January 2009

Dear Member:

Re: Economic Recovery and Healthcare Reform — Opportunities for Mental Health and Addictions

Happy New Year.

In December, our Communications Director, Meena Dayak, passed on a request from Mental Health Weekly, asking for your responses to three questions:

• What are the most pressing challenges you expect your program or organization to face in the coming year?
• How do you plan to address them?
  
• As 2009 approaches, what are you most excited about?
  

The responses were not merely grim, they were frightening. Our already frayed safety net is near collapse.

Member after member in every state reported cuts that mean curtailment of services and access, further erosion of the workforce and quality, and in some cases, the possibility of not making payroll. Years of federal and state neglect coupled with the economic downturn have caught up with us. And we are culpable, accepting blame for inadequate services and agreeing that we just needed to reorganize, to transform, to be more efficient, and to work harder.

The time has come to end the charade. To many people, healthcare reform means universal coverage and the National Council views universal coverage as an American right. However, for people with serious mental illnesses and addictions, universal coverage isn’t enough. Under the banner of state rights, the federal government shifted financial responsibility for those with the most serious mental illnesses to states and states in turn downloaded the risk but not the resources to counties and not for profits. The result – financially fragmented, grossly underfunded, and insufficient community services.

2009 is a critical year. Promised economic recovery and healthcare reform legislation are opportunities for meaningful financial commitments to mental health and addictions services and the National Council is offering a practical actionable agenda:  

• The integration of primary care services in behavioral health settings: The National Council’s Healthcare Collaborative Project brings together behavioral health and primary care organizations offering a bi-directional approach for care. The need for behavioral health services in primary care is widely accepted. But the integration of primary care services in behavioral health settings remains controversial despite the fact that individuals with serious mental illness appear to have the worst mortality rates in the public health system. Therefore the National Council is actively pursuing single points of accountability to enhance continuity of care for this underserved population.
• Cost-based-plus financing that supports service excellence: People want and deserve quality services but quality services depend on skilled staff. Low salaries have created — and are perpetuating — a recruitment, retention, and quality crisis for behavioral healthcare. We need a workforce of skilled staff delivering nationally recognized practices within organizations that live by the rule “If you don’t measure it, you can’t improve it.”For the National Council, healthcare reform is an opportunity to bring “parity” to public mental health services by ending the second class status of community mental health and addiction providers in America’s safety net.
• Federal mental health funding stream dedicated to mental health and integrated treatment services for the uninsured: The uninsured have exceptionally high rates of untreated mental illnesses with co-occurring addiction disorders and there is no safety net.State plans to cover the uninsured have all but disappeared and federal universal coverage plans may well be incremental. We have large numbers of individuals with treatable mental illnesses and addictions in our overburdened emergency rooms, in jails, and on the streets with no access to services that can engage them, treat them and return them to work.We must stop denying our economy productive taxpayers and wasting human lives.
• Eligibility for social security disability for people with addiction disorders: Addiction has come a long way from the days when it was perceived as merely a failure of will. Today, there is growing public awareness and acceptance of addiction as a chronic, relapsing condition that requires continual monitoring and management, as do other chronic illnesses like diabetes, asthma, and hypertension and yes, mental illness. If we accept addiction as a chronic illness then we must advocate that people with addiction disorders be eligible for disability support.
• Funds to support investments by behavioral healthcare organizations in information technology: We talk about information technology and service transparency, but behavioral healthcare organizations that move forward to automate their clinical systems get no support, funding, or technical assistance. We and those we serve cannot continue to be marginalized. Healthcare reform and economic recovery will depend upon the expansion of information technologies and behavioral health providers must be included.
• Expansion of research-based education and prevention practices: There are mental health and addiction prevention and education programs that work. These include research-based prevention initiatives that reduce the risk of childhood serious emotional disturbance by treating maternal depression, the Nurse-Family Partnership Program that has an array of consistent positive effects across multiple trials, and Mental Health First Aid — an evidence-based mental health literacy program. Now we must adequately fund and support the spread of these interventions to communities across the country.

2008 brought an array of hard won legislative successes including the delay of damaging Medicaid rehabilitative and case management rules, introduction of the Medicaid Services Restoration Act, passage of Medicare parity, community mental health and addictions services for veterans, service collaboration with criminal justice, expansion of the disability definition in the ADA, and, finally, the passage of parity to end health insurance discrimination.

Over the coming weeks and months, we’ll be moving our 2009 legislative agenda — holding a series of conference calls to outline strategy, working with state and local associations to coordinate advocacy efforts, redoubling our key contact club recruitment efforts, hosting a healthcare reform town hall at our conference in San Antonio, and asking every member organization to join us in June for Hill Day. We must not lose momentum.

In difficult times, the temptation is to turn inward, preoccupied with day to day survival. We need to resist the temptation and to work together as never before. Few understand what it takes to deliver the quality, comprehensive treatment, and support services that can lead to recovery, that can help avoid homelessness, incarceration, and alienation. In fact it’s not in the interest of some groups to understand – it’s too complex and it’s too expensive. But we understand and we have an obligation to act.

Mental illnesses and addictions are bipartisan, pervasive, and expensive and have profound consequences for people's lives — yet support for care is not commensurate with impact. The National Council sees economic recovery and healthcare reform as opportunities to right this wrong.

Please let me hear from you, you can reach me at LindaR@thenationalcouncil.org or 202.684.7457, ext. 227.

Best Regards,
Linda Rosenberg, MSW
President and CEO
National Council for Community Behavioral Healthcare