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Making advocacy accessible: 5 learnings from my first congressional briefing

MHA Admin — Tue, 16 Jan 2024 13:40:23 +0000

Making advocacy accessible: 5 learnings from my first congressional briefing

MHA Admin Tue, 01/16/2024 - 08:40

January 16, 2024

by Makalynn Powell

If you’re like me, the idea of attending a congressional briefing may be intimidating and confusing. Initially, I expected what you might see on C-SPAN – to walk into a large meeting room full of older, influential government representatives questioning people as they stand in front of a microphone. As mental health advocates, or future advocates, our voices matter, and attendance at these types of forums is imperative for change. Perhaps, like you, the thought of something so formal was intimidating.

What I experienced, however, was far less stoic. In fact, it was the exact opposite of what I was expecting. They even provided snacks and refreshments.

Briefing basics

Congressional briefings are like mini informational sessions filled with people from all corners of the nation who share a common interest or concern. The main goal is to provide insights into an issue by detailing its prevalence and helping people understand that change is necessary for improvement. Once that information is provided, participants can explain how and why their proposed solution would benefit the greater good.

Recently, Mental Health America and our partners organized a congressional briefing to discuss the importance of peer support services and what is needed from Congress to expand access. You can check out the recording here. For someone new to mental health advocacy or wanting to become more involved in the legislative side, here are discoveries I made that might help on your journey.

5 takeaways and tips

1. If you're looking for a solution to a systemic issue, you must provide information on why and how that issue affects average citizens – and offer solutions.

At the latest briefing, Mental Health America gathered a group of experts in peer support services to discuss why new solutions are vital to their work and how others can get involved. Among the panelists, one provided direct peer support services in underserved communities; the second received these services as a young person and has since dedicated their life to ensuring other young people have that same access; the third works for a health insurance provider that reimburses peer support specialists, increasing access for many folks in need; and the fourth panelist shared her experience with institutionalization and professionals who claimed her diagnosis would prevent her from living an everyday life. All four experts provided in-depth knowledge and living proof that peer support services are effective and should be physically and financially available nationwide. The information they shared proved to attendees how beneficial peer support services have been to the lives of those they serve and showed how easy it would be to implement more peer services across the nation. As an organization led by the voices of lived experience, these real-life accounts gave insights into the issue. By then providing a solution and tips on how that solution can be molded and applied on a larger scale, policymakers are left with tangible mechanisms to work with.

2. Support from multiple groups and organizations is essential.

If you plan on asking for anything from Congress, or even your local or state legislator, you had better have ample support from several sources. With 1 in 5 adults and 1 in 6 youth experiencing a mental health condition in any given year, mental health will affect everybody either directly or indirectly at some point in their lives. Having this knowledge makes the case that mental health care is a bipartisan issue, which has resulted in overwhelming support from both sides. That support comes in handy when these asks are taken to Congress. In addition to bipartisan support, Mental Health America used this opportunity to gather like-minded partners and collaborators to inform the briefing. Increasing the breadth and depth of the information, along with the diverse bodies of representation, strengthened our asks.

3. “Leave-behinds” provide critical information and summaries.

Congressional briefings tend to provide much information within a short period, so it’s reasonable to assume some of that information may be glossed over or not retained. Staffers, liaisons, and others in attendance may need to relay what they heard to a Congressperson or other staff, and you want to make sure they hit the vital information. The purpose of a leave-behind document, or one-pager, is to ensure your audience understands the message and can reference it once the briefing ends. In this particular briefing, we had six asks that included information on different acts, bill proposals and calls to action, all mixed in with impactful stories of lived experiences from our panelists. Providing attendees with a short, concise summary of the focal points ensures those with the power and motivation to take action have the correct information to do so.

4. Invite the right speakers, organizations, and other attendees.

If you are hosting a briefing, or advocacy event, getting the word out to key individuals and organizations will go a long way to strengthen your message and improve the chances of asks being put into legislation. With mental health being a concern for everyone, regardless of their political affiliation or demographic profile, it stands to reason that most folks would want to see conditions improve. At this briefing session, the invite list included over 70 organizations who wanted to learn more about or shared our passion for peer support services. We also invited experts to share their lived experience: Tiara Springer-Love, a mental health advocate from New York; Lauren Foster, a behavioral health program manager at Blue Cross Blue Shield, Minnesota; Vesper Moore, a mental health advocate at Kiva Centers; and Dana Foglesong of the National Association of Peer Services. By having panel experts from various corners of the mental health world, we could discuss the multiple barriers to implementation and potential solutions to improving access. The wide array of attendees improved our chances of spreading that information throughout groups and organizations to garner even more support. This is crucial for goals like increasing funding for research and advocating for grants and support for community organizations that provide peer support services.

5. Congressional briefings are a great place to network and meet folks with similar agendas.

If you are attending a congressional briefing, it’s probably because you have a vested interest in the subject matter – along with the other attendees. Common interests make it the perfect opportunity to meet face-to-face with other people who share your passion and can discuss solutions. A business card is a must if you plan to expand your professional contact list. Additionally, introducing yourself to panelists after the session is always a good idea. After all, those speakers are experts in their field and have experience in your area of interest.

