Position Statement on Behavioral Health in National Health Care Reform

16 Foundations Nationwide Urge Focus on Behavioral Health Services

For decades, local, regional and national foundations have provided funding and technical assistance to improve behavioral health services (mental health and substance use services) across the United States. As policymakers wrestle with the details of national health care reform, the foundations listed below, including many members of Grantmakers in Health’s Behavioral Health Funders Network, urge decisionmakers to consider the crucial role of behavioral health as they reform our current health care system.

The Surgeon General has observed that “mental health is fundamental to overall health and productivity.”(1) Good behavioral health is essential to overall health and to our strength and economic prosperity as a nation. Mental illness and substance use problems are a leading cause of disability in the United States, presenting tremendous personal and financial costs to individuals and communities.(2)

Fortunately, there are proven interventions and straightforward policy mechanisms that can support efficient and effective behavioral health services. It is essential for these to be considered as part of overall health care reform. Specifically, the undersigned members of the philanthropic community encourage policymakers to address:

Integrated Health Care: For children and adults of all ages with mild to moderate symptoms, behavioral health problems often can be effectively addressed and treated in a primary care setting. For adults with more severe disorders, physical health care is essential, particularly given a recent study showing that people with severe mental illnesses die 25 years earlier than the general population, largely due to treatable medical conditions.(3) These individuals should have the option of accessing physical health care services at a community mental health center. Reimbursement mechanisms that cover integrated health care and a patient-centered health care home should be part of any efficient health care system.

Community-Based Services: Most individuals prefer to receive behavioral health services in their own communities, but currently a patchwork of local, regional and state systems provide widely varying services, leading to significant gaps in accessibility and coverage. Effective health care reform should support quality behavioral health services at the local level by establishing national standards and incentives (such as cost-based reimbursement) through a mechanism such as Federally Qualified Behavioral Health Centers modeled after our current Federally Qualified Health Centers.

Parity: Though regulations for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act of 2008 have not been finalized,(4) the law, which established parity of behavioral health with general health insurance coverage, should guide current discussions about designing insurance benefits packages and factors such as pharmaceutical discounting (including psychotropic medications). In an effective health care system, all major mental health disorders would be covered by all insurance plans.

Prevention and Early Intervention: Decades of research, reaffirmed this year in a groundbreaking federal report,(5) show that behavioral health problems can be prevented and intervening early is the most effective and efficient means to help our children lead fulfilling lives and grow into productive adults. Health care reform should cover early intervention for children exhibiting behavioral problems.

Workforce Development: Behavioral health faces severe workforce shortages than undermine access to quality services.(6) Recruiting and retaining a culturally and linguistically competent workforce is central to the provision of quality services. Modalities such as peer support can extend the current workforce and provide a cost-effective means to expand available services.

Health Information Technology: Health information technology has great potential for improving outcomes while reducing costs and empowering consumers. For electronic health records to be comprehensive, they must incorporate data related to all key components of health. Behavioral health information should be included in the process of creating secure, consumer-centered information technology systems.

In collaboration with many partners in the nonprofit and governmental sectors, the foundations listed below have funded numerous projects in support of the above strategies. We would be happy to share details and results of the projects or any other information that might be helpful to the health care reform process. Please consider us to be a resource and as always your allies in the struggle to provide quality behavioral health care services to all.

As of May 4, 2010, the following foundations have signed on in support of the Position Statement on Behavioral Health in National Health Care Reform (7):

Children's Fund of Connecticut (Farmington, CT)

Endowment for Health (Concord, NH)

Foundation for Community Health (Sharon, CT)

Foundation for a Healthy Kentucky (Louisville, KY)

Health Care Foundation of Greater Kansas City (Kansas City, MO)

The Health Foundation of Central Massachusetts, Inc. (Worcester, MA)

Hogg Foundation for Mental Health (Austin, TX)

Kate B. Reynolds Charitable Trust (Winston-Salem, NC)

Maine Health Access Foundation (Augusta, ME)

MetroWest Community Health Care Foundation (Framingham, MA)

Missouri Foundation for Health (St. Louis, MO)

Mt. Sinai Health Care Foundation (Cleveland, OH)

New York State Health Foundation (New York, NY)

Paso Del Norte Health Foundation (El Paso, TX)

St. David’s Foundation (Austin, TX)

St. Luke’s Health Initiatives (Phoenix, AZ)

1. United States Department of Health and Human Services (2001), Mental Health: Culture, Race, and Ethnicity – A Supplement to Mental Health: A Report of the Surgeon General, Rockville, MD.

2. President’s New Freedom Commission on Mental Health (2003), Achieving the Promise: Transforming Mental Health Care in America, Rockville, MD. World Health Organization (2001), The World Health Report 2001 – Mental Health: New Understanding, New Hope, Geneva, Switzerland.

3. National Association of State Mental Health Program Directors (2008), Measurement of Health Status of People with Serious Mental Illnesses, Alexandria, VA.

4. Interim rules to implement the law were issued on January 29, 2010, after this position statement was drafted. United States Department of Health & Human Services (2010), Obama Administration Issues Rules Requiring Parity in Treatment of Mental, Substance Use Disorders, Washington, D.C.

5. National Research Council and Institute of Medicine (2009), Preventing Mental, Emotional, and Behavioral Disorders Among Young People, Washington, DC.

6. Annapolis Coalition on the Behavioral Health Workforce (2007), Action Plan for Behavioral Health Workforce Development, Rockville, MD.

7. The position statement was issued October 30, 2009.