What Most Health Plans Should Provide
|Did a recent experience trying to find care leave you frustrated or happy?|
As a result of the recent health care reforms, most health plans are required to provide an array of mental health and substance treatment. Because these requirements are so new, not all of these benefits will be available right away, but together we can work toward comprehensive care. Under the recent health care reforms, most health plans should provide:
- Behavioral health check-ups in children. When you take your child for a check-up, their pediatrician should ask questions to see how your child is developing mentally, emotionally, and behaviorally. Are they making friends? Are they engaged during school? The pediatrician should use a form to ask a series of these questions and share the results with you. If there are any concerns, the pediatrician should help you to find a mental health specialist for further evaluation.
- Depression screening in adolescents and adults. During a check-up, your pediatrician or primary care doctor should ask a brief series of questions from a form to see if you might be experiencing symptoms of depression. The physician should share the results with you and, if there are any concerns, they should help you find a mental health specialist for further evaluation.
- Therapies and supports. Providers use a variety of different proven techniques to help individuals’ change their thoughts or behaviors to improve their mental health. These could include:
- ??Nurses or other specially-trained providers can help first-time mothers reduce parental stress, improve parental mental health, and promote positive child development, from the beginning of pregnancy through the two years of a baby’s life (e.g. Nurse-Family Partnerships or Healthy Families New York).
- When a child shows an early indication that they might need mental health help, specialists can train families on techniques that help the child develop as positively as possible, while support groups can help the families feel connected and supported as they work to help their children (e.g. The Incredible Years Program, Triple P Positive Parenting Program, or Strengthening Families Program).
- Throughout life, trained staff (including peer specialists) can provide early intervention supports and coordination to help individuals reduce stress and stay on track in the community (e.g. PIER or CARE for psychosis).
- Providers can administer sessions of evidence-based talk therapies, like cognitive-behavioral therapy, dialectical behavioral therapy, or exposure therapy, which are proven to treat different mental health needs.
- When therapy and moderate support are not enough, a coordinated care team can provide intensive treatment and support, where a number of different specialists work together with an individual to help that individual choose and pursue goals, and ultimately get his or her life back on track (e.g. assertive community treatment, multi-systemic therapy, PIER or CARE for psychosis).
- For those with severe mental health needs, different specialists can assist an individual in setting goals and helping them to build skills and connections to reestablish the life they want out in the community (e.g. psychiatric rehabilitation, which includes: support ideally using peers, clubhouses, supported education/employment/housing).
- Care coordination, case management, and support, ideally using peer specialists. No matter what care is provided, your care should be coordinated. Some questions to ask are: Do the individuals involved in your care communicate with one another? Does each individual know what the others are doing and know how you are doing? Do they support you in pursuing the services, supports, and opportunities you need in your recovery, whether in the office or out in the community? Do they check on and support your recovery at all stages? (e.g. collaborative care, targeted case management, psychiatric rehabilitation).
- Support groups and other community-based supports. Your health plan, along with those involved in your care, should be able to link you to support groups and other types of community-based supports (e.g. Depression and Bipolar Support Alliance, Alcoholics Anonymous, Narcotics Anonymous).
- Crisis response services. During crisis, a specially-trained team, including providers and peers, should be able to meet the individual out in the community and help them out of crisis and toward recovery (e.g. mobile crisis teams, ideally including peers).
- Other crisis services. There should be a place that you can go if you need immediate mental health help where staff are specially trained to understand your needs and respond in a way that makes you feel comfortable and helps you get back on track with your recovery (e.g. psychiatric urgent care, peer-run crisis respite, and specialized psychiatric emergency departments.).
- Medications. You should have access to a range of medications to help with behavioral health needs, but even with the new health care reforms health plans can place some restrictions on which medications they cover.
This may look like a lot more than what most people think of when they think of mental health care – fifty minute therapy sessions, medication management, and hospitalization if needed – but this does not reflect modern standards of care. We can work together now to ensure that behavioral health care meets modern stands.
Want To Tell Us About Your Experiences?
If you can’t access treatment under your current plan, or if your plan is doing an exceptional job, take our survey and share your story. Also reach out to your health plan and let them know, they will appreciate the feedback and they try to meet your needs. The above programs are evidence-based and many will even be cost-saving for your plan if they provide these services early. To learn more, visit the Washington State Institute of Public Policy’s Cost-Benefit Analysis.
To read more about the requirements under the new health care reforms and why many health plans should be providing these services, read our policy page on this topic here.