End stigma of behavioral health

Posted Sept. 02, 2009, at 6:57 p.m.

National health care reform provides us the opportunity to fix our system of care for people in need of mental health and substance abuse treatment. It is time to address the fragmentation and inadequacy of our current system and end the stigma associated with seeking behavioral health services.

In recent years, science has dramatically advanced our understanding of and treatment for people living with mental illness and substance addiction. Good comprehensive care can mean the difference between a productive life and one of handicapping disability, poverty and ongoing crisis. Access to these services, however, re-mains out of reach for far too many Americans.

Heath care reform must establish mental health and substance abuse parity, integrate mental and physical health care, promote wellness and provide affordable coverage and quality services for everyone.

Historically, insurance companies limited mental health coverage by requiring higher co-payments and stricter financial limits on mental health treatment than was imposed on other types of illnesses. Yet with the tremendous advances in neuroscience over the last 20 years, there is no longer any rationale for this discrimination. Mental illness and substance addiction are treatable and should be covered similarly to conditions such as diabetes or heart disease.

Leaders from both parties in Congress have acknowledged the need for changes in the private insurance market to establish mental health parity — the requirement that insurance companies provide mental health coverage to the same extent that they provide coverage for physical health problems. Last year, Congress passed the Wellstone-Domenici Parity Act, which applies mental health parity to all group health plans with more than 50 employees. The health care reform legislation currently moving its way through the House extends this provision to all participating health care plans. Unfortunately, the health care reform bill released in July by the Sen-ate Health, Education, Labor and Pensions (HELP) Committee does not include such a provision. It is critical that the final bill include the House’s provision to provide mental health and substance abuse coverage parity.

Health reform measures must also facilitate the integration of physical and mental health care. People with serious mental illness often do not receive adequate care for their physical health and are at higher risk for obesity, heart disease and chronic obstructive pulmonary disease. They die, on average, 25 years sooner than the general population. Requiring health insurance plans to provide financial incentives for more integrated care through medical homes, chronic disease management, better care coordination, prevention and wellness activities is an important step toward reducing these health problems among people with mental illness.

Health care reform must also make coverage affordable. Many people with mental illness and substance addiction are uninsured and unable to obtain treatment. They often are without ongoing care to help manage their illness. Many end up in the hospital requiring much more expensive acute care. Expanding the availability of Medicaid is part of the solution to this problem. Health reform should provide Medicaid coverage for all people with income below 150 percent of the poverty level and should provide those with income above that level sufficient assistance to make their health insurance affordable. People would then be able to get the care they need — when they need it — to prevent ongoing crises and expensive hospital admissions.

The prospect of health care reform offers great hope for people with mental illness and substance addiction. Parity, integrated physical and mental health care and affordable coverage are critical if we are going to provide the comprehensive care that leads to healthy outcomes.

As the debate moves forward, I hope that members of Maine’s congressional delegation, who have championed this issue in the past, will continue to work to assure that the health reform package includes both better access and improved quality of care for those with mental illness and substance addiction.

Kim Moody is the executive director of the Disability Rights Center in Augusta.

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