Editor’s Note: Mental Health America created this fact sheet to be considered by Congress while debating any Health Care Reform legislation. The following is a summary of the material MHA provided to Congressional leaders.

Legislation to extend health care coverage to currently uninsured individuals and improve the quality of care for all Americans must include the prevention and treatment of mental health and substance use conditions. 

Mental health and substance use conditions are some of the most chronic and disabling conditions.   They often begin in childhood and adolescence (with an average age of onset of 14) and interfere with a young person’s ability to succeed in school and successfully enter the workforce.  Moreover, treatment often does not begin until ten years after diagnosis, increasing the risk of developing a costly disability.  Serious mental illnesses alone are estimated to have cost $193 billion in lost wages in 2002  which exceeds the gross revenue of 499 of the Fortune 500 Companies. 
  
Mental health and substance use conditions often accompany and greatly increase the cost and complexity of treating other chronic conditions including diabetes, asthma, heart disease, and obesity.  Tragically, individuals with severe mental illnesses die on average 25 years earlier than the general population due to complications from these and other co-occurring disorders.   Public mental health system consumers are a segment of our population with some of the greatest unmet needs for improved care coordination and prevention services. 

MHA Priorities – Parity, Integration, Prevention, Quality

We urge that the following priority issues be addressed in any health care reform legislation:

1. Ensure Full and Equitable Coverage of Behavioral Health Services by –

• Including mental health and substance use treatment as core components of any benefit package offered to uninsured individuals; and
  
• Requiring parity in coverage for these conditions compared to medical and surgical benefits.
  

2. Support Integration of Behavioral Health and Medical Care, by improving coordination between primary care and behavioral health specialty providers and increasing access to primary care and specialty behavioral health services through --

• Incentives for medical home and collaborative care treatment models adapted to address the special needs of this population, for example the Medicaid demonstration program proposed by Senator Debbie Stabenow in the “Mental Illness Chronic Care Improvement Act of 2009” (S. 1136);
  
• Education of primary care providers about prevention and treatment of mental health and substance use conditions; and
  
•  Work force development initiatives to increase recruitment and retention of mental health and substance use disorder treatment professionals, especially people of color and those in recovery.
  

3. Prioritize the Prevention of Mental Health and Substance Use Conditions by –

• Covering the following interventions highlighted in a recent Institute of Medicine report  for reducing rates of behavioral health conditions:
  
  • home visiting by public health nurses for low income first time mothers;
    
  • coaching families regarding children’s social/emotional development needs during pediatric care visits;
    
  • screening for mental health and substance use in pregnant and perinatal women; and
    
  • behavioral health screenings as part of every well-child check-up.
    
• Funding community-based wellness programs focused on mental illness prevention/ mental health promotion including working with schools on mental health literacy and helping them engage in practices that strengthen social/emotional development and foster a positive school climate.
  
• Encouraging implementation of workplace wellness programs including through
  
  • tax credits;
    
  • educational campaigns on employer-based wellness programs; and
    
  • contracts with community-based organizations to provide technical assistance for employers in evaluating and implementing wellness programs.
    
• Establishing a national coordinating body to prioritize prevention of behavioral health disorders across programs overseen by the Departments of Health and Human Services, Justice, and Education.
  

4. Enhance quality of care by developing and implementing evidence-based therapies that reflect consumer/patient priorities by ensuring that patient/consumer and clinician perspectives are fully represented in all phases of research priority-setting, development, and interpretation, especially regarding comparative effectiveness research (CER) through establishment of —

• A patient/consumer advisory board on CER; and
  
• An Office of Patient Values and Inclusion within the Department of Health and Human Services.
  

Messages for Congress

• Include mental health and substance use treatment as core components of any health care benefits package and require parity in coverage of those conditions compared to medical and surgical benefits.
• Improve integration of mental health and primary care for both children and adults.
  
• Increase access to prevention services for mental health and substance use conditions, particularly for children and youth.
  

Improve quality by including patients/consumers in research development and dissemination.

1. The World Health Organization, The World Health Report 2004: Changing History, Annex Table 3: Burden
   of disease in DALYs by cause, sex, and mortality stratum in WHO regions, estimates for 2002.
   
2. Kessler, R.C., Heeringa, M.D., Lakoma, M.P., Rupp, A.E., Schoenbaum, M., Wang, P.S., and Zaslavsky, A.M., Individual and Societal Effects of Mental Disorders on Earnings in the United States: Results from the National Comorbidity Survey Replication, Am J Psychiatry, May 7, 2008.
   
3. Parks, J., Svendsen, D., Singer, P., Foti, M., Mauer, B., Morbidity and Mortality in People with Serious Mental Illness, National Association of State Mental Health Program Directors, 2006.