Ultimately, my frightening perception of congressional briefings at Capitol Hill was shattered, and I will attend more should I get the chance. I arrived feeling anxious and out of place but left feeling supported and rejuvenated in being a part of the solution. I also learned a lot despite being well-versed in the subjects. It helped to hear accounts of lived experiences and realize that others care about and want to improve mental health in our nation. Plus, the snacks they provided were excellent. If you get the chance to attend a congressional, or even state government, briefing, take it.

Watch recording of congressional briefing

Makalynn Powell is the Peer and Youth Policy Fellow at Mental Health America.

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No One Size Fits All: The Case for a Balanced Approach to Telehealth and In-Person Care

JCheang — Mon, 09 Aug 2021 17:59:39 +0000

No One Size Fits All: The Case for a Balanced Approach to Telehealth and In-Person Care

JCheang Mon, 08/09/2021 - 13:59

August 10, 2021

By Leslie Lundt, M.D, Executive Medical Director at Neurocrine Biosciences

Telehealth use rapidly increased in the early months of the pandemic, fueled by an unprecedented expansion of coverage and reimbursement by health insurers. Because these changes were a response to the COVID-19 public health emergency, they were intended to be temporary. They may not stay temporary, however, as stakeholders, from government to health insurers, weigh whether and how to make the current flexibilities a permanent part of health care in the future.

Today telehealth is at the center of health policy discussions, but many questions remain unanswered. Will the emerging research on telehealth and health outcomes align with public perceptions of telehealth? How will this research be used to inform the types of visits — in-person or virtual — people have with their doctors? And, fundamentally, do we have enough information even to determine which type of visit is best when choosing between telehealth and in-person care, particularly when it comes to mental health care? Of course, there is no one-size-fits-all answer and flexibility must be a central component of any path forward. As Congress and the Biden Administration examine which path to take, they should consider an approach that uses telehealth as an option that complements — but is not a replacement for — in-person care.

Face-to-face visits should remain an essential part of health care for many people who benefit from being seen in-person by their doctor. This is especially true for diseases and disorders where physical exams are critical for screening, diagnosis and treatment. People with involuntary movement disorders, like tardive dyskinesia (TD), fall into this group. TD is a condition usually caused by prolonged use of antipsychotic medications by those with serious mental illness. For people at high risk of TD, the American Psychiatric Association’s guidelines recommend physical screening for the condition occur at least every six months so that doctors can note even minor changes in movements.

With telehealth, there are substantial limitations on a doctor’s ability to conduct a thorough physical exam: some changes may not be noticed over telehealth, where video quality or the inability to see a person’s full body can hinder a doctor’s evaluation. This means that the use of telehealth without periodic in-person appointments can lead to missed or inappropriate diagnosis, and potentially incorrect treatment. In fact, experts in the field of movement disorders argue telehealth is not a substitute for face-to-face visits, but rather a helpful addition to clinical care.

Clinical experts also note telehealth can impact a person’s ability to provide a full medical history and make it harder for people to form doctor-patient relationships that make care more empathetic and conversation more honest. Similarly, although many psychiatrists indicated they were “pleasantly surprised” they could meet a person’s needs via telehealth, the majority indicated a strong preference to return to in-person care following the pandemic for various reasons that include the need for privacy and building an effective doctor-patient relationship.

The patient voice is a critically important part of the conversation about access to and quality of health care. A leading coalition for people living with chronic diseases argues the “appropriate use of telehealth services requires a balanced approach and should be based on patient preferences, needs and goals.” These advocates also note telehealth should be used with, not instead of, face-to face visits, and patients and providers should together determine the best setting — virtual or in-person — to achieve health care goals.

Where does this leave Congress and the Biden Administration? Clearly, post-pandemic telehealth policies must be flexible enough to support the unique needs of all people — those who may receive the care they need via telehealth, and those who need at least some in-person care. Telehealth policy should protect in-person visits as an essential part of health care moving forward, so everyone has access to care that meets their preferences and needs.

***

Leslie Lundt, M.D., is an internationally recognized clinician and educator in the neuropsychiatric field. She is board-certified in psychiatry and has over 30 years’ experience in active clinical and research practice. Dr. Lundt is also Executive Medical Director at Neurocrine Biosciences.

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New Peers in Medicare Legislation: A Bold Step Forward

JCheang — Thu, 01 Oct 2020 19:00:21 +0000

New Peers in Medicare Legislation: A Bold Step Forward

JCheang Thu, 10/01/2020 - 15:00

October 05, 2020

By Caren Howard, National Advocacy Manager at Mental Health America

Mental Health America and partner organizations helped usher the introduction of recent key legislation in the U.S. House of Representatives: H.R. 8206, the Promoting Effective and Empowering Recovery Services (PEERS) in Medicare Act of 2020. This bipartisan bill, introduced by Representatives Judy Chu (D-CA) and Adrian Smith (R-NE), would recognize for the first time in Medicare history certified peer specialists and would allow reimbursement of peer support services when they are offered as part of coordinated physical and mental health care provided by therapists, case managers, and physicians in holistic treatment. The National Association of State Mental Health Program Directors, the Depression and Bipolar Support Alliance, the National Association of Peer Supporters, and the Association for Behavioral Health and Wellness, were partners with MHA in this effort.

