Mental health: The secret sauce to healthcare reform
Mental health conditions affect tens of millions of Americans each year, but, according to the National Institute of Mental Health (NIMH), only about half receive treatment. Furthermore, serious mental illnesses, meaning severe disorders that affect about 6% of adults, have estimated costs of over $300 billion annually, according to NIMH.
“Mental health is the ‘secret sauce’ of healthcare reform. It can bring savings and profits to executives if they can more effectively get their arms around mental health and addiction issues,” says Patrick J. Kennedy, former member of the U.S. House of Representatives (D-Rhode Island) and leading political activist on mental illness, addiction, and other brain diseases. “These managed care executives need comprehensive research that will allow them to identify specific treatments for separate conditions.”
Managed Healthcare Executive (MHE): The stigmatization of mental illness and addiction is an over-arching issue for providers, insurance companies, the police and general public. What steps, as a society, can we take to begin overcoming this?
Kennedy: We need to tell our stories. Once you learn that your coworker is in recovery for opioid addiction, or has been successfully treated for depression, it’s harder to think of them as “the other.” Once you learn that your neighbor’s daughter has an eating disorder, you can’t help but feel compassion. The more we talk about this reality, the more we’ll realize that we have a responsibility to help create a safe and welcoming environment where our brothers and sisters feel comfortable stepping forward and getting treatment.
Mental health is seen as a carved out piece of the healthcare space—it’s been defined as those with a primary diagnosis of mental illness or addiction. However, those with a secondary mental health diagnosis often don’t receive necessary care. Additionally, a lack of integration with mental health can make it difficult for these illnesses to be treated appropriately, or even detected in the first place. For example, primary care physicians are responsible for over 70% of antidepressant and anticonvulsant prescriptions, despite having little to no training in evaluating patients with a secondary diagnosis of mental health or addiction. Furthermore, if someone has multiple ER and hospital visits for lacerations or contusions, care providers may not even ask about underlying conditions and addictions contributing to repeat visits.
Q: MHE: You have been an advocate for insurance coverage of an annual “exam from the neck-up” for mental illness as part of the traditional “annual physical.” What type of testing would you recommend be incorporated and what tools exist to help primary care physicians identify possible mental health issues?
Kennedy: Yes, thanks to the Mood Disorders Association of Ontario, which coined the term “checkup from the neck up” and allows me to use it. Every medical exam must include a mental illness and substance use disorder evaluation and, when needed, an aggressive plan for early diagnosis and intervention. Healthcare providers should be required to take additional medical classes on current brain health issues to ensure they’re prepared to deliver these screenings. Insurers should encourage these screenings through reimbursement and require that providers consistently use standardized outcomes measures to track patient progress.