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Mental health advocate Patrick J. Kennedy talks to Managed Healthcare Executive about reform, mental health equity, and how payers can help integrate care in mental health.
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.
Q: MHE: You have been the leading force in the creation of The Kennedy Forum and One Mind. How would you describe the focus and purpose of each organization?
Kennedy: Through these two nonprofit organizations, we hope to change the landscape around mental illness, addiction, and other brain diseases globally.
The Kennedy Forum aims to revolutionize the way mental healthcare is delivered. We brought together the best minds in the field to develop a strategic plan for moving the nation forward and uniting the mental health community around a common set of principles, including fully implementing the 2008 Mental Health Parity and Addiction Equity Act; bringing business and government together; working with providers to guarantee equal care access; ensuring that policymakers have the tools they need; and educating everyone on the benefits of parity and the need to eliminate stigma.
One Mind is pioneering a worldwide approach to open science that ensures scientific research, results, and data are available to researchers everywhere. Current initiatives focus on improving research and treatment for post-traumatic stress and traumatic brain injury, with the intention of extending One Mind’s open science principles to all brain diseases.
Q: MHE: Your leadership helped result in the passage of the Mental Health Parity and Addiction Equity Act in 2008. How are we doing with implementation?
Kennedy: We have a lot more to do. Federal and state regulatory agencies need to help end the secrecy that allows insurers, including the government, to discriminate against people experiencing mental illness and addictions, and demand detailed disclosures of how insurers make coverage decisions. The law has required this disclosure since the Parity Act was passed in 2008, but both private and public health insurers still haven’t complied.
Greater transparency is the only way to make sure that insurers are complying with the Parity Law and treating medical/surgical cases on par with mental health cases. We aren’t singling out private insurance companies; we are also calling on the major public insurers to disclose this information as well.
I’m also creating report cards for each state that allow advocates to research whether individual health insurers are in compliance. I want to create a registry of mental health denials and take the valid complaints to the insurers, and say, “What are you going to do about it?” Liability sparks interest. The resulting pressure will help maintain and improve the current system.
Q: MHE: You have advocated to have mental illness be considered a disease the same way we consider cancer or heart disease as diseases. Would you advocate changing the way we refer to the problems to something like “brain disease” to help reduce the stigma of mental health and addiction?
Kennedy: Yes. It’s common sense to say that the brain is part of the body, and diseases of the brain must be treated like diseases in other parts of the body. The language we use can be a powerful force in reducing stigma and encouraging long-term recovery.
I invite readers to check out “The National Behavioral Health Platform: A Nonpartisan Approach to Mental Illness and Substance Use Disorders,” at the end of the paperback edition of my book with Stephen Fried, “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction.”