MHA strongly supports Rep. Chu’s and Rep. Smith’s bill to provide Medicare coverage for peer support services for individuals within integrated physical and mental health care. Take action today and let Congress know why they should pass H.R. 8206.

Medicare is the federal health insurance program for which people qualify once they reach a certain age or have a disability when they also have a work history. Most private commercial insurance plans set their policies and benefits packages based on Medicare policy and benefits. Thus, because of its influence on the broader market, H.R. 8206 is more than just a stepping-stone bill. It will likely allow all adults with health insurance to enjoy the benefits of peer support within integrated care, once seniors and people with disabilities begin to enjoy its benefits.

As we see a growing surge in distress and demand for mental health services, increasing access to peer support is essential to meet people’s mental health needs and to empower individuals to live healthy lives in their communities.

Peer-Run Affiliate Solidifies Bill Sponsor

Peer support specialists use their own lived experience, have specialized training, and are certified by their state or national certification body, to assist individuals in achieving recovery goals by furnishing emotional, informational, and other support services to individuals with a mental illness, including dementia, and/or a substance use disorder.

The COVID-19 crisis is exacerbating a pre-existing behavioral health workforce shortage that is particularly acute in rural areas and for communities of color. MHA of Nebraska’s Executive Director Kasey Moyer and Wellbeing Initiative’s Executive Director Danielle Smith saw this and met with staff for Congressman Adrian Smith (D-NE) and discussed the important work of peers in the state. They requested that the Congressman co-sponsor H.R. 8206 with Congresswoman Judy Chu (D-CA).

Wellbeing Initiative, the state’s largest peer training entity counting over 500 peers trained, explained how the bill would help grow the reach of peers who are needed in remote areas of the state. These areas are experiencing extreme shortages of mental health providers, limited ability of residents to travel for in-person care, and limited opportunity to use telehealth platforms – all while people are experiencing increased isolation, fear, and anxiety. In the virtual meeting with Rep. Smith’s office, peers also noted their ability to provide technical assistance in setting up telehealth to help their clients engage in care.

MHA Nebraska reported seeing a dramatic increase to its emotional support warmline, staffed by peer specialists, at the beginning of the pandemic. At the time, Nebraska residents were facing disaster recovery from flooding. The Governor had also declared a state emergency on top of the COVID public health crisis. Other MHA affiliates and other providers across the country were also reporting an uptick of calls to their warmlines, support groups, and other peer programs, without receiving additional grant funding. Peers, alongside frontline health workers, are being asked to do more with less. Peer support specialists in Nebraska and elsewhere often work their way off federal/state assistance to be self-sufficient, but in many states peers are not paid a living wage and often are forced to live in poverty or leave the field they love for better wages. H.R. 8206 would help take care of that, by allowing for fair compensation for peers providing integrated care.

Peers Make a Difference: Why Medicare and Other Insurers Should Cover Peer Support

Peer support promotes recovery from mental health conditions and substance use disorders by helping individuals better engage in services, manage physical and mental health conditions, build support systems, and ultimately, live self-directed lives in their communities. The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes peer support as an effective, evidence-based practice. And, as of January 2019, over 43 states allowed Medicaid – the state program for individuals with disabilities, are low income, and for pregnant women and their children – to be billed for peer support services.

According to SAMHSA, the proven benefits of peer support include reduced hospital admission rates, increased social support and social functioning, and decreased substance use and depression.
A 2018 analysis showed that providers with peer services had 2.9 fewer hospitalizations per year and saved an average of $2,138 per Medicaid-enrolled month in Medicaid expenditures.
The Veterans’ Administration has recognized the value of peer support specialists to serve Veterans with mental health and substance use conditions. For example, a 2012 White House Executive Order to improve mental health access for Veterans included a directive to hire additional peer support specialists.
A peer support program in Pierce County, Washington reduced involuntary hospitalizations by 32 percent leading to a savings of $1,990,000 in one year.
A Federally Qualified Health Center in Denver found that using peers saved $2.28 for every dollar spent.
A New York-based peer support program for individuals transitioning from inpatient services back to the community resulted in a 47.1 percent decrease in total behavioral health costs.

Under H.R. 8206, co-sponsored by Reps. Judy Chu (D-CA) and Adrian Smith (R-NE), peer support would be covered by Medicare as part of integrated physical and mental healthcare and billed through the respective codes for integrated care. For example, under collaborative care models, a primary care doctor, care coordinator and other team members provide behavioral health services and coordinate mental and physical health care. Medicare has specific collaborative care billing codes to support this model. MHA strongly supports collaborative care because the model promotes screening, early intervention, addressing mental health as part of overall healthcare, and reducing health disparities. Adding peers will increase the emphasis on recovery, as well as strengths-based and person-centered care. This legislation specifies that peer support specialists can be members of the integrated care team and their services can be billed as part of that overall model of care under these codes.

