White House Conference on Mental Health: Example Actions in Support of the National Effort Submitted by NACBHDD Members
ARTICLE: The Affordable Care Act: Overview and Implications for County and City Behavioral Health and Intellectual/Developmental Disability Programs by Ron Manderscheid, PhD
CLICK HERE TO ACCESS ARTICLE
2013 Legislative and Policy Conference -- Power Point Presentations:
Click Kathol
Click Russell
Click Fleming
Click Forquer
Click Francis
Click Osberg
Click Brand
Click Baxter --Flie is too large please make a separate request
Click Manderscheid
Click Enomoto
Click Moore
Letter to the President Addresses Gun Screening and Duty to Protect
Access Letter and Attachment
NATIONALSIGN ON LETTER IN RESPONSE TO THE NEWTOWN TRAGEDY--PLEASE DOWNLOAD AND SEND YOUR OWN LETTER
National Letter
County Jails and the Affordable Care Act: Enrolling Eligible Individuals in Health Coverage
CLICK HERE TO ACCESS
SAMHSA AT 20: Celebration on October 4
CLICK HERE FOR A 20 YEAR RETROSPECTIVE
New Directions in Medicaid and Behavioral Health: Setting the Stage, November 4-7, 2012, New Orleans, LA
CLICK HERE FOR A BROCHURE
NACBHDD Board Meeting will be held on October 29-30 in San Francisco!
The Supreme Court Approves the 2014 Medicaid Expansion: What Now?
BEHAVIORAL HEALTHCARE
July 18, 2012
by Ron Manderscheid
Will the states recognize the financial benefits of the 2014 Medicaid Expansion?
Like a most welcome cool breeze on a very hot summer day, the recent Supreme Court decision on the Affordable Care Act (ACA) has reinvigorated our energy and enthusiasm. This should provide wind at our backs to move forward quickly with implementation efforts at the state level. Advocacy is needed urgently to attest to the moral and fiscal soundness of electing the 2014 Medicaid Expansion (ME), now that it has become a state option. Similarly, work is needed immediately on the Essential Health Benefit so that key mental health and substance use benefits are included at full parity, as states prepare their submissions to HHS in September. Finally, discussions must be undertaken around state health exchanges and the role that your state will play in implementation. Here, I want to focus only on our future work around the ME.
The Supreme Court decision on the 2014 ME left the Expansion intact, but removed the federal penalty for failure of a state to undertake it. In effect, this decision makes the ME a state option. This decision also has engendered new and difficult questions, such as: What is the Medicaid entitlement of a person below 138 percent of the Federal Poverty Level and not currently eligible to be enrolled in Medicaid in a state that does not elect the ME? Will the Medicaid Disproportionate Share Payments (DSH) for charity care in a state that does not elect the ME be decreased according to the schedule outlined in the ACA? More on these questions below.
In thinking about the 2014 ME, it seems clear that the 24 states and DC that did not oppose the ACA likely will adopt this option immediately. Among the remaining 26 states (AL, AK, AR, CO, FL, GA, ID. IN, IO, KS, LA, ME, MI, MS, NE, NV, ND, OH, PA, SC, SD, TX, UT, WA, WI, WY), targeted within-state advocacy will be necessary. As a result of this advocacy work, probably half will adopt the ME later this year. For the remainder, half are likely to adopt the ME after the fall 2012 elections. This probably will leave only the few states recently characterized as having "rogue governors". This latter group will require intensive, very well organized advocacy that crosses traditional boundaries.
Without any doubt, the ME will be of tremendous financial benefit to states. For new enrollees, 100 percent of the cost will be paid by the federal government for the first three years, after which this amount will become and remain 90 percent. In effect, federal funds will be substituted for state and county funds previously spent on this population. As one example, Texas is expected to receive $52.5 billion, in return for a $2.6 billion investment, not considering the state funds that will be supplanted by these federal funds for the ME population in Texas. (See the Kaiser analysis of this issue at: http://www.kff.org/healthreform/upload/medicaid-coverage-and-spending-in-health-reform-national-and-state-by-state-results-for-adults-at-or-below-133-fpl.pdf). Thus, in purely economic terms, the ME is really a "must do" for states.
Further, an estimated 40 percent of the new Medicaid enrollees are expected to enter coverage with pre-existing behavioral health conditions. The ME will lead to reduced use of expensive care in emergency rooms and inappropriate incarcerations in local and county jails by these persons. Thus, considerable secondary financial service-offset gains also will accrue to a state that elects the ME.
The ME also is a "must do" to promote social justice in our society. If we value all people equally, then equity demands that we make health care available to those who are poor and disabled. A decision to do this also makes very good economic sense, since good health is a prerequisite for fostering a competitive workforce in a global economy.
