A prescription for mental health care reform

As Congress struggles to bring about health care reform, those suffering from mental illness can only hope some improvement comes to the nation's mental health services. Author Timothy A. Kelly has a prescription for reform in his book "Healing the Broken Mind: Transforming America's Failed Mental Health System" published in August by New York University Press. Kelly, former commissioner of Virginia's Department of Mental Health, Mental Retardation, and Substance Abuse Services, is director of the DePree Public Policy Institute and associate professor of psychology at the Fuller Graduate School of Psychology in Pasadena, Calif.

GUEST BLOGGER: Timothy A. Kelly.

"For too many Americans with mental illness, the mental health services they need remain fragmented, disconnected and often inadequate, frustrating the opportunity for recovery.... [and adding] to the burden of mental illnesses for individuals, their families, and our communities." Those were the words of the President's New Freedom Commission on Mental Health (2003), which went on to recommend "a fundamental transformation of the nation's approach to mental health care."

That transformation has not yet occurred. As a former mental health commissioner and practicing psychologist, I have seen too many heart-breaking examples of people with mental illness who long to recover, but spend a lifetime seeking effective care. There are many good mental health providers across America, but not enough. Furthermore, the system (e.g., reimbursement structures and vested interests) fights against anything that challenges the status quo.

What to do? In my book, I present a five-fold vision for reform that would create a mental health system that is home-and-community-based, innovative, outcome-oriented, and patient-focused. Such care is designed to lead to recovery for people with serious mental illness - not healing but providing the ability to lead a successful life in the home community. This means having a real home, a fulfilling job, and deep relationships. It means being able to come home.

Health care reform is caught in the political maelstrom of the moment. It is not yet clear what mental health care will look like, but two improvements are likely - increased coverage (equality, or parity, with medical care), and seamless inclusion of mental health services in medical centers (the integration of care). Unfortunately, this addresses only one of the five areas needed in order to create a recovery-oriented system of mental health care, as follows:

1. We must embrace evidence-based practices both in health care and in mental health care. This means offering only treatments that are scientifically proven to help people recover quickly. It also means embracing an outcome-oriented system of care that measures how effective we are in the lives of people who come for services. Quality of care necessarily improves when we can see what's working well and what isn't.

2. We must break the states' monopoly on public sector psychiatric services, which is the system that eventually cares for most people with serious mental illness (even those with insurance, once it runs out). We need to open the public sector mental health system to genuine competitive practices to increase choice, lower costs, and raise quality of care.

3. We must have equal coverage (parity) for people with mental illness - meaning they should get the same amount of coverage as those with medical-surgical needs. A federal parity law was passed last year. But the devil is in the details -- effective implementation is going to be a challenge.

4. We must develop a truly patient-focused (consumer-focused) system, where those who are being treated are invited to collaborate with caregivers and policymakers. In both health care and mental health care, the provider should sit down with the patient to discuss the relative advantages and disadvantages of various treatment options. Since no doctor is perfect, the best care is delivered when treatment is a joint decision.

5. We must overcome the status quo's resistance to change. A lot of people are calling for mental health reform, yet the status quo prevails. The reason is that there is a system in place that spends about a hundred billion dollars a year on mental health care, and generates a good deal of vested interests. What's needed is visionary leadership, economic imperative, and public outcry -the perfect storm for lasting change to occur.

The good news is that with health care reform underway change is in the air. Now is the time, therefore, to work hard so that these five recommendations are incorporated in today's health care legislation and thus a new mental health system of care is created. The result? Our family members, friends and neighbors who struggle with mental illness will finally be able to come home.


By Steven E. Levingston |  November 2, 2009; 5:30 AM ET Politics , Steven Levingston
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I experienced a breakdown in 1989. I went through 6 years of therapy, with very little results. When I brought home a puppy that helped me more. The system is set up to keep a person as a patient. I descovered a way to recover. It's simple and can work for many others. Read about it in my book, "The Cross and the Psychiatrist" Found at amazon.com andd also you can google it. Terry Dorn

Posted by: tldorn | November 3, 2009 6:19 AM

As a family member and longtime advocate of mental illness treatment and healthcare reform, I agree that the vested interests are not in the patient's interest but in the vested and their piece of the pie, how to either make it a bigger piece or survive based in the sometimes pitiful rates of re-imbursement. Then of course there is the problem of what we have in public mental health is a crisis reactive system with some underfunded community treatment that is more about maintenance than recovery. It is hard to tell which came first but so many of the doctors and providers, even those modernly trained and able to come up with a diagnosis use the new generation medications and that’s about it. You are not sure if they know that it takes rehabilitation and therapies that not just maintain but lead to higher levels of recovery. It is all about money and not about the quality of life the serious and persistent mentally ill live. Also the statistics indicate that this population life span is twenty to twenty five years less than the ‘mentally” healthy population.

I live in Texas and in our area we have a managed care model which tries real hard and does not get nearly the level of funding to do a really good measurable job. Different from the rest of the state there are no wait lists so we treat more individuals for less and outcome measurements in all healthcare are lacking.

What Mr. Kelley does not address is the terrible stigma that remains regarding these brain diseases and how we all need to educate the public at large in as much as these illnesses attack one in five families and meaningful community treatment will work.

Posted by: katzdami | November 3, 2009 9:33 AM

Eating Recovery Center, an eating disorder center in Denver, is offering insurance guidance as U.S. Mental Health Parity Law takes effect. Visit https://www.eatingrecoverycenter.com/pdf/Eating_Disorders_Insurance.pdf to download this informational flyer.

Crystal (Eating Recovery Center)

Posted by: CNoel | November 6, 2009 5:38 PM

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