APA Unveils Vision of New, High-Quality MH System
Last month APA’s Board of Trustees released the 12-page report, “A Vision for the Mental Health System.”
APA President Paul Appelbaum, M.D., appointed psychiatrists from the public and private sectors and APA’s Board and Assembly to the task force and charged them with developing a vision statement.
In addition to Sharfstein, the members are Norman A. Clemens, M.D., Anita S. Everett, M.D., David Fassler, M.D., Susan L. Padrino, M.D., Roger Peele, M.D., Michelle B. Riba, M.D., and Darrel A. Regier, M.D.
Sharfstein said, “In our work, we were looking ahead to the final report of the President’s New Freedom Commission on Mental Health. For the first time in more than 30 years, a presidential commission is focusing on the problems of the mental health system. In addition, the Congress finally is seriously debating a law to provide parity in coverage for mental illness and other medical conditions.”
Commission Chair Michael Hogan, Ph.D., will speak to the members of APA’s Assembly on May 16 about the recommendations of the commission. Appelbaum and Sharfstein will reply on behalf of APA.
Sharfstein emphasized the critical importance of being able to describe what a comprehensive, high-quality mental health system can offer the American people.
“State budget crises require advocacy at the highest level,” he said. “We must be able to make a case for the effectiveness and importance of mental health services in light of intense and accelerating demand for public financial resources.”
Sharfstein also pointed out that mental health expenditures under employer-based private insurance had dropped from 7.2 percent of total health spending in 1992 to 5.1 percent of total spending in 1999.
“We want the commission to understand the complicated array of results when people are unable to access mental health services because of cutbacks in private insurance coverage,” he said.
Sharfstein argued that the costs for other medical services go up, and productivity frequently goes down. Costs also shift to the public sector, which is particularly ill equipped to absorb them now.
In fact, task force members call attention to the increased “blurring of the boundaries between public and private delivery of services.”
They also cite as a major problem “the managed care marketplace that carves out mental health care from general health care, discourages integrated psychotherapy and medication management by psychiatrists, denies payment for long-term treatment of severe illness in favor of less-effective episodic acute care, and disrupts continuity of physician-patient relationships as employers change from one MCO to another and yet another.”
The vision statement opens with a quotation from the interim report of the New Freedom Commission. “America’s mental health service delivery system is in shambles.”
The document offers 12 principles to guide the development of an effective system (see box).
Treatment Works
The report notes that new medical breakthroughs and psychosocial techniques have enhanced the likelihood of successful treatment for virtually every psychiatric illness.
Widespread use of APA’s Diagnostic and Statistical Manual of Mental Disorders has resulted in more reliable and consistent diagnoses. Evidence-based approaches, better medication, and the use of electronic technology to coordinate care have contributed to a professional climate that promotes serious discussion of the possibility of “recovery” and “cure.”
A “continuous healing relationship” is critical to the ability of patients and psychiatrists to take full advantage of the range of advances in psychiatry and mental health services, according to the statement.
Special Groups
Children, adolescents, older adults, and members of ethnic and racial minorities receive special attention in the statement. Task force members point out that one child in five suffers from a psychiatric or substance abuse disorder, but that research consistently finds that the majority of these children do not receive effective and appropriate treatment.
The statement offers the estimate of former Surgeon General David Satcher, M.D., that the number of adults over age 65 with major psychiatric illness will more than double from 7 million to 15 million by 2020 and identifies parity for mental health care under Medicare as a “long overdue and urgent priority” (see story on page 1).
In a supplemental report, Satcher found that racial and ethnic minorities “bear a greater burden from unmet mental health needs.”
Task force members relied on work of the APA Assembly Task Force on SPMI (Serious and Persistent Mental Illness) to describe 10 characteristics of a mental health system that can effectively meet the needs of people with SPMI.
Money Matters
It is an unrealistic expectation that any changes in the funding of the mental health system should be “budget neutral,” according to the statement. Reduced funding for treatment in the public and private systems has created the current crisis.
An accurate budget must reflect the cost offsets in general health, welfare, and criminal justice that would occur if more funds were devoted to quality mental health services. Many “resource-intensive” patients are being supported through other components of the public sector, such as the criminal justice system.
The task force argued that “payment for care should be nondiscriminatory, and cost-containment principles such as utilization review should be identically applied to health and mental health.”
Appelbaum urged APA members to study and discuss the vision statement. “We hope that it will become not only an effective tool for advocacy, but a resource that will help us conceptualize how to build a mental health system for the 21st century,” he said.
The statement will be available at APA’s annual meeting.
“A Vision for the Mental Health System” is posted on APA’s Web site at www.psych.org/news_stand/visionreport040303.pdf. ▪
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Published online: 16 May 2003
Published in print: May 16, 2003
Notes
APA develops key principles and a positive vision to help policymakers, psychiatrists, mental health professionals, and others bring about a transformation of this country’s mental health delivery system.
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