A Call to Action

Weigh in on the PEERS Act of 2020 with your Members of Congress! Anyone wishing to send an email may share their story in our customizable action alert. Let Congress know why they should pass H.R. 8206.

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Re: PASSING H.R. 8206

For all of my friends and loved-ones, who need extra support during all recovery periods, involving treatment, this House Resolution MUST BE PASSED! Let us not continue to do things "halfway," to save costs--the human condition has no time for that! Let us work to get positive results that matter for life! Thank you!

The Legacy of “Deinstitutionalization”

JCheang — Wed, 29 Jul 2020 13:13:37 +0000

The Legacy of “Deinstitutionalization”

JCheang Wed, 07/29/2020 - 09:13

July 29, 2020

Image description: grey and black stock photo of bars on a window. A person's shadow is in the center of the window

By Shivani Nishar, Health & Justice Fellow at the Center for Prisoner Health and Human Rights and member of Mental Health America’s Collegiate Mental Health Innovation Council

In today’s “deinstitutionalized” world, prisons and jails function as makeshift asylums with the shared goal of containing and segregating Black and Brown disabled communities from the rest of society. As of 2014, approximately 356,000 incarcerated people have severe mental illness, 10 times the number of people with severe mental illness in state hospitals. To make matters worse, for those who don’t enter prison with disabilities, the inhumane environment inevitably creates and compounds health conditions, mental illnesses and trauma experiences. The fact that “jails in New York (Rikers), Los Angeles (LA County Jail), and Chicago (Cook County Jail) are now the three largest institutions providing psychiatric care in the U.S," and that the “psychiatric care” comprises of solitary confinement, physical restraints, removal of food, and refusal of medication amongst other life-threatening actions, is deeply disturbing.

We can trace the over-pathologization and hyper-criminalization of disabled Black people back to “insane” asylums and the 1960s “deinstitutionalization” movement. Virginia legislators established the Central State Lunatic Asylum for the Colored Insane, the first asylum created specifically for non-whites, to maintain control over formerly enslaved African Americans. Post-emancipation, white society grew increasingly weary at the prospect of African Americans being viewed as equal and used the asylum to create a new forced labor class to exploit. African Americans were incarcerated at the asylum for “infractions” including arguing with a white boss and not stepping aside for a white person on the sidewalk. Moreover, legislators fabricated insanity diagnoses for African Americans who attempted to move to the North – resonant of the original fictitious “drapetomania” diagnosis used to re-capture and abuse fleeing enslaved individuals – allowing the state to shackle them once more through institutionalization.

Virginia’s legislators effectively weaponized mental illness to justify the forced commitment of African Americans to asylums by equating their supposed psychiatric disabilities to inherent degeneracy. This still happens today.

For instance, racist diagnosing in an educational context feeds into a new cycle of institutionalization and entrapment in the industrial prison complex. Doctors are much more likely to misdiagnose Black children, compared to white children, with schizophrenia, bipolar disorder, and/or other conduct disorders instead of their actual experiences with attention deficit hyperactivity disorder and autism spectrum disorder. These racial biases in diagnosing are pervasive despite the scientific evidence showing that Black and white children experience attention deficit disorders at nearly the same rates. Instead, doctors force diagnoses upon Black children that are some of the most stigmatized in the United States, often conflated with violent criminality. In this way, Black children are routinely viewed as being defiant and out of control; rather than receiving adequate disability care and services in schools, school resource officers arrest and the courts incarcerate Black children in juvenile detention facilities.

“Insane” asylums taught us to fear mentally ill communities, normalizing the removal of human rights through captivity as a suitable treatment protocol, even for children. This ableism, coupled with the United States’ sinister foundation of oppression against Black communities, has led to the carceral state pushing disabled Black people into prisons at alarming rates. It is crucial that we continue to examine how the treatment of mentally ill communities throughout the “deinstitutionalization” movement shaped minimally less overt forms of institutionalization that remain today.

Throughout this blog post, I’ve written “deinstitutionalization” in quotes because it was a movement towards community-based care that never materialized. We still live in a world that institutionalizes mentally ill people - but instead of in asylums, they are behind bars in prisons and jails (and psychiatric hospitals). Therefore, our fight against modern institutionalization is a protest movement that fights against all carceral responses to mental health crises and builds alternatives to incarceration. After all, deinstitutionalization will never occur if we continue to rely on state solutions; society must trust that our disability communities are able to meet each other’s needs with non-carceral, compassionate and proactive care.

