News Briefs

KFF webcast and other resources on the Supreme Court and the ACA: The Kaiser Family Foundation (KFF) has archived a webcast of its March 14 briefing that examined implications of the U.S. Supreme Court case on the Affordable Care Act (ACA). The 1.5-hour briefing included KFF president and chief executive officer, Drew Altman, Ph.D., and seven policy analysts from KFF, private organizations, and academia. They discussed potential outcomes of the case, how they might affect health care reform and the Medicaid program, and the likely policy and political responses from the Administration, Congress, and the public. KFF has also issued a policy brief that examines the legal issues in the case, including the challenge to the individual mandate, and a separate brief that details the legal challenge to the law's Medicaid expansion. At the briefing KFF released data from its monthly poll of the public's views of the reform law, which showed a nearly perfect split: 41% of Americans held a favorable view and 40% an unfavorable one. KFF has created an interactive graph that allows users to explore the past year's polling data by party identification, race, age, income, insurance status, and other demographic factors. A column by Dr. Altman looks at why public opinion on the ACA has been so resistant to change and compares the debate about the health reform law to the debate about fluoridation in an earlier era. These resources, along with a podcast and transcript of the briefing, are available on the KFF site at www.kff.org/healthreform/scotus_aca_video.cfm. A decision in the Supreme Court case is expected in late June.

SAMHSA's online tools for shared decision making. The Substance Abuse and Mental Health Services Administration (SAMHSA) has assembled a set of online tools to support an interactive, collaborative connection between consumers and their behavioral health care providers to make decisions that promote recovery. One tool is designed to help consumers make informed choices about antipsychotic medications by weighing the side-effect profiles of various drugs. The information is available in printable format for consumers to share with their provider during a treatment session and to guide discussions of preferences and concerns. A workbook that offers a step-by-step approach to making important decisions and talking with others about them is posted, along with a video illustrating ways to use the workbook. The site also includes information on shared decision making for family members and friends, providers of mental health services, psychiatrists and medical staff, and program administrators. The shared decision-making tool is available on the SAMHSA site at www.samhsa.gov/consumersurvivor/shared.asp. It is also available on DVD at no charge from the SAMHSA store (www.store.samhsa.gov/home).

Bazelon Center initiative to reassert role of community mental health. “What community mental health was supposed to be and why it hasn't turned out this way” is the heading of the introduction in a new report from the Bazelon Center for Mental Health Law. The report explains the origins of a “too-common scenario” across the United States—the reliance on police to intervene in preventable mental health emergencies. The Bazelon Center is partnering with community mental health systems in five states in an initiative called the Performance Improvement Project (PIP). Its goal is to reassert the intended role of community mental health programs as responsible for meeting the needs of consumers who are at risk of involvement with police as a result of mental health crises. PIP seeks to change the “reactive stance” taken by public mental health systems toward psychiatric crises in which high-cost interventions—police calls, hospitalization, and jail beds—are provided, with few follow-up services and supports. PIP's aim is to empower community mental health agencies to address the diverse factors that place people with serious mental illnesses at risk of crisis and bring them into contact with law enforcement and enable a community to take more cost-effective, less harmful proactive approaches. The report documents activities and progress at the five sites: Austin; Detroit; Pittsburgh; Portland, Oregon; and Westchester County, New York. The 22-page report, Asking Why: Reasserting the Role of Community Mental Health, is available on the Bazelon Center Web site at www.bazelon.org.

SAMHSA review of research on health promotion programs: Over 40% of adults with serious mental illness are obese, and fewer than one in five people with schizophrenia engage in regular moderate exercise. Current research findings indicate that lifestyle interventions for this population result in clinically significant weight loss (5% of body weight) for only a minority of participants. Studies have not yet shed light on why some participants achieve significant weight loss and others do not. However, certain program characteristics seem to facilitate greater success. These include program duration of longer than three months and designs that combine education and activity-based approaches and that incorporate both nutrition education and exercise. These findings are from a literature review conducted for SAMHSA's Center for Integrated Health Solutions by the Dartmouth Health Promotion Research Team, under the leadership of Stephen Bartels, M.D., M.S. The systematic review addresses nonpharmacological lifestyle interventions aimed at reducing obesity and improving fitness for people with serious mental illness. The authors note that improving cardiorespiratory fitness has substantial benefits independent of weight loss. Improvement by just one metabolic equivalent per day is associated with a 10%–17% reduction in mortality risk. The 40-page literature review is available on the SAMHSA center's Web site at www.integration.samhsa.gov/health-wellness/wellnesswhitepaper.

Tool for promoting mental health and preventing suicide on college campuses: The Jed Foundation and the Education Development Center, Inc., have released Campus MHAP: A Guide to Campus Mental Health Action Planning. The publication is designed to help college and university administrators implement a plan to promote the mental health of campus communities and support students who are struggling emotionally. Many schools around the country have adopted the model, and the new guide makes it more accessible by leading schools through a step-by-step process to define campus-specific issues and priorities, develop programs and policies, and evaluate their efforts. In a 2010 survey conducted by the Jed Foundation and MTV, more than half of college students reported high levels of stress that prevented them from studying in the past year, and 13% had a friend who had attempted suicide. The guide can be downloaded for free at www.jedfoundation.org. The 36-page guide is part of a series that includes four webinars, which are also available on the site.

AHRQ's PCMH Resource Center: A new white paper, Early Evidence on the Patient-Centered Medical Home, has recently been added to other resources available from the PCMH Resource Center (www.pcmh.ahrq.gov) on the Agency for Healthcare Research and Quality (AHRQ) Web site. The patient-centered medical home (PCMH) aims to reinvigorate primary care and achieve the triple aim of better quality, lower costs, and improved experience of care. The white paper, which was prepared in collaboration with Mathematica Policy Research, systematically reviews the early evidence on effectiveness of the medical home. Other resources include a brief for decision makers, Improving Evaluations of the Medical Home, that describes the importance of effective evaluations of the PCMH and how they can be achieved. A second guide, Building the Evidence Base for the Medical Home: What Sample and Sample Size Do Studies Need?, provides further information about why evaluations of the medical home should account for clustering of patients within practices, how this can be achieved, and how large patient and practice samples need be to achieve adequate statistical power.