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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

From 2017 to 2018…

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Asked to write a column for Mental Health Weekly’s Special Preview Issue, it was a chance to connect with Mental Health Weekly’s audience and then to share the piece as my first blog for 2018. But limited by space in both the column and blog forced choices on the focus of content.

There are so many topics I was unable to cover including leadership and workforce; NatCon17 our annual conference; improving practice and measuring care; partnerships with other organizations including member agencies; Hill Day 2017; the struggle to get services for a loved one; the complex business of health care; and the issues and areas of agreement and disagreement about policy and practice. I remind myself that in 2018 I’ll have the opportunity to examine these topics and more.

But what makes written pieces come alive is feedback from you, the audience. I invite you to take a few minutes to read the 2017 reflections below, and then share what’s on your mind. I look forward to what we can accomplish together in 2018.

In 2017, we held our own; in 2018, let’s do what works
by Linda Rosenberg

I measure the success of a year by my answer to the question, did we improve the lives of people affected by mental illnesses and addictions?

2017 is a year when perhaps the best I can say is we held our own in the face of attack. It was a year bookended by bad ideas. We began with a health care bill that, had it passed, would have radically restructured Medicaid and used the savings to give tax cuts to the wealthy – and we ended the year with a tax bill that provides tax cuts to the wealthy and repeals the Affordable Care Act’s individual mandate, potentially eliminating health insurance for 13 million Americans. With entitlement “reform” on the table for early 2018, the war on Medicaid, Medicare, and all income supports continues.

In between, we declared the opioid crisis a public health emergency, but the federal investment required to stop our family members, friends and coworkers never materialized. The CDC reported that more than 42,000 Americans died of opioid overdoses in 2016, a 28 percent increase over 2015 and said that, “we could very well see a third year in a row. With no end in sight.” In 2018, our job is to compel Congress to provide the resources required to address this crisis, with its attendant drop in life expectancy.

Toward the end of the year, a bright spot emerged when the federal Interagency Serious Mental Illness Coordinating Committee (ISMICC) recommended expanding Certified Community Behavioral Health Clinics (CCBHCs), strengthening the workforce and addressing the needs of individuals with mental illnesses in the justice system. We applaud the work of this group, and need to ensure this is not just another report on a shelf. In the coming year, we will work hard to make sure the recommendations set the stage for investments in mental health.

Investments that must support the work of states, local governments, and health and behavioral health systems and organizations – our living laboratories for change. We are on the cusp of a tipping point thanks in good measure to the federal Center for Integrated Health Solutions. Increasingly, behavioral health is practiced in integrated care settings, and the National Council is honored to promote full integration between primary and behavioral health care across the lifespan.

In 2017, we saw people freely share their stories of recovery from mental illness and addiction, and this simple, brave act is breaking down barriers. Through a partnership with Lady Gaga’s Born This Way Foundation, an additional 150,000 individuals are newly minted Mental Health First Aiders. And the International Association of Chiefs of Police is calling for 100 percent of its sworn officers to be trained. Since introducing Mental Health First Aid to the United States 10 years ago, more than one million people from all walks of life have been trained to recognize the signs of a mental illness or addiction and connect someone to help.

Through all the ups and downs of 2017, the National Council –our board and our members – held steadfast to our belief that health care is a right, not a privilege. We won the initial battle to protect Medicaid, but the health care war rages on, and individuals with mental illnesses and substance use disorders are the ultimate casualties.

A Community Solution

The solution is at hand. Just six months after launch, the CCBHCs authorized by the Excellence in Mental Health Act are adding new staff, offering integrated treatment, expanding crisis services and using mobile apps and telehealth to extend their reach. They have increased access by 25 percent, and many are seeing patients the same day they call. Nearly 80 percent of CCBHCs have initiated or expanded medication-assisted treatment, a lifesaving treatment for opioid addiction.

In return, CCBHCs receive a Medicaid rate based on the actual costs of providing treatment, allowing them to hire psychiatrists and other professionals to meet patients’ multiple and complex needs. The shortage of behavioral health practitioners is one of the most significant treatment barriers people experience, and CCBHCs are helping close this gap. So, too, will the Mental Health Access Improvement Act, which will bolster the workforce by allowing licensed marriage and family therapists to independently bill Medicare for their services. We urge Congress to pass it.

Ultimately, we need CCBHCs in every community in America. We support the bipartisan Excellence in Mental Health and Addiction Treatment Expansion Act, which would extend CCBHC operations by an additional year in the current eight states and allow 11 more states to participate. We wholeheartedly agree with ISMICC’s recommendation to make the program nationwide. We haven’t a moment to lose. We must do what we know works, because people are literally dying for our help.