatment services,” he said. “The system treats about 7 million people annually.”

The majority of funding for state mental health programs comes from state general revenue funds and Medicaid, Miller said. A smaller portion comes from Medicare and other federal funding such as community mental health block grants. 

Angela Kimball, director of state policy for the National Alliance on Mental Illness, said the funding goes predominantly to provide services to people who are uninsured or who need services not covered by private insurance. 

“Essentially at a basic level, private insurance in our country doesn’t always cover mental health care equitably with other health care conditions,” she said. 

Insurance typically doesn’t cover services for people with serious mental illness who cross over into the realm of disability. Things like housing support, employment assistance and other services are not typically covered by private insurance. 

Even with all of these cuts, there are ways to bolster the system, Kimball said. First, the state health exchanges will help when launched this October. Health plans purchased through the exchanges will be subject to laws that require parity of physical and mental health coverage.

Another way to increase mental health coverage is by states opting to expand Medicaid coverage. Miller said that about 17 million new people would be on Medicaid if all states expand coverage – one third of them have a serious mental illness and would have mental health coverage through Medicaid. Most adults make too much money to qualify for Medicaid and Kimball said doing so for a mental illness is a difficult process.
“Adults are only eligible if they meet disability criteria,” he said. “An adult with schizophrenia would have to declare themselves disabled and make it through a federal process to qualify,” she said. 

Strengthening the state mental health systems is also important. Right now, state behavioral health services include managing and coordinating public mental health policy. They help create mental health regulations and are first responders during a crisis. They act as coordinators to track mental health 

funding and maximize the use of funding. 

Each state should be providing wrap-around services. People in the system have “intensive needs,” Kimball said, often having difficulty getting or keeping a job or staying in school. They are often kids in the foster care system. 

To reach these people, she said they need to provide therapy and medication as well as housing support and peer-support services. 

One major part of what Kimball said would help the system is to focus on prevention. 

“Youth and young adults are the least likely to seek and get mental health care even though it is the most common time for serious mental illness to develop,” she said. “If we want to focus on prevention, we need early identification and intervention for young adults.”

She said this would not necessarily be costly, but it would require changes in the system. Because teens are not likely to walk into a mental health clinic and say, “I need help,” providers should be reaching out to them. 

Kimball said there should be screening wherever they might enter into the system. This would include primary care offices and in schools. She said school-based mental health services were provided in the 1970s and 1980s and they were very successful. They allow children and teens to talk with nurses or professionals in the schools in a “low-stigma setting.” But budget cuts have since made these services extras instead of requirements.

“These are people who have the ability to do outreach or notice issues with kids, like isolation or bullying, and stopping them early,” she said. “It requires a big shift in how we conduct health and mental healthcare.”