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Tele-mental health now and from now on

JCheang — Mon, 18 May 2020 14:19:50 +0000

Tele-mental health now and from now on

JCheang Mon, 05/18/2020 - 10:19

May 19, 2020

By Debbie Plotnick, Vice President of State and Federal Advocacy

As Mental Health America’s (MHA) Vice President for State and Federal Advocacy, it is my job (and my passion) to push people (mostly legislators and policy makers) to make changes that help people access mental health services and support. The COVID-19 pandemic has had the paradoxical effect of removing some of the barriers that advocates have been fighting to overcome for years. This is especially evident with respect to telehealth, including tele-mental health.

Tele-mental health has long held the promise for extending limited workforce, overcoming transportation barriers, reducing the number of people that miss appointments and people’s ability to get help when they need it, and accessing services before crises. At MHA, we call that addressing mental health Before Stage 4.

The best integrated care services have expanded existing scarce resources by connecting people directly from primary care offices to on-site mental health practitioners, or in-office tele-mental health. This has been especially valuable in helping people accessing the limited number of specialty providers, such as child and geriatric psychiatrists. But following an initial assessment, if follow-up therapy was indicated, it almost always had to take place in the therapist’s office. Additionally, even when and where telehealth was available, insurance including Medicare, Medicaid and private coverage set very stringent parameters. Medicare required a first visit in-person before allowing tele-mental health, and then it required audio and video. Some state Medicaid plans had allowed tele-mental health, some did not. And private insurance for tele-mental health has been and, in some cases, remains a patchwork of coverage or lack-there-of.

Since the COVID-19 pandemic, not surprisingly the need for mental health services has increased, and many of the regulatory barriers have eased. Thanks to advocacy, the federal government agency that oversees Medicaid and Medicare (CMS) has encouraged states to amend their Medicaid state plans to allow for, or reduce barriers to, tele-mental health. And Medicare has removed the requirement for an in-person first visit. It now allows for telephonic only tele-mental health. Employer-provided private insurance, and Affordable Care Act (ACA) polices have also allowed (and sometimes encouraged) people to use telehealth—including tele-mental health. Mental health services for students that were provided in school have moved to tele-mental health while schools are closed. That said, some advocacy is still needed regarding tele-mental health services for some employer-funded plans that come under the Employee Retirement Income Security Act (ERISA) of 1974. Even though tele-mental health should be covered if other types of telehealth services are allowed, sometimes it takes is a call the employer to tell them to inform the plan administrator to add tele-mental health. Such extra steps should not be needed and advocates are working this and other barriers within ERISA plans.

By all accounts tele-mental health services are working well. People like accessing care from their homes, and students are still being served. Seniors and those without broadband can get help by telephone and without having to leave their homes. Providers can serve existing clients and add new ones.

Peer services have gone virtual too. MHA affiliates and other community providers have been moving supports groups and peer support online and expanding help by telephone.

Most of the expanded means of access are happening because a national emergency was declared in March because of COVID-19. These expansions are expected to be in place for the duration of the pandemic. But what about after the state of emergency is over?

Here is what I am doing: I have adopted a new mantra: “Tele-mental health now and from now on.” Our elected officials need to hear from all of us with that very message. I hope that you will email and call your elected representatives and send the message loud and clear: tele-mental is here to stay.”

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What the pandemic storm is revealing and what will be left in its wake

JCheang — Mon, 27 Apr 2020 14:54:13 +0000

What the pandemic storm is revealing and what will be left in its wake

JCheang Mon, 04/27/2020 - 10:54

April 29, 2020

By Debbie Plotnick, Vice President of Federal and State Advocacy at Mental Health America

Data tells a story, and here at the national office of Mental Health America (MHA), and through our affiliate network, we’re able to tell an undisputable story about how COVID-19 is showing us - now more than ever - there an astonishing need for behavioral health services and supports. In the best of times we’ve known that at least one-quarter to one half of us experience a mental health need. As we’ve learned from previous disasters, the need for behavioral health supports will skyrocket and will continue to grow for some time. This pandemic, unlike most other disasters does not have a discrete timeframe. It’s not like a hurricane that does its damage and then is done. Maybe it’s more like an earthquake, where we know there will be aftershocks but can’t say how big, or how long they’ll go on. But we know we have to repair the damage and rebuild. But this time, we must not return to pre-COVID policy and practice.

As stay at home orders were being rolled out in in late February and March of 2020, the number of people coming to the MHA's Online Screening Program showed what we’re all feeling, that we’re increasingly anxious and depressed. In late February through March, the number of people taking screens rose by 18%-22%. And the screening results for the 2,500 screeners were much more likely to be in the severe range than we’ve previously seen. Not surprisingly, at least a third of the screeners reported that they also have one or more chronic conditions. But most of the screeners still fit into the most common age demographic—they are overwhelmingly young.

Over the past five years, MHA's Online Screening Program has shown what those who work in the mental health field have always known: mental health conditions begin when people are young. The age demographic for screening has held steady - about two-thirds of screeners being under the age of 24. These astute young people know when something is going on, but it often takes 8-10 years to get the kind of help they really need. All the while, things were often getting worse.