I expect that we will find kindred traditional allies in the broader disability community to support our advocacy efforts for ME. However, less likely but equally important allies also are likely to emerge. These include the hospital industry and the insurance industry. Hospitals' charity care costs can be expected to skyrocket in the absence of the ME and the DSH payments. Similarly, health insurance companies will not be able to share in all the anticipated new business to be generated through the ME. Similar comments could be made about the potential of collaborating with other allied health industries. Efforts to organize these advocacy efforts need to be initiated immediately.
The Coalition for Whole Health (CWH) will continue to work with state advocates who are committed to ensuring that their state adopts the ME. If your state does not have a CWH, please consider developing one in the short term. This group can serve as the nucleus for organizing your state advocacy efforts.
No work is more important during this very hot summer than encouraging your state to adopt the ME. I wish you strong cool breezes at your back for these important endeavors!
Redeeming the Tragedy in Aurora
BEHAVIORAL HEALTHCARE
July 24, 2012
by Ron Manderscheid
Are we prepared to take action to improve our mental health response to this tragedy?
(Note: The following commentary is virtually identical to one that I prepared 18 months ago in the wake of the shooting tragedy in Tucson, Arizona.)
Last weekend, a tragedy of national proportions occurred in Aurora, Colorado. Twenty-four-year-old James Holmes repeatedly fired an assault rifle, a shotgun, and a pistol into a group of movie-goers attending the premier night showing of a new Batman film, The Dark Knight Rises. Twelve people were killed outright, including a 6 year old girl; 58 more were wounded, 9 seriously. Urgently, we need to understand and act on this very sad event so that a similar event does not occur in another setting with other participants. Disconcertingly, this event is remarkably similar to the shootings that occurred in Tucson, Arizona, just 18 months ago.
Based on CNN media reports and elsewhere, a picture emerges of James Holmes as an extremely bright and talented college student who developed a serious mental illness shortly after he began graduate school at the University of Colorado. Allegedly, he had taken on the identity of the Joker, an evil character in the Batman film series. Over time, he apparently spent progressively larger amounts of time in isolation and delusional thinking. A critical question can be raised as to why he did not receive appropriate mental health care.
Clearly, it will not be productive to point fingers at school officials, at fellow students, at friends, or at his family. We cannot know their personal motivations, what they actually noticed, or why they did not intervene. Rather, let's look at what could have happened, but didn't.
We must look at two things. First, how can we give people the knowledge and the skills to take action when they encounter a family member, friend, or acquaintance who is obviously descending into a mental illness? Second, how can we assure that appropriate and effective mental health services are actually available in the community?
Developing Knowledge and Skills
Before someone will feel secure and confident to intervene, including friends, classmates, teachers, family members or other community members, they must have an appropriate understanding of the signs and symptoms of mental disorders; they must know how to respond; and they must know what resources are available to assist them. Most people have received no training in any of these areas; in fact, most people are unaware of current mental health treatment resources available in their own communities. Obviously, we must do something about this.
As part of health education in high school and college, every student should be informed about the signs and symptoms of mental illness and the types of helping responses that are appropriate. Clearly, appropriate responses will vary depending on whether a person is suicidal, depressed, violent, incoherent, remote, etc. As a major part of this training, when in any doubt, students should be taught to reach out for help to other authority figures-teachers, counselors, school authorities, other adults, etc. Such training will do much to combat the culture of silence and inaction that frequently surrounds such encounters.
As part of undergraduate college education, and when entering a new job, including teaching or the police force, adults should be exposed to the principles and concepts of Mental Health First Aid. In addition, they should be informed about the mental health resources available in their own communities and how to find these resources in the future through use of the Web and other tools available locally.
Assuring Appropriate and Effective Community Mental Health Services
In his remarks at the memorial service held in Tucson, President Obama made reference to some key questions that this tragedy should engender in our national dialogue. Among them was his question: "Are our mental health services adequate?" He could have asked the same question in Aurora. We must help the President to answer this question, and we must do it in a helpful, operational way. It is a stark fact that current mental health services are inadequate in most US communities.
When we address this question, we must not only examine actual primary service availability, but also whether appropriate inter-organizational links exist. For example, is there a good working relationship between county mental health services and the local university?
A related point also needs to be made. This sad event documents the crystal clear need for implementing the Affordable Care Act. Under this Act, James Holmes could be covered under his family's health insurance policy to pay for mental health care. Or, if the family does not have insurance, he could be covered under a Health Exchange or the Medicaid expansion. Further, disease prevention and health promotion provisions of the Act could have led to early detection of his illness and early treatment before the disease became severe.
Going Forward
James Holmes literally fell through the cracks because he never came to anyone's attention. Many people encountered him; virtually no one reached out or sought the mental health care that he desperately needed, especially in the most recent four months. In that sense, he was invisible; no one really saw him. Appropriate knowledge and intervention strategies could have changed all of this. We need people who are trained to intervene appropriately, and who have the courage to reject the culture of silence and inaction.
When courageous people do intervene, they must feel confident in what they're doing and that appropriate and effective mental health services are actually available in their own communities. Such services must be consumer friendly and easy to access.
The Affordable Care Act can help us address both of these needs.
