[NYAPRS Enews] U.S. Mental Health Experts Testify at Senate Hearing: Reuters

Fri Jan 25 08:07:58 EST 2013

NYAPRS Note: While the articles below provide some of the telling points
make yesterday in a Senate hearing on our mental health service systems,
please do take a look and listen to the actual testimonies. Both Mike
Hogan and Larry Fricks went 'off script' and provided some very strong,
insightful and inspiring comments, as did SAMHSA Administrator Pam Hyde.
Watch it at: 

http://www.c-span.org/Events/Experts-Testify-on-State-of-the-US-Mental-H
ealth-System/10737437542-1/ 

U.S. Mental Health Experts Urge Focus on Early Treatment

Top of Form

By David Morgan, Reuters  January 24, 2013

WASHINGTON - The U.S. mental health system has huge gaps that prevent
millions of people with psychological problems, including children and
teens, from receiving effective treatment that could prevent tragic
consequences, experts told U.S. lawmakers on Thursday.

Just over a month after the shooting rampage in Newtown, Connecticut,
experts told a Senate hearing that three-quarters of mental illnesses
emerge by age 24, but fewer than one in five youths with diagnosable
problems receive treatment that could avoid later problems including
violence and suicide.

Overall, experts said as many of 45 million Americans experience mental
illnesses such as depression, eating disorders, post-traumatic stress
disorder and drug abuse each year. But only 38 percent get treatment.

"These are the chronic disorders of young people," said Dr. Thomas
Insel, director of the National Institute of Mental Health.

The hearing, before the Senate Health, Education, Labor and Pensions
Committee, was held in response to the shootings at Newtown's Sandy Hook
Elementary School, where a young 20-year-old man described as having
mental issues gunned down 26 people including 20 young children with
assault rifle on December 14. It was the first time the committee has
addressed the issue of mental health since 2007.

The Newtown tragedy and other mass shootings in recent years have
ignited a debate about gun control and mental health, including a push
by President Barack Obama for stronger gun controls and better mental
health training for schools and communities.

But the committee's Democratic chairman, Tom Harkin, warned against
drawing a bold parallel between mental illness and violence against
others.

"One of the most insidious stereotypes about people with mental illness
is that they are inherently violent," said the Iowa senator. "People
with mental illness are much more likely to be the victims of violent
crimes than they are to be perpetrators of acts of violence."

Insel said a relatively small number of mentally ill people, who suffer
from symptoms such as paranoia and hallucinations, are violent. "Far
more common than homicide is violence against the self," he said,
pointing out that 90 percent of the 38,000 suicides each year involved
mentally ill people.

All told, he said, the risk of violence, including suicide, among people
who develop mental illness is 15 times greater without treatment.

Experts cautioned that treatment should avoid powerful drugs for
children who are often vulnerable to side-effects and recommended extra
care to ensure that the normal behavioral problems of childhood and
adolescence not be mislabeled as mental illness.

In response to the Newtown tragedy, Obama has announced a series of
initiatives intended to help teachers and other adults identify
children, adolescents and young adults with mental illness and ensure
they receive treatment.

Experts said Obama's healthcare reform law is expected to lead to the
biggest increase in mental health access in a generation. After January
1, 2014, it is scheduled to extend health coverage to millions of
Americans currently locked out of the $2.8 trillion U.S. healthcare
system because of a lack of insurance.

Pamela Hyde, administrator of the U.S. Substance Abuse and Mental Health
Services Administration, said that as many of 10 million people with
mental illnesses could gain access to care as a result of the Patient
Protection and Affordable Care Act. "Prevention works. Treatment is
effective. And people recover," she said.

But Senator Patty Murray, a Democrat from Washington state, expressed
concern that the Obama administration is not moving fast enough to
produce detailed rules on how mental health access should be made
available through new state-based online health insurance marketplaces
being set up under the law.

"It's really essential that we see a final rule before April," Murray
told Hyde. "Our states are working on the exchanges and they need that
clarity. I can't urge you strongly enough."