Why did it take so long? Why did insurance companies and elected officials only direct resources and help when people were in crisis, deemed to be a danger to themselves or others, or had become involved with the criminal justice system?

There is a workforce shortage in mental health, and these terrible policies are part of the reason why.

People have been forced to go from crisis to crisis. Many need the most highly specialized care, and because of regulation and segmentation of the healthcare system, have had to seek practitioners with the highest level of training and licensure - of which there are the fewest.

Now, we’re seeing the tsunami of increased need caused by this global pandemic. We can’t follow old models of relying on the police, sending people to the ER, or worse yet - to jail.

We must expand the workforce, but not from the top down and by just expanding crisis services. It’s way beyond time to act Before Stage 4. And the pandemic just might help policy makers to finally see this.

People know they need help; more are screening and reaching out. MHA at the national level and throughout our affiliate network report that the number of people coming to warmlines is up 30%, 50%, even doubling. Peer services are going virtual and more people are availing themselves of all types of virtual treatment and support.

In this time of increased need, we are seeing hopeful signs. As services and supports have had to move online, insurance payers (public and private) have removed many barriers for tele-mental health, including allowing practitioners to work across state lines, and ridiculous requirements for face-to-face assessments before people can access virtual help. Ironically, more people are able to access peer and other virtual services when they no longer have to deal with transportation issues, and long waits before they can do anything. The MHA network and community mental health providers are coming up with creative ways to serve more people at earlier stages. They are using COVID relief funds to purchase equipment for virtual use, maintain and even expand staffing, and provide phones to staffers working remotely and to those receiving help.

When the waves of people needing acute care from the pandemic subsides, there will be the need for additional help with grief (over lost loved one, livelihoods, and way of life) and untold numbers of people will show the effects of traumatic stress. We must be even more prepared to help. Removal of barriers, loosening of regulations, more options for help, and policy that will allow an expanding workforce to support and serve must become permanent. Proactive mental health services must become part of the entire health care landscape. Peers, social workers, and counselors should be part of all delivery systems -from primary and emergency care, to prevention and universal screening - especially for young people and those with chronic conditions.

We hope that policy makers, payers and the public will support and value mental health as not just an afterthought. It must be understood that when people say they are experiencing depression or anxiety, post-traumatic stress, or have a substance use disorder, that there is the will and workforce in place to show a path forward.

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Loosening Some Coverage Reins - Please Loosen More

JCheang — Wed, 18 Mar 2020 17:57:50 +0000

Loosening Some Coverage Reins - Please Loosen More

JCheang Wed, 03/18/2020 - 13:57

March 18, 2020

By Debbie Plotnick, Vice President, State and Federal Advocacy, Mental Health America

The Federal Government and many states have taken some important steps to relax regulations and remove barriers due to the COVID-19 emergency. But there’s still more to do.

The Centers for Medicare and Medicaid (CMS) has expanded the use of telehealth for Medicare and Medicaid with respect to non-procedural interactions. This means that consultations and even mental health therapy may take place virtually.

More barriers are being removed daily, such as a person having to have had a previous telehealth relationship/ The prohibition of prescribing scheduled drugs via telehealth has also been waived.

Barriers are also being loosened for hospitals and providers. These include allowing states to apply for 1135 emergency waivers. This includes allowing providers to practice across state lines, waiving prior authorization for testing and treatment of COVID-19 and making it easier for providers to become Medicaid-approved practitioners.

More needs to be done to facilitate not only a move from hospital-based services to rehabilitation settings, but to expedite whenever possible home-based care.

Things that have not been done yet, but for which there is a precedent, as was done during Hurricane Katrina and during the immediate aftermath of 9/11, include allowing states to expand and expedite Medicaid eligibility. It is to be expected that many who now have employer-provided coverage will lose it along with their jobs, making Medicaid eligibility more important.

There are additional important issues that need strong advocacy. These include waiving cost-sharing for COVID-19 related treatment, and surprise billing due to out of network and in-hospital services. It can’t be expected that someone with presumptive, let alone confirmed, COVID-19 should have to go to a free-standing facility for x-rays or blood tests.

Expanding health care provisions in these ways will not only hold down transmission of COVID-19 and allow people to seek treatment when its needed, but will also help set people’s minds at bit more at ease, thus supporting everyone’s mental health.

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How Connection Saves Lives and How Policymakers Need To Understand That

JCheang — Thu, 23 Jan 2020 15:49:05 +0000

How Connection Saves Lives and How Policymakers Need To Understand That

JCheang Thu, 01/23/2020 - 10:49

January 23, 2020

By Mary Giliberti, Executive Vice President of Policy at Mental Health America

Over this past weekend, I participated in my first outreach event for Mental Health America at the NBC4 Telemundo 44 Health and Fitness Expo in Washington DC. Dr. Martin Luther King, who’s memory we honored this week, said that people “fear each other because they do not know each other. They do not know each other because they do not communicate with each other.” Here is what I learned at the event: it is easy to communicate with people about mental health because the topic is accessible across culture, race and age. In addition, talking about mental health is especially important to those with mental illness.

