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APA and the federal Substance Abuse and Mental Health Services Administration (SAMHSA) must work together to convince policymakers to broaden insurance coverage for mental illness and substance abuse, SAMHSA Administrator Nelba Chavez, Ph.D., told participants at APA's Institute on Psychiatric Services in Los Angeles October 2.
Recent studies have concluded that parity for mental illness and substance abuse "would not break the bank," said Chavez. Now SAMHSA's challenge is to translate surveys and data into policy. An even greater challenge is obtaining "the resources to implement some of those policies," she added.
APA and SAMHSA should work together to overcome stigma and encourage more and better treatment for mental illness and substance abuse, said Chavez. One concrete step would be for SAMHSA to encourage managed care organizations to adopt the APA practice guetidelines on depression and anxiety disorders, she added.
Partial parity legislation enacted so far has been but "a baby step," said Chavez. Despite a number of passionate advocates for parity in Congress, she said that she does not "see that movement out there." Lack of parity continues to hurt "the folks we really care about," she added. APA must continue its strong advocacy for parity, she urged.
All Americans pay for lack of parity, Chavez observed. One in five American children and adolescents has a serious mental disorder, yet 60 percent lack access to the services they need. Only 25 percent of the 50 million Americans who experience a mental disorder in a given year receive treatment. The costs are "needless suffering, compounded medical conditions, suicide, domestic violence, unemployment, drug addiction, and crime," she said.
In struggling to define a role for the federal government in health care, it is necessary for policymakers to understand whether managed care trends represent appropriate cost control or denial of services, Chavez said. More than 150 million Americans enrolled in employer-sponsored managed health plans "are at risk because of distorted attitudes and beliefs about mental illness," she noted. These beliefs lead many managed health plans to deny coverage for mental illness and substance abuse disorders.
As part of the battle to change the way Americans think about mental illness and substance abuse, SAMHSA will work with U.S. Surgeon General David Satcher, M.D., to develop, for the first time, a Surgeon General's report on mental health next year.
Satcher "has really made mental health one of his priorities," said Chavez. "We see this [report] as very, very important." The hope is that the new report will transform public attitudes on mental illness, just as the Surgeon General's report on smoking and health transformed attitudes on smoking.
"You should not expect anything less," she said. "I believe that mental health services are a basic, essential human right."
People need not only "access to knowledge, but also access to services," she continued. "If this does not happen, we are not going to be a healthy nation."
SAMHSA needs help from clinicians in shaping public attitudes and policy, said Chavez. "You're out there on the front lines. You're out there in the trenches." Psychiatric clinicians must continue to educate the public and policymakers regarding the nature and treatment of mental disorders.
Although state block grants have, in many cases, worked well in giving states the means to fund mental health and substance abuse services, there has been no increase in the overall federal block grant for mental health services in six years, she added. SAMHSA currently has a $2.3 billion budget, much of which goes to block grants, she said.
Although the federal government can provide significant program funding, SAMHSA is also "trying to negotiate with partners outside government" so that good pilot programs don't disappear when federal funds dry up, she noted.
One problem in how states use federal block grants, as well as state funds, is that in many states "the mental health commissioner, substance abuse director, and Medicaid director don't know each other," she observed. This fragmentation results in unnecessary duplication of services, higher administrative costs, and poor continuity of care.
While state governments must work toward the better integration of mental health and substance abuse services, SAMHSA has launched an initiative to train state program directors to negotiate better managed care contracts, Chavez said. SAMHSA is also working with the federal Health Care Financing Administration (HCFA) and state Medicaid officials to train administrators how to better understand and apply survey data on the prevalence and impact of mental disorders.