Transforming the Mental Health System
With a variety of services and supports, people with mental health concerns or psychiatric disabilities can and do thrive in their communities. Unfortunately, many Americans lack access to the services and supports they want and need. For those who receive services, it is often only after an extended period of struggling and crisis that services and supports become available.
We hear time and time again about the broken mental health system that contributes to school drop-out, job loss, homelessness, incarceration, and suicide. As individuals with lived experience of mental health conditions and their family members continue to share their stories of struggles and hope, the American people are more aware of how common mental health conditions are and how improvements to the way we deal with mental health are crucial and urgent.
Fortunately, there are many steps we can take in order to improve the mental health and well-being of all—no matter where they are in life. Mental Health America (MHA), supports advocates, policymakers, consumers, and providers in transforming the mental health system by:
The goal of all mental health services and systems should be to support individuals at all stages of their recovery to live their best lives. Beyond simply “symptom management” recovery means that people living with mental health conditions or psychiatric disabilities can live meaningful lives in their community of choice while striving to achieve their full potential. This means that recovery-based systems include not only a focus on health but also on home, purpose, and community. A system that focuses on recovery also ensures evidence-based healthcare values and honors consumer needs and wants.
MHA calls for the following changes:
- Public and private health plans and provider groups should use recovery outcome measures and recovery-oriented planning tools to continuously improve the delivery of services. This means that advocates, policymakers, health systems, and behavioral health practitioners must work together to create systems that work to best support individuals in their recovery.
- Reimbursement and coverage policies must reflect the need for individualized care and maintain flexibility to respond to consumer needs and to test promising practices. In addition, it is important to advocate for wider investment in Patient Centered Outcomes Research, practical clinical trials and other research methods that generate evidence applicable to real-world treatment settings.
- Safety and individually tailored treatment should be the top goal of an evidence-based healthcare system. Treatment costs are relevant to the discussion but must be weighed in the system context—total burden of disease costs for an individual across services and settings- rather than restricting costs to a particular cost center—like outpatient care. In the context of clinical decision-making, cost should be evaluated by providers and consumers after a careful weighing and discussion of benefits and risks and a dialogue that emphasizes choice across a range of therapeutic options.
Mental health is an essential component of overall health and well-being for everyone. As a public health issue, mental health promotion and prevention and intervention services should be available for all. Not investing results in massive losses in health, work productivity, and quality of life for countless Americans. The costs of not investing in mental health in conjunction with overall health is especially profound among individuals living with serious mental illnesses, where high rates of health problems and premature death are alarmingly common.
MHA calls for the following changes:
- Based on the considerable existing research and the work yet to be done, implementation of science-based promotion and prevention approaches for the entire population must be a high priority at the national, state, and local levels.
- Mental health and substance use conditions should be detected early and treated effectively. Routine screenings in schools, pediatric clinics, the workplace, and primary care, among others, should be the norm. When individuals are identified as needing care, adequate treatment systems that focus on recovery and resilience should be available along with supports. Financing strategies that reimburse collaborative care services are essential to realize these goals.
- Assure financing methods for service improvements, including reimbursement for coordination activities, community case management, transportation, and other supports to ensure access to general healthcare services. Total healthcare costs are actually reduced, both in the near and long-term when appropriate physical and behavioral health services, including rehabilitation-recovery services, are provided in a coordinated healthcare system.
All Americans should have a right to healthcare benefits, including needed mental health services. Systems must be integrated with general health care to support people at all stages of their lives and must offer culturally and linguistically competent services and supports that are reflective of diversity of communities being served. The federal government, in partnership with the states, must continue to take a leading role in the development of evidence-based, recovery oriented services that are comprehensive, community- and strengths-based and consumer- and family-driven. Setting up systems also includes ensuring that, as a matter of law, public and private health plans afford people access to needed care and treatment at parity with other healthcare services.
MHA calls for the following changes:
- Information technology has the potential to improve the delivery of comprehensive services through improved communication and coordination. The coordination of information systems that bridge systems should promote the use of shared databases across all health service areas while maintaining patient/consumer rights and privacy. Integration also requires better coordination of quality outcome/performance measures. If the quality metrics used to measure healthcare are not aligned, efforts to establish best practice in integration will be pointless. Measurement standards should cross mental and general health and should be influenced by consumer preferences and input.
- All organizations that provide mental health services should assess the diversity and needs of the people and community they serve and develop and implement plans and practices that work best for them. This can include providing materials and offering services in different languages and ensuring that providers are skilled in specialized assessment and treatment techniques to serve consumers with diverse ethnicities, sexual orientations, and gender identities.
- MHA continues to support the principles of the Parity Act and the implementation of the final rule. Although MHA is concerned about potential expansion of residential services using parity as a lever, and continues to support community-based care and cost containment, individual cases must be decided based on detailed individual findings of medical necessity and monitored by HHS to determine if a systemic problem needs to be addressed with further guidance or plan enforcement.
To read our full position statements on transforming the mental health system, check out System Transformation Issues.
To see a full list of our position statements, go to Position Statements.