We had a spinning wheel at the event and children were particularly excited to spin the wheel, answer a question, and get a prize. One little girl ran up to the wheel and I saw her dad looking on with concern, trying to read our large poster. I walked up to him and said “We are with Mental Health America, a national non-profit dedicated to mental health. We have materials on sleeping, eating right, exercising – ways to improve your mental health.” I could see his face instantly transform and relax into a smile. “Those are important,” he said as he looked through our materials and waited for his daughter.

Over the course of the day, we had amazing diversity across race, culture and age in our booth. Everyone could relate to mental health. Some people wanted to talk about themselves. Others were more comfortable discussing family and friends. All of the participants were interested in our screening tools and we quickly ran out of materials on exercise and mental health. Children talked about how they supported friends who were struggling: “I tell them jokes,” “I give them a hug,”” I talk with them.“ They also talked about what they did when they were stressed – “I talk to my dad,” “I sit in my room quietly.” They were able to answer questions about the relationship between the brain and the body – “when I feel sad, I feel tired.”

In having conversations about mental health with people of all cultures and backgrounds, I often learned that they or someone they loved were struggling with mental illness. There was a man who asked to rest a bit in our booth who had been diagnosed with both bipolar disorder and schizophrenia; a woman who wanted to discuss the suicide of her cousin whom she had not realized was struggling.

From a policy perspective, this speaks to the need for primary, pediatric and geriatric primary care professionals to communicate with patients and their families about mental health. Sleep, exercise, social connection and diet are all important topics and screening should focus on whether the person is engaged in mentally healthy behaviors as well as whether they are experiencing symptoms of a mental health condition.

Current prevention guidelines only require depression screening for individuals 12 years of age and older. Yet as we saw clearly this weekend, children and younger tweens also are very aware of mental health and can experience mental health conditions. Youth who are over 12 years of age experience issues beyond depression. Having more conversations about mental health and screening to promote mentally healthy behaviors as well as discover mental health conditions will advance both prevention and early intervention.

I also noticed in my conversations this weekend that those with more serious mental health conditions were particularly interested in how to improve their mental health. When the man with bipolar disorder and schizophrenia spun our wheel, he landed on the question of how do you know if you are struggling with your mental health and he said – “I have problems with my sleep and my medications.” Sleep was a key component of his mental health and wellbeing. His clinician could have a richer conversation with him about his medications if it were framed as promoting mental health and wellness and included a conversation about sleep.

A woman, who had previously been homeless and struggled with a serious mental health condition, talked at length about the comfort she received from her pet and how caring for her pet had helped her when she considered suicide. Her mother had recently recommended that she develop more friendships. We talked about the importance of those social connections and the relationship to mental health.

Peer support specialists are trained to help people think about tools toward maintaining their mental health, including sleep, opportunities to socialize and connect, exercise and eat better. Clubhouses are another service that promotes connection, eating well, and mental health. These services are no different than paying for someone with diabetes to work with a nutritionist or attend nutrition education classes. We all need to eat well, but those with pre-diabetes or diabetes need to be particularly mindful of their diet and nutrition. Similarly, we all need to sleep, exercise, and connect with others, but people with serious mental illness need to be particularly mindful and connected to supports that can help them promote their mental health.

Yet peer support specialists are not covered by Medicare and private insurance and are paid very little in the Medicaid program. Clubhouses struggle to get reimbursed in our current financing system which focuses on sick care, rather than promoting mental health.

In a polarizing time, we often get caught up in divisions – whether between parties or between advocates for mental health or mental illness. Recognizing that promoting mental health is important to everyone and is even more critical to those with mental illness may be a way to bring people together and provide primary and specialized services that make us all mentally healthier

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Newsletter

The Tragic Story of State Custodial Institutions

JCheang — Wed, 09 Oct 2019 17:08:40 +0000

The Tragic Story of State Custodial Institutions

JCheang Wed, 10/09/2019 - 13:08

October 09, 2019

By Frank Proctor, Former MHA Board Chair (pictured left above with Joan Crawford and President Kennedy), and Phil Ryan, Former MHA CEO

From time to time, MHA invites guest blogs on issues of current discussion and debate. The following timely piece was co-authored by two former MHA executives. Please excuse their somewhat archaic language; these are their exact words, and we wanted their voices to remain authentic.

The tragic story of the State custodial institutions has been too often told to warrant repetition in detail here. The neglect, abandonment, overcrowding, shortness of staff, inadequacy of equipment and facilities are all already old stories.

But, if all that were corrected today, if the hospitals were by some miracle renovated, refurnished, supplied with all the staff and supplies and equipment that they needed— and it would take nothing short of a miracle to accomplish this — if all that were to happen, this would still not provide an ultimately satisfactory solution for the problem, nor an ultimately satisfactory answer to the needs of the mentally ill.

There is one thing that physical change can never do for these hospitals, and that is to remove from them the quality of separateness and difference.

