Continuity of care between the inpatient and outpatient settings continues to be a challenge. Current hospital payments assume that hospitals are actively involved through discharge and the transition to outpatient settings and advocating for payments for outpatient providers to assist in this process is viewed as duplicative. This undermines mental health care providers’ ability to smoothly transition clients between service settings.
Meeting the credentialing requirements for program services and mental health professionals has posed new challenges. Community behavioral health organizations employ professionals that may not meet private insurers’ credentialing standards (for example, 3 years of post-licensure experience). Community providers have addressed this through contractual arrangements in which quality assurance and supervision requirements substitute for these credentialing standards. Services are billed under a supervisory protocol in which the supervising professional’s national provider identifier is used.
Additionally, some programs offer services that rely on a combination of funding sources such as county, state, and private insurers. In these situations, counties sometimes want to limit private insurance clients’ access to these programs because a portion of the overall program is covered by the county.
Impact of State Budget Cuts on Mental Health Care -
In a dramatic turnabout that may foreshadow dilemmas faced by other states, the governor of Minnesota vetoed funding for the state’s mental healthcare program. The legislature would have extended the program for several months, as a compromise was negotiated to retain elements of coverage for the state’s mental health population – a hospital uncompensated care fund, medication/pharmacy, and “coordinated care delivery systems.” In the system, an accountable hospital-centered program paid a fixed amount to cover about 40% of the state’s mental illness population who elected to participate. As there is no reimbursement for outpatient clinic and all non-hospital services, providers and consumers now are scrambling to seek disability determination or enroll in Medicare type coverage after the six month state mental illness coverage enrollment period ends.
While these cuts are only effective as of June 1, 2010, it is expected that they will result in increases to the uncompensated care burden on hospitals and community safety net providers.
How Do We Minimize The Impact of Budget Cuts on Mental Health Care?
Many not-for-profit membership organizations representing community mental health and other service provider agencies throughout Minnesota have been working in coalition with national mental health groups on advocacy related to the state’s mental health program changes. Initially, advocacy efforts were focused on encouraging the state legislature to vote in support of expanding the state Medicaid program early to receive additional federal funding (as provided for in the national healthcare reform bill). Unfortunately, this proved to be politically untenable in the immediate future; however, a measure was passed to allow the governor to use executive authority to expand Medicaid coverage for mental illness patients.
While being actively involved in this advocacy process is vitally important to the community behavioral health system, national mental health advocacy medicaid organizations and their members are also evaluating ways in which they can optimize their business practices to meet this changing budgetary reality. Among other strategies, community behavioral health providers are working to develop partnerships with community hospitals to reduce the number of avoidable emergency department admissions and ease the transition from the inpatient to outpatient settings, supporting clients through the disability determinations process so they may become eligible for Medicaid as quickly as possible, and raising funds that will help to cover the cost sharing requirements for state sponsored mental health care and the enrolled clients that are unable to pay.
Through this two-pronged approach that includes both advocacy and pragmatic business considerations, it is hoped that the community behavioral health system will be able to develop new cost-effective ways of delivering services that will be well-positioned to withstand funding changes while taking advantage of new opportunities made available through national and state health care reform initiatives.
One in four people will suffer a mental, neurological, or substance use disorder at some point in their life; yet many cannot get access to basic medicines or basic mental health care. The mental health Gap Action Programme (mhGAP) asserts that with proper care, psychosocial assistance and medication, tens of millions could be treated for depression, schizophrenia, and epilepsy and prevented from suicide even where resources are scarce. For more information: www.who.int
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While there have been many advances made in the mental health field over the last quarter century, with mental health professionals acknowledging more and more mental illnesses and how they develop, one aspect of mental health is still not widely discussed. This is the actual impact that physical illness has on one’s mental health.
In fact, few people who are not in the mental health field even consider the part that physical illness plays when it comes to mental health. For example, when you get a cold, you may be a little irritable, and most of us would attribute the fact that we don’t feel good to that irritability.
However, it goes a little deeper than that. When we don’t feel good – even if feeling bad comes from a simple cold – we also tend to feel a little ‘blue.’ Things that would not otherwise be a big deal in our lives become a little larger. We do not respond or react as we normally would.
Fortunately, the cold does not last long, and we get back to being ‘normal.’ But what if that cold turned into a long term illness, or even a fatal illness? How does that affect our mental health? It affects every area of your life, including personal relationships, social interactions, work, and even religious beliefs and spirituality. With such illnesses, it isn’t even so much a question of not feeling good, in the physical sense. It is a question of not feeling good in the mental sense.
Naturally, when confronted with long-term illnesses, no matter how mild or serious they are, we experience a range of emotions, such as anger, worry, and sadness. We feel that our bodies let us down. We feel that we have no control. We may feel lonely or feel that people don’t understand what we are going through.
The biggest concerns, from a mental health standpoint, when it comes to long-term illness, are depression and anxiety. It is not at all uncommon for someone who is suffering from a long-term physical ailment to experience either of these conditions. It is, however, often overlooked and left untreated. This, of course, can be very dangerous, and as research has shown, even have a negative impact on the physical recovery process.
These days, doctors are more aware of how physical ailments affect our mental health, and they are on the lookout for signs of anxiety or depression in their patients. However, for the most part, your doctor will not be aware that a problem exists if you are not open and honest with them about your feelings and what is going on in your life.
Overall, it is perfectly fine and perfectly normal to feel a little blue when you are under the weather. But when it comes to long term illnesses, you need to be able to recognize the signs of depression and anxiety. When you see those signs, let your doctor know immediately, and seek treatment. Don’t try to ‘go it alone’ and do not assume that ‘it will pass.’
Jennifer B. Baxt, LMFT, LMHC, PA
Complete Counseling Solutions
http://www.completecounselingsolutions.com