Assessing the State of America’s Mental Health System
Mental disorders cases are reported frequently in America. The disorders affect about 44 million adults and 13.7 million children every year. Deaths that result from suicide are the 8th largest death causes in the United States. Between 80 percent and 90 percent of all individuals who succumb to suicide suffer from mental illnesses (Russell, 2010). However, regardless of the existing evidence that shows that the danger of mental disorders is similar to that of heart disease or cancer in relation to the premature deaths that they cause and that most mental disorders are treatable using therapies and medication, only below 50 percent of the adults and 1/3 of children who suffer from mental illnesses that can be diagnosed can access treatment. For a long time, people have made mental health a hidden issue. In America, mental health hardly captures the attention of the public and it does not get sufficient funding from both the public and private sectors (Russell, 2010). The focus of this paper is on evaluating the current system for mental health in the U.S.
The Challenges to Mental Health Service Delivery Today
Reimbursement Policies have made it impossible to convert research into practice
The limits and difficulties in paying different entrenched and evidence-based practices or EBP for children and adults are the causes of differences in mental health quality. Reimbursing for specific EBPs is hard for the private insurance such as Medicaid or Medicare within the current system. The rules of the current insurance coverage make its implementation difficult. Private players such as Medicaid and Medicare have systems for fee-for-service reimbursement which do not allow charging for vital elements of different EBP programs such as flexible management of cases, home visits and non-face-to-face services. Most private insurers lack cover for useful treatments, services, practices or supports. Although covering most practices is possible under Medicaid, providers can only get reimbursement if providers get the approval to provide these services within an option or a waiver (National Alliance on Mental Illness, 2014).
Severe labor force problems
The current system for mental health faces a crisis of the workforce. Apart from experiencing providers’ shortage, the system also has providers who do not have training that is necessary for the provision of evidence-based and innovative practices. This has led to a work force that is not equipped properly to use modern medicine advances in helping patients who suffer from mental disorders. Rural areas are the worst affected by the inadequate professionals’ supply in the system. Additionally, specific shortages can clearly be seen in America for professionals who handle the elderly, children and adolescents (National Alliance on Mental Illness, 2014).
Failure to incorporate cultural competence in training curriculum
Without considering the importance of services that are culturally relevant, the curricula for training professionals in the mental health field in America generally is lacking in regards to the development of cultural competence. Consequently, racial, ethnic and linguistic minorities are less represented within the current labor force. As such, Pacific Islanders, African Americans, American Indians, Hispanic and Alaskan Natives are affected the most by the disabilities that relate to mental disorders. This is not due to the high rates of prevalence among these populations but due to the poor care quality and less care that they get (National Alliance on Mental Illness, 2014).
Most facilities that offer mental health services are underfunded. This challenge is worse in the rural areas where specialty care for people with mental health problem can only be accessed in the Community Mental Health Centers (CMHCs). There are serious financial challenges that CMHCs face and this limits their capacity to offer health services to the rural areas’ Americans. These include the long-term care recipients (Talbot & Coburn, 2013). In general, Medicaid funds CMHCs in the rural and urban areas. They get income from sources that include the state revenues and block grants from the federal government which the state agencies for mental health allocate to these centers. Considering that the reimbursement rates for Medicaid are low, CMHCs in the rural areas on average get less funding for every patients that they care for in comparison to the urban service providers (Talbot & Coburn, 2013).
The funds that were allocated to the state agencies that provide mental health were reduced by most American states between 2009 and 2011. This reduction amounted to $2.1 billion in the entire U.S. This pushed the state agencies that offer mental health services and their CMHCs further into the financial crisis. Consequently, the services that CMHCs offered were terminated and the workforces reduced. Some closed while others merged operations. Mental disorders patients have been extremely affected by this trend especially those in the rural areas because they depended on CMHCs. Additionally, their over dependence on the block grant from the federal government whose main targets were adults suffering from severe mental disorders and children with emotional disturbance means that the services that the facilities provide to people with mental health problems are narrow (Talbot & Coburn, 2013).
