The Bell: MHA's Newsletter

Volume 7, #4 | Fall 2012

In This Issue

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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: The Important Work We Do

By Wayne W. Lindstrom, Ph.D., President and CEO
Dr. Wayne Lindstrom

This is my first column for The Bell. I came to Mental Health America after working for more than 40 years in the for-profit and not-for-profit behavioral health fields.  It is an honor to serve as president and CEO of an organization that has played such a historic and leading role in advancing the health and well-being of Americans.

Over the past weeks, several events have occurred that underscore the important work we do. The election results ensured that health reform will move forward. Mental Health America advocated at the federal level to ensure coverage for mental health and substance use services was included in the legislation. We are now doing the legwork to provide advocates across the country with tools and resources to ensure benefit packages for policies offered through state Exchanges 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 health reform implementation. 

Prior to the election, Hurricane Sandy devastated communities along the Atlantic Coast and affected the mental health of millions. Mental Health America's affiliates in New Jersey and New York and other states are lifelines that provide the support and services that make the difference for so many in times like these. Many of our affiliates were affected by the hurricane and suffered power outages and damage to their offices. Through the efforts of dedicated staff and volunteers, our affiliates in the northeast have continued to provide services to the consumers and families they serve.

They, like all our 240 affiliates across the country, are making a difference in the lives of people with mental health and substance use conditions, empowering them to live full and productive lives and achieve wellness.

Next year, we will join with our affiliates and advocates across the country to more closely examine wellness—where we stand and where we are headed in implementing strategies for society at large—at our Annual Conference, June 5-8, at National Harbor just outside of Washington, D.C. The conference, Why Wellness Works: Breakthroughs and Pathways to Whole Health, will look at cutting edge approaches, new policy initiatives and imperatives, and tools and programs that are working in communities across the country to address this important topic. More information can be found in an article below. I hope you can join us.

 

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Capitol Hill Update: The Fiscal Cliff - Which Way Back?

With the elections over, Congress and President Obama are confronting how to step back from the so-called fiscal cliff. The term refers to more than $500 billion in tax increases and across-the-board spending cuts scheduled to take effect after January 1 unless President Obama and Republicans reach a deficit reduction deal.

The cuts of between 8 and 11 percent are required under The Budget Control Act of 2011, which had directed a “Super Committee” to find $1.2 trillion in savings over 10 years in both defense and non-defense discretionary spending. Because the committee failed to reach a deal, the automatic cuts are scheduled to be triggered at the beginning of next year.

These mandatory cuts will have a devastating impact on mental health and substance use services and related public health programs that are supported by the Substance Abuse and Mental Health Services Administration, the National Institutes of Health, the Centers for Disease Control and other key agencies. A Mental Health America report on the sequestration details how these indiscriminate cuts would harm individuals living with mental health and substance use conditions.

Although initial talks between President Obama and Congressional leaders offered some hope that a deal will be reached, both sides remain far apart. President Obama called on Republicans to raise tax rates on the wealthy, which would generate $1.6 trillion in revenue, while extending current tax cuts for the middle class. House Speaker John Boehner (R-Ohio) offered conciliatory words and did not rule out raising revenue. But he suggested that Congress just put off dealing with the fiscal cliff, allow all the Bush tax cuts to remain in place, and then negotiate tax reforms to lower rates even further while closing unspecified loopholes.

Some experts believe a two-part deal will be crafted. The first part would extend tax cuts for the middle class and repeal the automatic spending cuts to avert the changes scheduled after January 1. But it would be contingent on the second part: a framework for reducing projected long-term deficits by overhauling both the tax code to raise revenues and making changes to Medicare and Medicaid.

Therefore, even if the sweeping cuts called for under sequestration are averted, new threats would emerge. An overhaul of the tax code could lead to a limitation of the charitable deduction (see story below). And because health care takes up a large chunk of the budget, Medicaid and provisions of the Affordable Care Act like the Prevention and Public Health Fund will continue to be targets for cuts.

