24 Jul Who are the private and public stakeholders

Reply to at least two of your classmates.

Behavioral Health: What two public policies have been recently proposed or adopted to improve access to behavioral health services and treatment? Who are the private and public stakeholders? Name some organizations pushing for policy changes.

Respond to Amy: 

Behavioral health has always seemed to be neglected by major medical insurance companies and even some providers. The Affordable Care Act (ACA) was passed in 2010 and required insurance companies to have mental health benefits as part of their policies (Koons & Tozzi, 2019). The ACA combined with the Mental Health Parity Act (MHPA) of 1996 stated that insurance companies cannot put limits on mental health or addiction benefits (Centers for Medicare and Medicaid Services, n.d.). While these items have increased access to mental health care and substance use disorders the increase is mainly being used by those who were already accessing care.

During the Covid-19 pandemic, mental health and substance use disorders have increased, especially for those on Medicaid. The American Rescue Plan Act (ARPA) improved Medicaid funding for behavioral health providers and crisis services (Guth, 2021). The Build Back Better Act (BBBA) was passed by the House in November of 2021. The BBBA built on the ARPA to expand funding for community mental health centers. The new push is to institute Certified Community Behavioral Health Clinic (CCBHC). These clinics are designed to be comprehensive in the care that they offer, including mental health care, substance use services, and even primary care services all embedded in a single location. Per the National Council for Mental Wellbeing (2020), there are now 430 CCBHCs in 42 states across the country and more are opening National Council for Mental Wellbeing. They are similar to Federally Qualified Health Clinics (FQHC) in that they are an “integrated and sustainably-financed model for care delivery” (National Council for Mental Wellbeing, 2020). A CCBHC must ensure access to care including mental health, substance use, and 24/7 crisis response. Care must be evidence-based. There are strict criteria for timeliness of access, reporting requirements, staffing, and coordination with law enforcement and social services. To do all this there is special funding that is available for clinics that apply and qualify to become a CCBHC. I’m proud to say that my clinic in Washington is a CCBHC.

The stakeholders for mental health care are immeasurable because nearly anyone has something to do with mental illness. The private stakeholders would be those suffering from mental illness, their families, and their friends, insurance companies, providers, hospitals, and clinics. Public stakeholders include law enforcement, paramedics, hospitals, and cities. While you may not think about mental illness as including depression, ADHD, or anxiety, but rather diagnoses like psychosis or schizophrenia, all those diagnoses are considered a mental illness. Therefore, you likely know someone that struggles with mental illness, or you’ve seen people around your town that are behaving oddly. These individuals deserve the ability to access and engage in treatment just the same as you or I do.

There are several organizations that make it their mission to help those with mental illness and push for policy changes. The National Institute of Mental Health is the main federal agency for research on mental disorders and is part of the National Institute of Health and the US Department of Health and Human Services (National Institute of Mental Health, n.d.). Mental Health America works at promoting mental health awareness, prevention, and intervention for those that need support and work toward recovery (Mental Health America, 2022). The National Alliance on Mental Illness works towards advocacy, education, support, and awareness of mental illness. They work toward these goals for those who suffer from mental health concerns, families, and friends of patients (NAMI: National alliance on mental illness, 2022). All these organizations offer different opinions and thoughts about how to improve mental health care, but they all agree that we need more access to care. 

Stefanie: 

Hi everyone,

    Behavioral health and substance abuse/addiction have always been important areas that contribute significantly to overall well-being to me. As mentioned, many times in the HarvardX videos, it is mostly because of many of my family and friends that suffer from and live with these conditions. It is saddening that many of my friends from high school are longer on this earth due to overdoses or suicide. “Over the last two years, behavioral health (BH) has been one of the biggest growth areas in the health care ecosystem, fueled by the Public Health Emergency (PHE) but in many ways, ignored, overlooked, understaffed, and underfunded element of care delivery in the United States” (Donovan et al., 2022). Koons (2019) states, failures of the mental health system contributed to trends that have lowered U.S. life expectancy over the past three years. It made sense when listening to the HarvardX presentation when talking about financing and structure that the one of many reasons for this failure is because there really is not a system. “Commissioners have tried to patch together a series of financing structures to pay for services” (edx.org, 2022). This clearly does not work and makes access and payment difficult for these desperately needed services. 

    “The Department of Labor (DOL) has made enforcing the Mental Health Parity and Addiction Equity Act (MHPAEA) a priority” (Donovan et al., 2022). The DOL is now requesting that health plans and health insurance carriers provide documentation proving that they have reviewed non-quantitative treatment limitations (NQTLs) MHPAEA compliance (Donovan et al., 2022). As a result of COVID-19, telehealth services have expanded across the health care system, especially in behavioral health. Organizations, facilities, and other health insurance providers need to be monitored and held accountable to ensure that they are providing mental health and addiction services especially in a time when most are working remotely. The 2 out of the 5 most common NQTLs found non-compliant that I found interesting were “limitation or exclusion of applied analysis therapy or other services to treat autism spectrum disorder and requiring Mental Health (MH)/Substance Abuse Disorder (SUD) providers to bill through specific types of other providers” (Donovan et al.,2022). This required analysis is called the Mental Health Parity Compliance Act which was introduced to Congress and is still in progress.

    “Mental Health America (MHA)-founded in 1909- is the nation’s leading community- based nonprofit dedicated to addressing the needs of those living with mental illness and to promoting overall mental health” (mhanational.org, 2022). MHA worked alongside policy experts, practitioners, and other community leaders to support and promote the Mental Health Services for Students Act of 2020 (mhanational.org, 2022). This act was designed “to amend the Public Health Service Act to revise and extend projects relating to children and to provide access to school-based comprehensive mental health programs” (congess.gov, 2020). This passed the House of Representatives on 9/29/2020. As mentioned in HarvardX (2022), majority of mental health disorders are actually first prevalent in children. School should not only a place where children go to get an education but also should get support and counseling if needed for mental health treatment and screenings for prevention