Their isolation and distance from the community constitutes more than physical alienation. It constitutes spiritual, philosophical, and ethical alienation. So long as we continue to treat the mentally ill in distant and separate institutions, away from the rest of society, so long will we continue to regard the mentally ill as separate and different, and so long will we continue to deny to them the same kind of care, the same kind of medical attention, the same kind of sympathy and interest that we accord to our physically ill.

And so long as we do that, the problem of mental illness with its gigantic human and financial cost will continue to grow and not diminish.

The fact is that the mentally ill are not different. They are sick people. Their strange and often difficult behavior is the symptom of their illness. They are in need of medical care like other sick people. And they are in need of this care in the community where they live, among family and friends — near the church or temple where they worship and near the job where they have worked — near other health and welfare services — in facilities which are similar to or part of those in which the physically ill are treated; with the same medical and humane considerations; and with the same level of quality and adequacy.

This is not merely an ethical or moral necessity. This is a medical necessity.

It has been reported to us time after time that the necessary period of treatment is much lower and the recovery rate much higher among patients treated in the community and under such conditions as I have just described, than it is for patients who are treated in the State mental hospitals.

Mr. Proctor and Mr. Ryan gave this statement to Congress fifty-six years ago in March, 1963.

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Medicaid's 54th Birthday

JCheang — Thu, 29 Aug 2019 18:32:40 +0000

Medicaid's 54th Birthday

JCheang Thu, 08/29/2019 - 14:32

July 31, 2019

By Caren Howard, MHA Advocacy Manager

Fifty-four years ago, on July 30, President Lyndon B. Johnson signed into law the Social Security Amendments Act of 1965 establishing the Medicare and Medicaid public health insurance programs. The bill was the start of a commitment federal government made to its citizens to provide a safety net to the uninsured who did not have a way to pay for health care.

How Would Medicaid Help Me and My Loved Ones?

Over the past five decades, Medicaid has become a bedrock of our nation’s health system. It is the number one payer of behavioral health, paying for nearly one-third of all mental health and substance use services. It also covers nearly half of all births and half of children with special health care needs.

Medicaid offers key benefits that many private insurers won’t cover. For instance, Early Periodic Screening, Diagnosis, and Treatment (EPDST) is a comprehensive benefit for children that may prevent the development or exacerbation of mental health conditions. We know that mental health problems affect one in five young people at any given time, and about two-thirds of them are not getting the help they need. Early identification, accurate diagnosis, and effective treatment can help young people to more quickly recover and benefit from their education, to develop positive relationships, to gain access to employment, and ultimately to lead more meaningful and productive lives.

Medicaid also covers three crucial supports for adults: 1) peer support for personal recovery, 2) vocational rehabilitation for those wishing to return to school or work, and 3) transitional housing services for those leaving institutional care to return to their community. With these kinds of supports in place, a person’s overall health care costs can be reduced, and it may mean the difference between a fulfilling life in recovery and remission in the shadows.

In 2010, the Affordable Care Act (ACA) increased the reach of Medicaid two ways:

By giving states flexibility to change their Medicaid program design to better meet the needs of their state through the 1115 Medicaid waiver program (which “waives” standard Medicaid rules and allows states to operate the program under special rules, provided this does not increase overall costs).
By offering additional federal funding to states to cover non-traditional populations that would be otherwise uninsured (i.e., now dependent-less adults making up to 138% of the federal poverty level could qualify for coverage).

When more people have insurance to help them pay for their chronic and acute health needs, they end up living longer, more productive lives. They are more likely to find and keep work that contributes to the community. Thus, Medicaid helps increase access to care and reduce the strain of uncompensated care on health systems. Rather than becoming sicker, and waiting until a crisis or emergency, it has been shown that individuals and families with Medicaid find help and get better sooner.

How Can We Protect our Medicaid Programs?

We must reinforce the original intent of the law— to provide a safety net for people who are uninsured.

We must reject policy changes that arbitrarily cap or cut funding, turn funding into a block grant, or create additional work documentation requirements as an eligibility barrier that dis-enrolls people from their coverage.

If this issue hits home for you, take action to contact your elected officials online, via telephone, or through the press, to tell them to protect Medicaid and not to undercut the families and children it serves.

We would like to see Medicaid continue to be a safety net for people who need it for another fifty-four years. Let’s celebrate the success of Medicaid and all those who live better lives because of it!

policy

Making advocacy accessible: 5 learnings from my first congressional briefing

Briefing basics

5 takeaways and tips

1. If you're looking for a solution to a systemic issue, you must provide information on why and how that issue affects average citizens – and offer solutions.

2. Support from multiple groups and organizations is essential.

3. “Leave-behinds” provide critical information and summaries.

4. Invite the right speakers, organizations, and other attendees.

5. Congressional briefings are a great place to network and meet folks with similar agendas.

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What the pandemic storm is revealing and what will be left in its wake

Loosening Some Coverage Reins - Please Loosen More

How Connection Saves Lives and How Policymakers Need To Understand That

The Tragic Story of State Custodial Institutions

Medicaid's 54th Birthday

Further Reading: