Health care reform is likely to lead to greater integrated care
It seems that even with health-care reform, mental health care in the United States is under assault. Closing psychiatric facilities, gaps among patients who need ongoing care, cultural competency issues (and impending doctor shortages), cuts in funding—these are all serious issues for folks with mental disorders and the people who treat them. Black Health Matters spoke with Rahn K. Bailey, M.D., past president of the National Medical Association and chair of the department of psychiatry at Wake Forest in North Carolina, about what he sees on the horizon for mental health care.
BHM: What might people be surprised to learn about mental health problems?
Rahn K. Bailey: If a person has a mental health problem, a brain illness, they are more likely, not less likely, to have a medical problem, not to get well as fast with medical problems, more likely to have early death. Society should be very interested if someone has a brain illness. If you have major depression, you have a higher likelihood of heart disease. It could make your cardiac problems worse, and your cardiologist should know. People with bipolar disorder have a higher likelihood of having diabetes. We’ve known this for a long time—that those with schizophrenia or who are biopolar with psychotic features—have greater risk of developing endocrine and hormonal disorders. One makes the other one worse.
How is the Affordable Care Act helping on the mental health front?
We must all be very aware of the increasing complexity of the currently evolving health-care system in America. The Affordable Care Act has the potential to be very helpful in several ways: A) The basic concept of increasing the number of individuals who have health insurance is positive, can help people maybe get preventive care, decrease likelihood to going to emergency rooms, which are not set up to care for people in non-emergent situations.
B) The focus on innovation is timely. Effort to ensure all physician’s offices and clinics will have access to optimized national medical records, electronic medical records. We get at a moment’s notice access to patients’ entire records, treatment options that have been successful—this is germane to making quality medical decisions to taking care of patients. It is likely to be very significantly positive.
And C) We’ll see greater care coordination. Integrated care. Physicians trained in psychiatry will see patients with a balanced team approach. [We’ll have] cardio taking care of heart, endocrine taking care of diabetes, ortho taking care of bones. This is likely to lead to greater outcomes and less likely for readmission.
One doctor, one team focused on one area didn’t give adequate attention to all confounding factors. Now we’ll have people going to the right location for care.
We also have a variety of treatments for patients who have psychiatric issues—oral, long-acting treatments. With early diagnosis, the ACA can potentially allow access to more of those treatment options.
What’s the disadvantage?
Cost—clearly it makes sense that if more people receive care, there would be a greater cost to the system. We should work collectively to try to modify those risks. Those of us in medicine are hopeful that if folks go in early stage, in preventive stage, it decreases the likelihood that later they will have to receive something expensive because we didn’t treat them at an in early stage.
We’re hearing a lot about veterans lately, with the crisis in the Veterans Administration system. What about veterans with mental health disorders? How will ACA help them?
It gives the opportunity for better care across full array. Clearly vets are a bit different because we already have a system that takes care of all of their health-care needs across country, though many vets receive care outside the VA system than within system. Access issues, coordination of care, may end up a higher burden on non-VA settings and cost containment issues.
Historically, mental health patients have been treated differently than patients with physical conditions. How is this changing?
We remain hopeful for full implementation of the Mental Health Parity Act [of 2008]. We’ve been working for decades for parity. [Without it] patients have higher lifetime premiums, lower lifetime caps, higher copays. They often had disproportionate treatment options—for instance, they could be in hospital for less time than someone with a physical ailment, but spend more. There’s inherent unfairness.
The MHPA was first step for mental health patients to receive fair, adequate treatment. Insurance companies are very slow to change and provide equal health care. As recently as 2013, Vermont filed a lawsuit against an insurer for violating the rule of law in not honoring MHPA and creating differences in writing structurally how they provide insurance support for mental health services of need versus medical health services of need.