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New Report Identifies Barriers and Policy Options to Integrating Clinical and Mental Health

Headshot of Joann Donnellan
Joann Donnellan

Washington, D.C.– A new report released today by the Bipartisan Policy Center examines the major barriers to integrating clinical health care and mental health services in the United States, including insurance coverage and payment disparities, workforce shortages, and administrative challenges. The report, Integrating Clinical and Mental Health: Challenges and Opportunities, also identifies federal and state policy options that could help remove these barriers and advance evidence-based treatment for mental health care.

In 2016 alone, nearly 45 million Americans age 18 and older were affected by some form of mental illness, more than 20 million endured a substance use disorder, and 8.2 million experienced both. Research shows that integrating mental health and primary care services improves access to care and treatment outcomes, lowers rates of mortality, and provides cost savings.

However, there have been significant inequalities in the treatment and insurance coverage of mental health compared to physical health in America, creating a fragmented system of care.

“Those with mental health and substance use disorders currently face a separate and unequal system of care in this country,” said former Rep. Patrick J. Kennedy, founder of The Kennedy Forum and former member of the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, who spoke at today’s event. “Diseases of the brain can and must be treated on par with diseases of the body, such as diabetes and cancer, using evidence-based approaches. There is no health without mental health,” Kennedy said.

“While policymakers have worked to improve care around mental health, most notably through policies like the Mental Health Parity and Addiction Equity Act, more can be done to improve coordination of care, avoid duplication of services, and move toward seamless and comprehensive integration of services,” said Benjamin Miller, Chief Strategy Officer of Well Being Trust. “There should be no wrong door for a person presenting with a mental health need—and federal and state policy should reflect this goal.”

BPC’s report identifies three main areas for federal policy solutions that are based on a series of public and private discussions with leading experts in the field.

1. Insurance coverage and payment barriers. Disparities in coverage continue in public and private health insurance plans. Mental health as an “essential health benefit” and the expansion of mental health parity laws are no longer guaranteed under new interpretations of short-term insurance and state insurance waivers. Enforcement of mental health parity laws remains inconsistent, and such laws do not exist in either Medicare or Medicaid. Studies also show that reimbursement rates for mental health services across payers are lower compared with clinical health services.

Policy options for private insurance include strengthening mental health parity compliance and reporting on the impact of insurance market regulations on patients. Medicaid policy options should include fully integrating behavioral services into the program, repealing the Institutions for Mental Diseases exclusion, and requiring mental health parity. Options for Medicare include removing the limits on inpatient psychiatric facility admissions when appropriate, improving access to reimbursement for mental health providers, including telehealth services, and promoting the integration of mental health care into primary care.

2. Workforce barriers. A shortage of mental health professionals currently exists due to inadequate training opportunities, conflicting state scope-of-practice laws, and insufficient reimbursement which affects access to mental health services and prevents integration of care.

Policy options include promoting and subsidizing workforce training programs, providing financial incentives to clinicians to specialize in mental health in high-need areas, improving graduate medical education for behavioral health, financing evidence-based training, developing evidence-based telehealth, and adopting consensus guidelines for appropriate standards of care.

3. Administrative barriers. Multiple agencies and programs serve patients with mental illness. While Congress has taken action to improve coordination, experts express concerns about overlapping responsibilities, duplication of services, and the absence of a strategic plan to address gaps in services.

Policy options include reporting on the impact of programs serving patients with mental illness, directing federal funding to stand-alone mental health facilities, and providing financial incentives for mental health providers to use electronic health records.

“Research has consistently shown the importance of integrating clinical and mental health services in improving outcomes,” said Katherine Hayes, BPC’s director of health policy. “Moving to a fully integrated care system will require leadership; a commitment to addressing parity in coverage and reimbursement, delivery and financing of care; a willingness to address mental health workforce shortages; and a unified vision across the myriad of programs that fund the treatment of mental illness.”

Read the Report

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