Entities that Provide Funding and Expenditures for Behavior Health
The state and local governments used to finance the behavioral health help. Nevertheless, there have been changes
with time as a more complex network has been established. Today, there are several sources of funding with more agencies funding behavioral health (Goldman, Buck & Thompson, 2009). An example of this is the housing programs that the housing departments fund. The Social Security Agency funds income support and the labor and education departments finance job training. Private insurance has also been expanded further to cover behavioral health. Nevertheless, it has smaller roles as compared to medical care in general. Consequently, public funding currently takes the largest share in funding behavioral health. Successful implementation of Affordable Healthcare Act can lead to an important change in funding sources distribution for the behavioral healthcare since private and Medicaid insurance coverage expansion will make the sources accountable for a large proportion of the expenditure in behavioral healthcare. There is a broad categorization of entities that fund behavioral health which includes the private and public sector financing (Garfield, 2011).
Public Sector Financing
Public financing includes entities like the Medicaid program which operates at the federal and state levels. Other programs that are funded by the public sector include the programs that the states fund through State Mental Health Agencies as well as the block grants from the federal governments that the states receive (Garfield, 2011).
This source provides more funding for the behavioral health in the U.S. This was not originally intended for funding behavioral health. However, it now acts as a foundation that is used to expand behavioral health financing in the United States. Medicaid under the Obamacare includes all Americans living up to 133 percent of poverty. Most individuals who are eligible suffer from mental problems (Garfield, 2011).
Block Grants for Community Mental Health Services
Block grants provide financial assistance to states and territories that allow them to provide comprehensive mental healthcare to the adults in the community who suffer from serious mental illnesses as well as children with emotional disturbances. Progress in the implementation of complete community-based systems for mental health is monitored by this fund and this also includes technical assistance to Mental Health Planning Council and to the States (CFDA, 2014).
Private Sector Financing
Finances for behavioral health in the private sector comes from private insurance and pocket expenditures. Other sources of funding include charity care although this plays a minor role in financing behavioral healthcare (Garfield, 2011).
Review of my Health Insurance Plan
Coventry Healthcare policy covers me and it provides the benefits of mental health. Coventry provides mental benefits that compares to those of medical services in relation to financial limitations and treatment (deductibles and co-pays) in regards to the 2008’s Mental Health Parity Act. My opinion is that medical benefits should not be different from mental healthcare benefits. This is important to me since if parity is not present, most Americans with mental disorders would experience cost-sharing arrangements, financial limits and reduced coverage that would exclude some conditions as well as limitations in treatment type and duration. All these can cause poor and insufficient care and health outcomes.
Health Services in Las Vegas
In Las Vegas, mental healthcare and treatment services that are available include:
- Psychiatric confidential assessment
- Treatment program for the assertive community
- Mobile Crisis Team (MCT)
- Coordination for intensive service
Drugs and alcohol addiction services that are available include the outpatient services, inpatient treatment for abuse victims, centers that offer long-term care, rehab centers, recovery centers, group and private counseling services (Grant, 2014).
In a nutshell, the system for mental health in the U.S is still facing serious challenges in relation to personnel, evidence-based practices application and funding. Similarly, mental healthcare services are largely offered by the primary healthcare services, especially in the rural areas. Something positive and worth noting is that several insurance firms that provide mental health policies provide parity services due to the 2008’s Mental Health Parity Act.
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CFDA. (2014). Block grants for community mental health services. Retrieved on 2 February 2014 from: <https://www.cfda.gov/index?s=program&mode=form&tab=core&id=6dfed5efc06aa5ac7a5b11b889abd057>
Garfield, R. L. (2011). Mental health financing in the United States: a primer. Retrieved on 2 February 2014 from: <http://kff.org/medicaid/report/mental-health-financing-in-the-united-states/>
Goldman, H. H., Buck, J. A. & Thompson, K. (2009). Transforming mental health services. Arlington, VA: American Psychiatric Association.
Grant, N. (2014). About mental illness. Retrieved on 2 February 2014 from: <http://mhds.nv.gov/index.php?option=com_content&task=view&id=23&Itemid=53>
National Alliance on Mental Illness (2014). Achieving the Promise: Transforming Mental Health Care in America. Retrieved on 2 February 2014 from: <http://www.nami.org/PrinterTemplate.cfm?Section=New_Freedom_Commission&Template=/ContentManagement/ContentDisplay.cfm&ContentID=28322>
Russell, L. (2010). Mental health care services in primary care. Washington, DC: Center for American Progress. Retrieved on 2 February 2014 from: <http://www.americanprogress.org/issues/healthcare/report/2010/10/04/8466/mental-health-care-services-in-primary-care/>
Talbot, J. A. & Coburn, A. F. (2013). Challenges and opportunities for improving mental health services in rural long-term care.