The Bell: MHA's Newsletter

Volume 7, #1 | Winter 2012

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The Bell Story
MHA Bell
During the early days of mental health treatment, asylums often restrained people who had mental illnesses with iron chains and shackles around their ankles and wrists. With better understanding and treatments, this cruel practice eventually stopped.

In the early 1950s, Mental Health America issued a call to asylums across the country for their discarded chains and shackles. On April 13, 1956, at the McShane Bell Foundry in Baltimore, Md., Mental Health America melted down these inhumane bindings and recast them into a sign of hope: the Mental Health Bell.

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President’s Corner: Challenges Ahead

By Dr. David Shern, President & CEO
Dr. Shern

Over the past few years, we achieved major successes with the passage of mental health parity and health reform. In 2012, our challenge will be to protect these gains and successfully implement reforms.  Several issues of concern are on the horizon. 

First, in March, the Supreme Court will hear oral arguments on a case challenging the constitutionality of the Affordable Care Act (ACA).  Mental Health America has joined in a friend of the court brief arguing that the law be upheld. It is likely the court will rule on the case toward the end of its term in late June or early July. Many of the most important features of the legislation rely on the individual mandate to buy insurance.  We are hopeful that the court will rule favorably.

Second, the government’s recent decision to allow each state to define the essential health benefits (EHB) that insurance plans will have to cover beginning in 2014 is of great concern.  As we discuss in this issue, while mental health and substance use services must be included in these benefit packages, the lack of national standard for EHB raises concerns about the adequacy of the benefits.  We are working with our coalition partners and our Regional Policy Council to help ensure the design of these benefit packages meet the needs of individuals with mental health and substance use conditions.  Mental Health America’s state presence will be critically important in this and many other aspects of ACA implementation. 

Third, work also continues on implementation of the federal mental health parity and addictions equity act. A recent government study found that following the passage of the act, the vast majority of employers maintained or enhanced behavioral health coverage. We are continuing to push HHS to release final regulations that clarify important issues in interpreting the law and that will help ensure that the rights and benefits guaranteed to individuals under the law are realized.

Finally, our Capitol Hill Update reports on our success last year in winning increases in federal funding for mental health and substance use services block grants and the challenges we face in the year ahead. The failure of the Super Committee to produce a deficit reduction plan and election year pressures will make it even harder to protect vital programs and services.

Your support and involvement through our Advocacy Network are crucial to meeting these challenges and building on the progress we have achieved.

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Health Reform Update: States Given Flexibility on Essential Health Benefits

The Department of Health and Human Services (HHS) announced last month it will give states broad flexibility to define the minimum benefits (Essential Health Benefits) that many health insurance policies will be required to offer under the Affordable Care Act (ACA).

HHS’ decision, which was announced through a bulletin in December that was provided to offer information and solicit comments on the department’s approach to Essential Health Benefits (EHB), requires a redoubling of efforts to ensure mental health and substance use services are adequately covered in plans offered through state exchanges.

HHS has been undergoing an exploration process to determine the parameters of the EHB with input from the Institute of Medicine, departmental agencies, and stakeholders like Mental Health America. (An article in the last issue of The Bell reports on recommendations made by the Institute of Medicine.)

The ACA requires all plans to cover 10 categories of services, one of which is mental health and substance use disorder services. The bulletin clearly states the mental health and substance use disorder services must be included in the benefits packages for individual and small business insurance plans and the Medicaid expansion population.

However, giving the states flexibility in determining what services should be covered—instead of creating a national standard—raises questions whether any state’s EHB will be sufficiently robust to meet the needs of individuals with mental health and substance use conditions.

As a result of HHS’ decision, states will be required to identify a benchmark plan that includes the services offered by a “typical employer plan.” States could choose from one of these plans to utilize as their benchmark:

  • One of the three largest small group plans in the state by enrollment;
  • One of the three largest state employee health plans by enrollment;
  • One of the three largest federal employee health benefits plan (FEHBP) options by enrollment;
  • The largest HMO plan offered in the state’s commercial market by enrollment.

For states that do not choose a benchmark plan, HHS will utilize the small group plan with the largest enrollment in the state as the default plan. If a state picks a benchmark plan that does not include the 10 categories required by statute, the state would examine other plans like the FEHBP to determine what benefits must be added.

Mental Health America will be issuing comments on the decision. In those comments, we will challenge the department’s decision to punt the EHB determination to the states. We will specifically address ensuring that the scope of services provided in the sample plans are adequate for individuals with mental health and substance use conditions, as well as the application of the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA) to the plans. Mental Health America and fellow groups in the mental health and substance use community advocated for the application of MHPAEA to provisions of the ACA, and will continue to monitor and promote parity in exchange plans.

The EHB bulletin can be found here.

