July | August 2017






Mental Health Experts Weigh in on Health Care Reform

By Samantha-Jane Harris, CSG Fellow
In health, states increasingly look to prevention and early intervention as ways to provide better health outcomes and to reduce health costs. Models of mental health care reform also are moving toward a complete behavioral health system with the goal of providing patients with early access to treatment. “Mental health conditions are the only chronic conditions that we wait until Stage 4 (the most severe stage of illness) to treat,” said Debbie Plotnick, vice president for mental health and system advocacy at Mental Health America at the CSG Medicaid Policy Academy in Washington D.C. in September.
“And then it is almost always only through incarceration,” Plotnick added. “We know that at least 15 percent of men and 31 percent of women in jails and prisons have diagnosable behavioral health issues. It is really the unpleasant reality we are in right now.” Plotnick made the parallel between the stigmatization of mental illness and the stigmatization of cancer years ago when patients—often isolated in hospitals—felt shame, received pity and took harsh medical treatments for their conditions. She said that people used to whisper about “the big C,” but no longer do so today.
Unfortunately, said Plotnick, people still tend to whisper about mental health complications. “We have to increase the number of people who are willing to have a conversation,” said Steve Shannon, executive director of the Kentucky Association of Regional Planning, the statewide group for community mental health centers.
“We need to pay more attention to early signs. We understand what we need to be doing; we just need to not be afraid to talk about it. We need to be proactive.” Early intervention is a priority among legislators.
“Early intervention in the area of children and maternal care is needed to ensure that children grow up in positive environments instead of toxic environments,” said Rep. Susan Lontine of Colorado, reacting to recent research on how toxic environments negatively affect both physical and mental health outcomes.
Florida is among states that are working to increase access to early identification and treatment of mental health conditions. Two years ago, the state started a Community Action Team to work with troubled youth with the goal of early intervention to address mental health needs. Since then, Florida has added 17 teams that provide wrap-around services at the cost of $34 per day per patient as compared to $400 per day when a child is institutionalized.
Florida also started the Family Intensive Treatment Team that works to address behavioral health issues holistically in families in which parents also face mental health challenges.
In addition to providing care more holistically, the program also saves taxpayer dollars, said Florida state Rep. Matt Hudson.
“There is somewhere around $10,000-$12,000 cost per year to run these programs, but putting someone in a mental health facility costs $100,000 a year,” said Hudson. “The outcomes have been staggering.”
According to Plotnick, programs that address the various needs of individuals with mental health conditions, such as housing and job training, provide a much better return on investment than either institutionalization or imprisonment. What’s more, she said, it offers “tax drainers the opportunity to realize their potential and become tax payers.”
“Ultimately, there are things we should be looking out for and doing that we’re not,” Shannon noted. “The sooner the treatment, the better the treatment; the longer you wait the worse it is. We all know this. Mental health first aid is the answer.”
During a CSG eCademy session last year, Byron Gibb, director of public education for the National Council for Community Behavioral Health Care likened mental health first aid to first aid or CPR. “It teaches how to reach out to people, refer them to services and de-escalate a crisis,” Gibb said.
According to Gibb, an eight-hour training program in mental health first aid is offered by more than 4,000 certified instructors in every state, as well as Guam and Puerto Rico.
Mental health first aid teaches the signs of addictions and mental illness. It includes a five-step action plan to assess a situation and help and provides information about the impact of mental and substance use disorders, local resources and where to turn to for help.
Statewide programs in Arizona, Colorado, Georgia, Maryland and Missouri require some public employers to undergo the training as part of their jobs. In Rhode Island, police officers are required to take mental health first aid.
By addressing behavioral health issues early, experts argue, there are a number of advantages, including cost. “We can talk about return on investment and savings, but I prefer talking about cost avoidance,” says Shannon. “You’re not going to have to spend any money if we take care of people early and correctly.”
CSG Resources:
Debbie Plotnick Presentation
CSG Webinar on Mental Health First Aid 2014
Additional Resources:
Mental Health First Aid
http://www.mentalhealthfirstaid.org/cs/ Mental Health America- www.mentalhealthamerica.net

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