Will Mental Health Be the Congress’ Bipartisan Swan Song?

After decades of being relegated to the back burner, the mental health system in America may as yet be revamped by Congress in November during what is traditionally known as the lame-duck session.

Following the enactment of a legislation addressing opioid addiction in July, lawmakers are on the brink of bringing forth sweeping reforms in mental healthcare. The new laws would boost the government’s efforts in increasing funding for the prevention, diagnosis, and treatment of mental illness. Advocacy groups are hopeful that the rancor of the presidential election will be put aside and the Senate will follow the House’s lead in approving the much needed bipartisan legislation.

“Close to 1000 Americans die every day from mental health related conditions – homicides, suicides, overdoses, and premature deaths of mentally ill homeless people,” says psychologist Tim Murphy (R-Pa.), chief sponsor of the bill. This is a problem of epidemic proportions and we have to take action, he elaborates.

With just 20 days in the November session, the worrisome question is whether other items on the agenda will leave the Congress enough time to pass this important legislation. Advocacy groups are optimistic. “This is a priority for both parties,” says Paul Gionfriddo, CEO of Mental Health America. The legislation will overhaul the nation’s mental health system and lay the groundwork for larger investments in training mental health professionals and improving services, he says.

There is a broad consensus amongst lawmakers that something needs to change. “Whenever I ask a room full of people if they’ve been touched by mental illness, hands shoot up,” says Senator Bill Cassidy (R-La.). The stress that mental health places on hospitals and prisons is all too evident. Tense encounters between mentally ill homeless people and the police are common. The rare, but devastating incidents of mass violence almost always involve a mentally ill person.

The financial burden of mental health conditions was estimated to be more than $200 billion in 2013, exceeding the money spent on cancer, heart disease, and trauma. More than 8 million Americans are living with bipolar disorder or schizophrenia, of which roughly half are not receiving any treatment. Major depression goes untreated in 64 percent of youth.

The Mental Health Reform Act, if passed by the Senate, will be less comprehensive than the Helping Families in Mental Health Crisis Act passed by the house in July, but it will build upon the framework laid by President Obama’s Affordable Care Act. These changes in policy are based on a growing body of evidence suggesting that early diagnosis and intervention can significantly impact the long-term prognosis of people with serious mental conditions. The key provisions of the Act include:

• Coverage of short-term inpatient stays in psychiatric hospitals under Medicaid managed-care programs
• Appointment of a new HHS assistant secretary for mental health and substance abuse
• Permission to bill Medicaid for same-day same-facility services for mental health and substance abuse
• Strengthening of the community crisis-response system
• Specialized training for first responders and law enforcement officers in dealing with mentally ill people
• Grants to improve crisis-response services and bed tracking for psychiatric inpatients
• Clarification on when providers may share information
• Enhancement in training of mental health professionals
• Early diagnosis and treatment of children with mental health conditions
• Reduced incarceration of non-violent offenders with mental health conditions

Mental healthcare providers say the legislation is a good first step, but will only authorize a modest increase in funding.

“We won’t have enough for everyone who needs it,” says Heather O’Donnell of Thresholds, a Chicago area community-based agency that works with mentally ill people. “What is really needed is greater Medicaid payment and broader insurance coverage,” she says.

Over half the counties in America do not have a mental health professional, so people cannot get the services they need, says Murphy. Bernard Tyson, CEO of Kaiser Permanente, agrees. Providers and health plans need to rethink their coverage of mental health conditions and launch broad initiatives to address deficiencies, he says. Kaiser has added telehealth sessions and employed more mental health providers as well as restructured its system to ease access to care.

All is not hunky dory, though. There are sharp differences over many issues such as the sharing of patient health information, the most effective approaches to treatment, and expanding Medicaid coverage. Nonetheless, experts agree that the legislation will lay the foundation for a more innovative and effective course in the diagnosis and treatment of mental illness.