Speaker Boehner raised new concerns when he argued in an op-ed that health reform adds to the debt and that the law has to be on the table in negotiations on resolving the fiscal cliff. His statement ignores the fact that the Affordable Care Act doesn’t add to the debt, it lowers the debt. According to a Congressional Budget office report, repealing the law would add $109 billion to the debt through 2022.

With respect to Medicaid, some of the proposals call for creating a blended rate or changing a state’s ability to assess provider taxes in Medicaid, which affect their share of money. The problem with these and other proposals is that they may ultimately lead to cuts in services for beneficiaries.

Mental Health America has worked to educate lawmakers on the dangers of sequestration and argued vigorously for a balanced approach to deficit reduction that protects vital programs and services for people with mental health and substance use conditions. We will continue that effort as negotiations continue.

 

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The Charitable Deduction: Mental Health America, Nonprofits Advocate against Limits 

As Congress addresses the fiscal cliff and considers possible changes to the tax code, there are reports that suggest limits to the charitable deduction may be under consideration.

Mental Health America has joined with fellow members of Leadership 18, an alliance of the leaders of some of the country’s largest and most well respected charities, in advocating against any change to the deduction.

Data suggests that for every dollar a donor gets in tax relief for his or her donation, the public typically receives three dollars of benefit. No other tax provision generates that kind of positive public impact. Tax policies that encourage charitable giving are particularly important during difficult economic times and in the wake of natural disasters like Hurricane Sandy.

If the charitable deduction is limited, donations would drop. That would hurt communities as nonprofits and aid organizations are often the first lines of relief to reach people in need after disasters, filling an assistance void often left by government and private corporations. Nonprofit groups, like Mental Health America and our affiliates, which are already dealing with tighter budgets and fewer contributions due to the recession and slow economic recovery, will also suffer.

Independent Sector, a leadership network for nonprofits, foundations, and corporate giving programs, has created an action alert where individuals can send automatic, targeted letters to local lawmakers and the White House to oppose any efforts to limit the charitable deduction.

 

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Health Reform Update: Election Ensures ACA Implementation Moves Forward

The results of the 2012 Election mean the Affordable Care Act (ACA) will not be repealed and the federal government and state policy makers will need to move forward with plans for implementation. 

In the months prior to the election, the Department of Health and Human Services (HHS) had been slowing its release of guidance on various aspects of the law. The department is now moving forward on several key aspects of the law. Below is an update on implementation and proposed rules.

State Exchanges: HHS informed the states that it has extended the time to submit their intention to establish a state-based or partnership Exchange and the more detailed Blueprints describing plans for establishing the state-based Exchanges until December 14. HHS will then approve or conditionally approve the state-based Exchange plans by January 1, 2013.  For those states pursuing a partnership Exchange with the federal government, the deadline to declare their intention and submit their blueprint application was extended to February 15, 2013.

Essential Health Benefits: On November 20, HHS released proposed rules on Essential Health Benefits (EHB), on employer-based wellness programs, and how insurers can vary premiums based on age, geography, tobacco use, and family size—the only categories that can cause variability in premiums when insurers can no longer discriminate based on pre-existing conditions and gender in 2014.  The proposed EHB rule addresses issues of non-discrimination in plan design, including prohibiting discrimination in costs and utilization management for beneficiaries based on race, age, health status, or health care needs.  In addition to the 10 broad categories of essential benefits included in the statute (mental health and substance use disorder services is one of the categories), the EHB must include specific preventive services outlined in the ACA and any state mandates that were in effect as of December 2011.  Importantly, the proposed EHB rule explicitly states that the Mental Health Parity and Addiction Equity Act (MHPAEA) must be complied with in the EHB. A prior bulletin indicated that HHS would require plans to cover only one medication per class, a problem given the variability of response individuals have to mental health medications.  The proposed rule indicated that plans must cover either all of the drugs that were covered in the benchmark plan or one drug per class, whichever is greater.  This is an improvement over the previous guidance, but Mental Health America continues to push for a Medicare Part D benefit structure that designates mental health medications as protected classes.

