Beyond the Community Mental Health Service Improvement Act

As demand for mental health and addictions treatment grows, insurance coverage must be preserved and expanded. It's critical that we preserve the guarantee of Medicaid coverage for low income, disabled Americans. Commercial parity must be passed; Medicare parity must follow; and if we accept what research is teaching us--that addictions are chronic, relapsing conditions that require ongoing monitoring and management, just like diabetes, asthma, and yes like mental illnesses--then we must act. We must lead the fight to restore eligibility for social security disability for people with addiction disorders.

Data collected by non-profit organizations documents increased demand and increased numbers of uninsured. States reallocated their general fund mental health dollars to the Medicaid match. And now state plans to cover the uninsured are floundering. This leaves large numbers of individuals with treatable mental illnesses in our overburdened emergency rooms and without access to the services that can engage them, treat them, and return them to work.

We're denying our economy productive taxpayers. We're wasting human lives. We must introduce and champion a federal funding stream to cover the mental health and addictions treatment costs of the uninsured.

The Community Mental Health Service Improvement Act begins to address our workforce crisis, but it's just a beginning. 

We cannot stand by and watch our best and brightest become plastic surgeons and investment bankers. Skilled staff demands adequate compensation. We must be attractive to leaders that reflect the diversity of our communities. And we can't allow people with serious mental illnesses or addictions to wait for weeks and months for an appointment with a psychiatrist. We must be clear and forceful advocates for cost based reimbursement that supports salaries that can attract and retain skilled staff.

If we truly want to narrow the gap between science and service, we must stop investing in manuals and planning grants, and start investing in retooling the organizations that deliver services.

We must preserve, strengthen and expand the mental health and addictions treatment capacity in this country. But it has not been and it will not be easy.

We are part of a healthcare system that reflects the American belief in the marketplace. A healthcare system that talks universal coverage but hates taxes. A healthcare system that resists cost containment, counting on disease management and prevention for savings, although so far they show little evidence of delivering savings. A healthcare system that's promoting "medical homes" as the newest cost saving strategy, confusing a strategy to improve the quality of care with one that saves money.

But we do know something about saving money. Pioneering studies are telling us that there are enormous disparities in healthcare expenditures from one region of our country to another, with no difference in healthcare outcomes. If the entire nation could bring its costs down to match the lower spending regions, we would cut 20 to 30 percent off America's healthcare bill. Most of the difference in spending is for hospital care. Hospitalization, including inpatient psychiatric care, is a vital intervention that must be available but in many communities we can do better.

If we're serious about improving consumer outcomes, point of service is where improvement will occur.