New Type of Mental Health Center Would Stress Coordinated Care

A proposed new national network of federally funded “behavioral health centers” was dropped from the final version of the health care reform law, but similar mental health treatment programs may be established anyway through future regulations, according to the congressional leader who proposed the original initiative.

After a proposal to establish a national network of federally qualified behavioral health centers (FQBHCs) was eliminated during legislative wrangling over terms of the Patient Protection and Affordable Care Act, Rep. Doris Matsui (D-Calif.) introduced legislation (HR 5636) that would authorize a total of $2.1 million in Fiscal 2012 and Fiscal 2013 to begin creating these new entities. These centers would help expand the nation's public mental health system and provide additional services beyond those provided by existing federally funded community mental health centers, according to the legislation.

Matsui's initiative was originally included in the version of the health care reform law (HR 3962) passed by the House of Representatives in November 2009. However, the measure was not included in a Senate version of the reform legislation, which was the version ultimately enacted into law (PL 111-148).

But the health center network proposed in Matsui's bill may come into existence through regulatory actions by President Obama's administration, Matsui said in a November 2010 interview with Psychiatric News.

“We didn't get [the behavioral health center network] into the final bill, but we believe that the administration will undertake this on its own anyway,” said Matsui in an interview following a Capitol Hill forum on federal support for mental illness screening programs.

Such a regulatory initiative would likely come from the Department of Health and Human Services, but its media office did not respond to a request to comment for this article.

Matsui said she was disappointed that the health care law did not contain her initiative, because the proposed network of behavioral health centers would expand the types of mental health care beyond those now provided by federally funded community mental health centers. Those care expansions include integrated treatment for substance use disorders that are comorbid with other psychiatric illnesses.

Matsui also explained that FQBHCs would expand access to care by creating more public mental health treatment locations in addition to those of existing federally funded centers, which already provide care to 6.4 million low-income people with psychiatric illness, according to the bill's supporting documentation. An additional 1.5 million people are expected to seek mental health care at existing community mental health centers due to other provisions of the health care law (including the expansion of Medicaid eligibility and the creation of subsidized state insurance marketplaces), according to estimates by the National Council for Community Behavioral Healthcare (NCCBH). The expected increase in demand for care from community health centers was among the reasons that her legislation was added to the House version of health care reform, Matsui noted.

The proposed centers also would expand the use of integrated care, which combines mental health and other types of medical care as well as screening (though not treatment) for chronic non-psychiatric conditions such as diabetes and hypertension.

Such coordinated care is needed to address the high rates of early mortality among people with co-occurring serious mental illness and other health conditions, according to many mental health advocates. While the average U.S. life expectancy in 2006 was nearly 78 years, the average age of death for people with either schizophrenia, bipolar disorder, or major depression was 53, according to a survey that year by the National Association of State Mental Health Program Directors.

“These horrific mortality rates are primarily caused by co-occurring chronic illnesses [such as] asthma, diabetes, cancer, heart disease, and cardiopulmonary conditions,” said Linda Rosenberg, president and CEO of the NCCBH, during a September 2010 congressional briefing. “Lack of access to primary care and specialty medicine is a critical factor in these tragic outcomes, and health care reform provides unique opportunities to address this public health emergency.”

Rosenberg said the FQBHC measure introduced by Matsui also is needed to at least partially replace an estimated $2 billion in state and local mental health program funding that has been cut during the recession of the last few years.

Some of those eliminated local programs nationwide provided vital wraparound services—such as assistance in obtaining housing and transportation help—to people with “serious mental illnesses.” Matsui's bill directs the new FQBHCs to provide those ancillary services, which mental health advocates describe as critical in helping people with psychiatric conditions adhere to their treatment plans.

Additionally, the bill would help raise the clinical standards of mental health care, according to Matsui, by requiring FQBHCs to provide only evidence-based treatments (such as cognitive-behavioral therapy, according to the bill's supporting documentation). Clinicians in existing federally funded community mental health centers may use any type of mental health care they choose.

The Mental Health and Addictions Safety Net Equity Act can be accessed at <http://thomas.loc.gov> by searching on the bill number, HR 5636.