Full Immersion in the Mainstream: How Years of Promise for Mental Health and Substance Use Disorders Came to Fruition with the Affordable Care Act

Abstract

With passage of the Patient Protection and Affordable Care Act (ACA), the behavioral health community has achieved entry into the mainstream of U.S. health care. Passage of the law was the culmination of a long effort by advocates. At the same time, findings from research and practice have informed the nation's understanding that behavioral health is integral to health. The primary task before the behavioral health community now is to ensure that the advances of recent years are secured through implementation of the ACA and approaches to service delivery that emphasize integrated care.

KEYWORDS:

• advocacy
• health care
• mental health
• mental health recovery
• mental illness
• peers
• policy
• policy practice
• professional organizations
• recovery
• serious mental illness
• substance abuse

Notes

The term behavioral health is fully embraced by few advocates or practitioners from either the mental health or substance abuse communities, but it has become the de facto comprehensive label understood to encompass the two conditions.

The IMD prohibition has continued to generate controversy to the present day. Whereas some credit it with forcing states to develop and fund community-based services, others see it as inherently discriminatory, leaving potential patients without access to services they need.

Under the Medicare Improvement Act of 2008, the Medicare program is gradually improving mental health benefits to bring them closer to the standard set by the Mental Health Parity and Addiction Equity Act (MHPAEA), which does not apply to Medicare. Generally, by 2014, Medicare patients will pay a 20% copay for mental health care. For more information, see http://www.medicare.gov/publications/pubs/pdf/10184.pdf

Until 2005, NAMI's full name was the National Alliance for the Mentally Ill. The name was changed to National Alliance on Mental Illness to better reflect the “person first” language espoused by the organization. The National Mental Health Association (NMHA) changed its name in 2006 to Mental Health America.

The Mental Health Parity Act of 1996 did not require employers to offer mental health coverage, but did require mental health coverage, if offered, to be on a par with coverage for other conditions, as defined by the law. It applied only to employers of more than 50 employees. It did not apply to substance use or chemical dependency. It did not apply to Medicare or Medicaid, and it put no restrictions on managed care practices affecting mental health services.

For more information on ERISA, access http://www.dol.gov/compliance/laws/comp-erisa.htm

Texas implemented parity for state employees in 1991, providing a model of sorts for the states that brought reforms in the broader marketplace a few years later.

The goals of the President's New Freedom Commission are as follows:

	Goal 1: Americans understand that mental health is essential to overall health.
	Goal 2: Mental health care is consumer and family driven.
	Goal 3: Disparities in mental health services are eliminated.
	Goal 4: Early mental health screening, assessment, and referral to services are common practice.
	Goal 5: Excellent mental health care is delivered and research is accelerated.
	Goal 6: Technology is used to access mental health care and information.

Housing First was pioneered by Pathways to Housing in 1992. To find out more about this model, see http://www.pathwaystohousing.org.

The Criminal Justice/Mental Health Consensus Project is an ongoing program of the Council of State Governments Justice Center. For more information on the project, see http://consensusproject.org.

See http://1mind4research.org/about-one-mind.

See http://smokingcessationleadership.ucsf.edu/MentalHealth.htm.

See the testimony of William Emmet before the Senate HELP Committee, January 22, 2009 at http://www.asph.org/UserFiles/Emmet%20Testimony.pdf, and a summary of the White House Forum on Health Reform, March 5, 2009, at http://www.whitehouse.gov/assets/documents/White_House_Forum_on_Health_Reform_Report.pdf

HHS guidance has made it clear that any state could subsequently opt to expand their Medicaid program. However, the timetable for reduction of the 100% federal match to 90% by 2019 would remain in effect.