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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Reality Check

September 20, 2016 | Time for Action | Comments
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I think of myself as someone who lives the values I hold dear. But reality can test our values every single day.

September is the real new year for me and I think for many others. September was the start of school, complete with the excitement and anxiety of a new class, new kids and new possibilities and challenges. Those feelings still return every fall. It’s become a time I take stock of how I’m living my life, of what’s important – personally and professionally.

I thought I’d share my updated list of what’s important to me and hope to hear from you about yours.

The work we do is of great value and should be paid for accordingly.

New overtime rules mean that staff working with people damaged by trauma, neglect and abuse, struggling with addictions and mental illnesses, will receive pay that more adequately reflects their important work. But, the gap between new pay thresholds and stagnant behavioral health rates is forcing good people to lobby against their values.

It’s time to close the gap between decent wages and reimbursement for services.

Every child belongs at home, in school and out of trouble.

With proper support, most children can stay where they belong. There are, however, children whose communities have failed them. There are children whose families have tried it all. If the family has financial resources, they hire an attorney and the school district is forced to pay for safe and therapeutic residential treatment. But, poor families are usually denied this alternative. Unable to hire a legal advocate, they take time off work, risking their jobs to navigate a complex web of agencies and services. They may even be forced to give up custody of their child to get needed services. And too often these children end up in the custody of juvenile justice. No one wants children sent away, but neither should we tolerate philosophies and policies that apply only to the poor.

It’s time that all children requiring highly specialized settings have access to those settings.

Every American should have equal access to mental health and addictions care.

In most states, people with serious mental illnesses qualify for Medicaid services, including case management, counseling, medication and other community supports. And now in Medicaid expansion states, there is a growing array of Medicaid-supported addiction treatment and recovery services. But, there are working people in those same communities who are denied a better life because they can’t get treatment. Escalating deductibles and copays are putting treatment out of reach for addiction and mental illnesses like anxiety, depression and OCD – conditions highly responsive to medication and cognitive interventions. Equally destructive are stagnant insurance reimbursement rates that have made behavioral health one of the few remaining cash-only businesses.

It’s time to make health care a right, not a perk for the highest earners.

Clinical competence matters.

My mother told me that you get what you pay for, and my mother is often right. To get services to where they need to be, the treatments delivered need to be based on the best research and delivered in a way that enables us to measure what’s working (or what isn’t). Unfortunately, science-based practice is limited. When a for-profit business wants to introduce a new product or service that research says is effective, they raise capital – hundreds of thousands of dollars, even millions. They hire experts, retrain staff and mount a high-priced marketing campaign. Not-for-profit addiction and mental health organizations have no access to capital, operate with slim to no margins and are increasingly unable to afford to recruit or retain skilled staff. As a result, most communities are unable to duplicate the services that research tells us work. As a result, tens of thousands of people are relegated to a life of disability.

It’s time to pay trained experts what they – and their patients – deserve.

In September 2016, we have a school-to-prison pipeline filled with poor children – often children of color. More people have health insurance, but can’t afford care. And we’re still waiting for the promise of value-based purchasing while the frayed behavioral safety-net is near collapse.

As the leaves turn, I have an agenda of solutions – solutions that align with what matters to me – making sure everyone gets the care that has the best chance of improving their lives.

What matters to you? And are you ready to turn those values into concrete action? If you’re ready to fight so those who need help can get it, I’d like to hear how. Our loved ones, friends and neighbors deserve nothing less.