Creative Thinking Needed To Stretch Limited Budgets
Reflecting an increasingly austere federal and state budget environment, a number of leaders at the 2006 annual meeting of the National Mental Health Association (NMHA) urged colleagues to find more cost-effective ways to spend the large sums already devoted to the various areas of mental health care.
Taking the stage at the mid-June event in Washington, D.C.—one of his first public appearances since returning from a substance abuse rehabilitation program—Rep. Patrick kennedy (D-R.I.) urged attendees to push their elected officials for more funding to prevent mental illness, including substance abuse.
“That's where we get the biggest bang for our buck,” kennedy said.
David Shern, Ph.D., president and CEO of NMHA, said no level of treatment ever eliminated a disorder. He urged the increased use of “preventive strategies” as the only way to eliminate mental illnesses.
Another way to make better use of existing funds is through increased accountability from existing programs. kennedy called for more research on and accountability from special-education programs, which have received steadily larger amounts of funding in recent decades without showing commensurate gains for the children in those programs.
One way to obtain more benefits from existing mental health programs is to mandate the use of evidence-based practices and increased research into the uses of cognitive-behavioral therapies that appear to be the most efficacious, he suggested.
`Smarter' Spending Urged
“How can we spend smarter?” asked Jane knitzer, Ed.D., director of the National Center for Children in Poverty, who noted that about $4 billion is spent annually nationwide on children's mental health, excluding juvenile-justice programs.
Jane Knitzer, Ed.D., tells attendees to push for a family-based mental health treatment system.
David Hathcox
She urged the replacement of the mental health systems for both children and adults with a family treatment system to treat all of the people affected when mental illness arises.
She criticized the fact that many mental health programs “only grudgingly” focus on the emerging research on various aspects of children's mental health systems.
Another money-saving approach that kennedy urged mental health advocates to take when approaching legislators is to highlight the low cost of the long-sought goal of mental health parity coverage in insurance. He cited the federal Office of Personnel Management's 2001 report, which found that adding the benefit of mental health parity for federal employees increased costs by just 1.3 percent, while other research has found parity's benefits exceed its costs.
Change Traditional Treatment Paradigm
Expanding mental health care beyond the traditional single-patient-focused approach was a common theme among the meeting's speakers. knitzer said new data have identified the benefits of treating young mothers for depression as an early intervention for their children. Research also has identified benefits from cognitive-behavioral therapy for new mothers and their children.
The benefits of familial approaches to therapy often extend beyond mental health to other areas.
For example, depressed parents are less likely to buckle up their children and provide adequate care for their asthmatic children, knitzer noted.
Comprehensive approaches can address increased use of the juvenile-justice system as a place to confine children with mental illness, Shern said. Comprehensive approaches also will benefit from increased use of community-based care, which research has shown can facilitate recovery from even the most severe mental illnesses.
A person not often cited by mental health advocates, former Speaker of the House of Representatives Newt Gingrich, urged advocates during his keynote address to push legislators to reorganize health care in ways that provide mental health care as part of a person's comprehensive care.
Comprehensive approaches should include efforts to bring entire families into planning the mental health treatment of individuals.
“More than enough” health care funding is now provided by federal and state governments, he suggested, but antiquated allocation methods squander much of the money on bureaucracy and allow fraud on a massive scale.
“When you believe that money is being wasted, it is much more difficult to get people to agree to give you new funding,” Gingrich said, noting that studies have found that about 10 percent of some Medicaid programs' funding is lost to graft.
Rep. Patrick Kennedy (D-R.I.) advises attendees at the National Mental Health Association's annual meeting to seek more government funding for mental illness prevention efforts.
David Hathcox
Massive savings and better care are possible only when the current budget system of program “silos” is scrapped in favor of an approach that funds health care of the long-term, overall needs of each individual, said Gingrich, founder of the Center for Health Transformation.
The major changes and reductions in Medicaid and Medicare programs in recent years will likely accelerate over the next five years. The recent controversial changes to those programs only make them more expensive and less beneficial because the changes “are all chewing around the edges of the programs.” Only fundamental change will provide more care with fewer dollars, he said.
Knitzer pointed out that mental health advocates spend considerable time and money “end running the system” to get care for those in need and that both could be better spent through a system that provided mental health care regardless of the specific circumstances of those who need it.
Among the “key fiscal challenges” for mental health advocates, knitzer said, is the ability to create new partnerships with emerging family groups that push for improved mental health care for families and children.▪
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Published online: 7 July 2006
Published in print: July 7, 2006
Notes
Advocates are urged to work toward shifting juvenile-justice funding to mental illness prevention and treatment programs.
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