Finally, this is a very urgent call to action for every one of us. Each of us must become engaged with our local communities, our schools and our police, and our neighbors. Our message must be very clear:
- Training in Mental Health First Aid is every bit as important and lifesaving to our fellow citizens as the CPR and first aid training that many of us already know and take for granted.
- Such training is urgently needed to identify and respond to the ordinary mental health challenges that our friends, neighbors, and children face every day and is essential to the continued healthy growth of people and communities.
- All citizens ought to have knowledge about the mental health resources available in their own communities.
- And, community leaders must ensure that effective care is available and easy to access.
Because preventing and treating mental health problems is so important to our country's public health, we ourselves must model and lead the effort to combat the stigma of silence and inaction.
•· NEW BOOK: OUTCOMES MEASUREMENT IN THE HUMAN SERVICES
NACBHDD is very pleased to announce the publication today of Outcomes Measurement in the Human Services: Cross-Cutting Issues and Methods in the Era of Health Reform by NASW Press. This 25 chapter text provides an up-to-the-minute overview of outcomes measurement in the health, mental and behavioral health, and child and family services fields, together with overviews of outcome issues and methods, and special topics. It will serve as a valuable background source as these fields undertake implementation of national health reform through the Affordable Care Act.
The text is co-edited by Jennifer L. Magnabosco PhD (Co-Principal Investigator and Projects Director at the Center for Implementation Research and Practice Support and Health Science Research Specialist at the HSR&D Center of Excellence, Center for the Study of Health Care Provider Behavior, Department of Veterans Affairs; and Adjunct Professor in the Department of Social Work, California State University, Los Angeles) and Ron W. Manderscheid, Ph D (Executive Director, National Association of County Behavioral Health and Developmental Disabilities; Adjunct Professor in the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University; and President of ACMHA-The College for Behavioral Health Leadership).
CLICK HERE FOR THE COMPLETE PRESS RELEASE
CLICK HERE FOR NASW BOOK DETAILS
REFLECTIONS ON SOCIAL JUSTICE
Behavioral Healthcare July-August 2011
CLICK HERE TO READ
Generations Conference, SLC, April 20, 2011
Beyond the Basic Rhetoric: How Healthcare Changes will Impact Your Practice
Click for Presentations:
Ron Manderscheid
Pat Fleming 1
Pat Fleming 2
Juergen Korbanka
Chad Morris
Linda Leckman
Ronald Gephardt
Judi Hilman
ADVERSE EFFECTS OF PSYCHOTROPIC MEDICATIONS ON TEENAGERS
CLICK HERE FOR A COMMENTARY
FALL BOARD MEETING - 2011
The NACBHDD Fall Board Meeting was held in Albany, New York on October 24 and 25, 2011.
SUMMER BOARD MEETING - 2011
The NACBHDD Summer Board Meeting was held at the Portland Paramount Hotel in Portland, OR, on July 18-19, 2011.
CLICK HERE FOR A SUMMARY OF THE SUMMER 2010 BOARD MEETING IN RENO NV
ONLINE PRESENTATIONS ON NATIONAL HEALTH REFORM
Richard Frank of Harvard University Describes Parity and Payment Reform in National Health Reform....
CLICK HERE TO ACCESS THIS PRESENTATION
Presentation by Patricia MacTaggert of GWU on the Role of IT in National Health Reform....
CLICK HERE TO ACCESS THIS PRESENTATION
Presentation by Tonya Bowers of HRSA on FQHCs/FQHC Look-Alikes....
CLICK HERE TO ACCESS THIS PRESENTATION
Ken Wells presents details on Comparative Effectiveness Research for Behavioral Healthcare....
CLICK HERE TO ACCSS THIS PRESENTATION
Dale Jarvis elucidates the new Accountable Care Organizations (ACOs)....
CLICK HERE TO ACCESS THIS PRESENTATION
Melissa Harris of CMS discusses the new Health Home State Plan Amnendment in Medicaid....
CLICK HERE TO ACCESS THIS PRESENTATION
Ben Druss presents on health and health improvement among persons with serious mental illness....
CLICK HERE TO ACCESS THIS PRESENTATION
Joel Ario of HHS discusses State Health Insurance Exchanges....
CLICK HERE TO ACCESS THIS PRESENTATION
Richard Popper of HHS discusses Health Insurance Reform, especially the new Pre-existing Condition Insurance Program
CLICK HERE TO ACCESS THIS PRESENTATION
Barbara Edwards of CMS talks about Medicaid Reform.
CLICK HERE TO ACCESS THIS PRESENTATION
Ron Manderscheid provides an overview of the Patient Protection and Affordable Care Act, and its implications for counties and cities.
CLICK HERE TO ACCESS THIS PRESENTATION
PARTICIPATE IN AN ONLINE SERIES OF WEBINARS ON NATIONAL HEALTH REFORM
NACBHDD is partnering with ACMHA on this important series of presentations.
CLICK HERE TO ACCESS INFORMATION ON THE SERIES