Hyde said a final rule on essential benefits is due next month. But she
could not say whether a separate rule on mental health parity would meet
Murray's deadline.

http://vitals.nbcnews.com/_news/2013/01/24/16681269-us-mental-health-exp
erts-urge-focus-on-early-treatment?lite

----------

Mental health: Will It Fall Between The Insurance Cracks?

By Allison Bell Life Health Pro  January 24, 2013

Regulators have to do more to make sure that two major federal laws
already on the books really improve access to mental health care
insurance benefits.

Witnesses delivered that message today in Washington at a hearing on the
state of the U.S. mental health care system that was organized by the
Senate Health, Education, Labor and Pensions Committee
<http://www.help.senate.gov/hearings/hearing/?id=b2048a10-5056-a032-529c
-340d7ae5f237> . 

The committee organized the hearing in response to the mass shooting in
Newtown, Conn., to look at how the United States might be able to
improve the way it manages psychological problems that lead to violence.

Pamela Hyde, the administrator of the Substance Abuse and Mental Health
Services Administration (SAMHSA), noted at the hearing that "most people
who are violent do not have a mental disorder, and most people with a
mental disorder are not violent."

"Demographic variables such as age, gender and socioeconomic status are
more reliable predictors of violence than mental illness," Hyde
testified, according to a written version of her remarks posted on the
committee website. " These facts are important, because misconceptions
about mental illness can cause discrimination."

Patients and their families now get 69 percent of the cash used to pay
for mental health care from state and federal government programs, 12
percent from their own personal resources, and 27 percent fromprivate
insurance plans, Hyde said.

One of the major laws governing private health insurance benefits for
mental health care, the Mental Health Parity and Addiction Equity Act of
2008 (MHPAEA), affects insured and self-insured group health benefits.

The MHPAEA does not require an employer to offer coverage for mental
health or substance use disorders.

If an employer with 50 or more employees does offer mental health or
substance abuse benefits, then the financial requirements and treatment
limits for the behavioral health benefits can be no more restrictive
than the typical requirements for benefits for other types of disorders.

The federal departments in charge of implementing the MHPAEA -- the U.S.
Department of Health and Human Services, the U.S. Labor Department and
the U.S. Treasury Department -- put the law into effect with temporary
regulations in July 2010. A lack of final regulations interferes with
efforts to enforce the law, critics say.

Another law, the Patient Protection and Affordable Care Act of 2010
(PPACA), is set to require all non-grandfathered individual and small
group plans to offer an "essential health benefits" (EHB) package that
includes coverage for mental health and substance use disorder services
starting Oct. 1.

The Obama administration intends to move forward by issuing a final rule
on the EHB package and PPACA mental health benefits parity requirements
in February, Hyde said.

The administration also intends to put out an MHPAEA final rule, Hyde
said.

Michael Hogan, a former New York state mental health office commissioner
and the chairman of the President's New Freedom Commission on Mental
Health, said improving the mental health system "must begin with a
realization that we have begun to take big steps away from an approach
that was both separate and unequal."

Going forward, to get the most out of the new, expanded access to mental
health care benefits, mental health care providers should be providing
"collaborative care" in primary care office settings, Hogan said.

"Station a mental health practitioner in the practice," Hogan said.
"Screen for mental health problems, measure progress, allow billing for
basic mental health services like educating patients about managing
their depression, and ensure that a psychiatrist or other specialist is
available for consultation."

The country also needs better programs to help people who are showing
signs of having psychotic disorders find and stay on effective
medications, and get and keep jobs, Hogan said. 

Dr. Bob Vero, chief executive officer of Centerstone, a community mental
health center in Tennessee, testified that the Obama administration
needs to ensure that "behavioral health has a seat at the table" in new,
PPACA-driven efforts, such as the Medicare "accountable care
organization" (ACO) pilot program, to improve coordination of care. 

Hogan said he has concerns about having the people who manage general
health care take over managing care for people who are dealing with
serious mental illness.

Although the idea of integrating behavioral care with general primary
health care is a good one, "we do not yet have national standards for
the quality of care for people with serious mental illness, so the
transition away from expert leadership is risky," Hogan said. "We failed
to maintain focus during an earlier era of deinstitutionalization; we
must not make this mistake again."