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Capitol Hill Update: Spending Increases Won, New Challenges Ahead

Despite pressure from some legislators to cut spending on social services, Congress approved a bill at the end of 2011 that includes important increases for mental health and addiction services, as well as a boost for biomedical research. The ability to sustain these increases will be tested again this year.

The legislation (H.R. 2055)—an omnibus spending bill that funds the government through this September—provides a nearly $40 million increase for the Mental Health Block Grant, the first funding increase for the Block Grant in close to a decade. The bill also provides close to a $20 million increase for the Substance Abuse Block Grant. These increases are critical to the behavioral health community because they come at a time when states have cut back funding for mental health care by nearly $3.4 billion over the last 3 years. (Our website has two webinars that explain the impact of the Block Grants in your community.)

The increases represent a substantial achievement by advocates in pushing Hill allies to reverse drastic proposals to cut the Substance Abuse and Mental Health Services Administration by over eight percent.

The bill also provides a nominal increase for important research activities at the National Institutes of Health. Key consumer programs such as the Consumer and Family Network Grants and the Consumer Technical Assistance Centers were not cut, as well as trauma-related services for children. The important Prevention and Public Health Fund was also spared the budget-cutting scalpel.

The omnibus package passed the House by a vote of 296-121, with 149 Democrats and 147 Republicans supporting the measure (35 Democrats and 86 Republicans opposed it), while the Senate passed the omnibus by a vote of 67-32. It was signed into law on December 23 (Public Law 112-74).

Despite the successes achieved last year, the outlook for the coming year is challenging. The budget process begins again in early February when the Administration releases its FY 2013 blueprint. The House and Senate will hold months of hearings of Obama's budget and the overall economic outlook. House Budget Committee Chairman Paul Ryan (R-Wis.) is expected to offer a House GOP budget outline in March. Last year, Rep. Ryan presented a plan that called for drastic cuts to Medicare and Medicaid. The annual appropriations process will begin in the spring. We are likely to once again see proposals to make deep cuts to public health and social service programs.

Congress must also decide on the fate of the across-the-board spending cuts that are set to be triggered in January of 2013 in the aftermath of the failure of the Super Committee to reach a deficit-reduction agreement last fall. There are a number of experts who feel that the hard triggers that must be enacted in the beginning of 2013 will be ignored or changed.

The November election will also factor into these and other decisions. If last year’s actions are any indication, it will be a difficult year that requires advocates to continue to speak out in advancing our goals and blunting proposals that threaten vital programs and services.

You can read about our legislative priorities for the year in Advocacy Notes.

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Advocacy Notes: Action on Legislation

Military Suicide Prevention Efforts Advance: Rep. Rush Holt (D-N.J) has secured $40 million in the final 2012 federal budget to support military suicide prevention efforts. The funding will support the activities that Holt originally proposed in the Sergeant Coleman S. Bean Individual Ready Reserve Suicide Prevention Act, which was named in honor of a New Jersey soldier who died by suicide after serving in Iraq. Mental Health America had strongly supported the legislation. Of the funds, $20 million will support suicide prevention efforts for active-duty soldiers and reservists at the Department of Defense, while the other $20 million will support veterans’ suicide prevention at the Department of Veterans Affairs. Activities funded may include outreach to vulnerable soldiers and veterans through TV, radio, and social media, as well as direct suicide intervention efforts.

Senate Measure Introduced on Seclusion and Restraints: Sen. Tom Harkin (D-Iowa) has introduced legislation that would limit physical restraint and locked seclusion of students. The Keeping All Students Safe Act” (S. 2020) is similar to legislation (H.R. 1381) introduced in the House by Rep. George Miller (D-Calif.). The House passed the bill last Congress but it was not taken up in the Senate. A 2009 report by the U.S. Government Accountability Office (GAO) revealed hundreds of cases in which children were abused, and some even died, as a result of misuses of seclusion and restraint in public and private schools, often at the hands of untrained staff. A 13-year-old reportedly hung himself in a seclusion room after being confined for hours. Earlier this year, a report called "The Cost of Waiting" chronicled additional cases of death and injury because of restraints or seclusion.

The Harkin and Miller legislation and the Holt measure are two of Mental Health America’s key legislative priorities. You can find additional information on specific legislation through the links below. Please use the fact sheets when contacting your legislators and asking them to support the legislation.

Keeping All Students Safe Act (S. 2020, H.R. 1381)
Behavioral Health Information Technology Act of 2011 (S. 539)
Garrett Lee Smith Memorial Act Reauthorization of 2011 (S. 740)
Mental Health in Schools Act of 2011 (H.R. 751)

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New Website Advocates Shared Decision-Making: “You’re On the Team”

Have you ever left a doctor’s office frustrated that your questions weren’t answered or you didn’t really understand the doctor’s orders? Health reformers have come up with a solution that could relieve your frustration and result in better medical care, to boot.

The technique, called “shared decision-making,” puts you and your doctor on the same team, making decisions that reflect what you want and need as well as what the doctor recommends. You have a say in choices made, and your questions are fully answered.

The medical profession is beginning to embrace shared decision-making, but health care reform is likely to spark new interest in its adoption. Doctors will be paid for good results, not just office time, and patient ratings will be made public.

Although shared decision-making has not been widely used yet in mental health treatment, it could have a tremendous payoff, empowering patients, engaging them in treatment and improving care.

To show how it works and explain why it matters, Mental Health America will launch in February a new website—one of the first to be totally dedicated to the use of this technique in mental health. You can preview it at www.mentalhealthamerica.net/go/youreontheteam.

At the heart of the website are videos introducing shared decision-making in mental health treatment and demonstrating how it works in practice. Mental Health America president and CEO Dr. David Shern and psychiatrist Dr. Allen Dyer explain the concept. During an office visit, Randy lays out his concerns to Dr. Dyer: new side-effects have appeared, he is worried he will lose his job, and he doesn’t want to take more medication. He shares a checklist that he filled out at the suggestion of Cicely, a peer specialist, to bring the doctor up to date on his status. Together, Randy and the doctor discuss possible solutions and find one that Randy is willing to try.

While this kind of cooperation is common sense, shared decision-making is a big change from traditional, doctor-knows-best medicine, putting both patient and doctor in new roles. The website is designed to separately educate patients and providers on how the process works, how it can help them, and how to handle difficult issues.

The new website was made possible by a contribution from AstraZeneca and additional funding from Merck and Co.

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New Emotional Coaching Tool Launched: The Thriving Mindset

Mental Health America has launched a breakthrough online emotional coaching tool called "The Thriving Mindset." Developed in collaboration with bLife, a California-based firm that specializes in cutting-edge online wellness products, "The Thriving Mindset" provides 18 lessons designed to enable users to begin to reframe the way they perceive their lives and their environment.

Viewers are taught to create positive, hopeful, and resilient life styles. At the end of each lesson, users are invited to learn more through selected articles and content provided by bLife, on the Mental Health America website, or through various academic institutions.

"The Thriving Mindset" also provides frequent opportunities for users to assess their own well-being through the Mental Health America website by taking the M3 mood monitor screen or by visiting Mental Health America’s "Live Your Life Well" website. Here visitors can learn how to better cope with stress and create more of the life they want.

"Emotional health is the cornerstone of healthy, prosperous living, but we know that the majority of Americans struggle daily to deal with the emotional stressors of daily life. The Thriving Mindset pulls the latest insights from psychology and neuroscience research to provide people with the tools they need to pivot their emotional perspective and be resilient in the face of stress,” said Dr. David Shern, president and CEO of Mental Health America.

In the coming months, Mental Health America and its affiliates hope to offer significantly discounted access to the tool through national and community cause marketing sponsorships or through Mental Health America or Clifford Beers Society membership. At present, the tool is only available for iPad download from the Apple store. But, if the tool is well received by the public, Mental Health America expects to offer "The Thriving Mindset" on several additional platforms.

A YouTube review of the product is available at http://www.youtube.com/watch?v=2RTTFEIt4ng&sns=em.

SZ Magazine

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Become a Member Today!

Become a member today!

The odds are that someone you know—a family member, one of your friends, or one of your colleagues—is affected by a mental health or substance use condition. And that's why Mental Health America was formed over 100 years ago.

For over a century, Mental Health America has been instrumental in reducing barriers to treatment and services and educating millions about mental illness and recovery. As a result of our efforts, many Americans with mental disorders have sought care and are now enjoy fulfilling, productive lives in their communities.

Whether you or someone you know has a mental health condition, or simply care about the issue of mental health and living a mentally healthier life, We Can Help, But Only With Your Support!

As a member of our nationwide movement, you will help us build on our century of service and strengthen our voice as we continue our ground-breaking steps to achieve victory over mental illness:

  • Our advocacy work helped pass landmark mental health parity legislation that ends decades of insurance discrimination and expands access to care.
  • Our firstofitskind Live Your Life Well program is providing the public tested tools so they can preserve and strengthen their mental health and wellness.
  • And through the programs and services of our affiliates, we are delivering critical support to the over 60 million individuals and families living with mental health and substance use conditions.

Become a member of Mental Health America for just $5 a month (or a $50 annual payment)! Your contribution will support Mental Health America and our 300 affiliates across the country as together we work to improve the lives of millions of Americans. RememberThere is No Health Without Mental Health. ::

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The e-Bell Newsletter is published by the Mental Health America, which works with its 240 affiliates nationwide to promote health, prevent mental disorders and achieve victory over illnesses through advocacy, education, research and service. To receive the e-Bell, visit Mental Health America’s Web site www.mentalhealthamerica.net  or call 800-969-6642.
Cited reproductions, comments and suggestions are encouraged.