Medicaid Expansion: States that were waiting to determine the results of the election to declare intent to opt for the Medicaid expansion are expected to begin to indicate their plans. At this point, it is still uncertain what regulations will be released from HHS addressing issues related to the Medicaid expansion no longer being mandatory. However, the department issued a Medicaid Director letter that provides guidance on the benchmark coverage options—the Alternative Benefit Plans (ABP) – for the Medicaid Expansion population in states that will opt for the new program.  According to statute, states can use four plans as benchmarks for the Medicaid expansion: the standard Blue Cross Blue Shield Preferred Provider Option offered through the Federal Employees Health Benefit program; state employee coverage that is offered and generally available in the state; the commercial HMO with the largest insured commercial, non-Medicaid enrollment in the state; and Secretary-approved coverage, which can include the Medicaid state plan benefit that is offered in the state to those currently enrolled in Medicaid. States do not have to pick just one benchmark; they can offer different plans to targeted populations to meet specific needs.  Importantly, the letter reiterated that the plans chosen must include or be augmented with additional benefits to include the 10 Essential Health Benefits that also apply to the Exchanges and that they must comply with the MHPAEA. For beneficiaries under the age of 21, the ABP must include Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services.

 

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Parity: Denver Hearing Set, Push for Final Rule Continues

A series of field hearings and public forums has helped to raise visibility about the Mental Health Parity and Addiction Equity Act (MHPAE) and the need to have final regulations issued. Although the MHPAEA was enacted more than four years ago, a final rule to implement the law has still not been issued by the federal government.

Modeled after the field hearings in 2007, which were successful in helping to enact the Mental Health Parity and Addiction Equity Act (MHPAEA) into law, the 2012 field hearings are intended to shine a light on problems patients are still facing as they try to access mental health and addiction services and the need for a final rule, as well as areas where parity is increasing access to care. The series of hearings and forums, called “Patriots for Parity,” has increased awareness among the general public about their new rights under the law. Studies have shown that a vast minority of Americans even know that the law was passed and they may be entitled to more comprehensive coverage of mental health and substance use treatment.

The next hearing will take place in Denver on January 10, 2013, from 5:30 to 7:30 pm at the Denver Art Museum, 100 W. 14th Avenue Parkway. Hosted by the Colorado Coalition for Parity, it will feature former representative Patrick Kennedy. Kennedy, along with former representative Jim Ramstad, championed passage of MHPAEA and has organized the hearings held around the country.

Mental Health America and fellow organizations in the Parity Implementation Coalition are continuing to urge the administration to issue a Final Rule so the law is fully enforced and operational and individuals have access to critical mental health and addiction services.

 

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Mental Health America's 2013 Annual Conference: "Why Wellness Works"

why wellness works 2013 annual conference logo

Wellness is central to the transformation of health care and the integration of general and mental health. Promoting strategies for achieving wellness is critical to the prevention of and recovery from mental health and substance use conditions.  Fully embracing the principles of wellness not only improves health in the mind, body, and spirit, but also maximizes one's potential to lead a full and productive life.

Mental Health America’s 2013 Annual Conference, Why Wellness Works: Breakthroughs and Pathways to Whole Health— June 5-8, 2013, at the National Harbor in Maryland—will examine where we stand and where we are headed in implementing wellness strategies for society at large. The conference will look at cutting edge approaches, new policy initiatives, programs, and tools that are working in communities across the country to address this important topic.

Building on Mental Health America’s evidence-based Live Your Life Well program, the conference will engage and educate attendees on research and scientific developments, management of mental health conditions and other accompanying chronic conditions, strategies for recovery, and a deeper understanding of why wellness is important for everyone. It will empower and equip consumers, MHA affiliates, health care providers, community gatekeepers and the general public so that they can advance wellness strategies in their work and communities.

The 2013 Mental Health America Annual Conference will feature:

  • Leading experts who will discuss wellness and its role in achieving whole health for individuals and communities.
  • Sessions that mirror the Ten Tools of Live Your Life Well, highlighting the concrete actions that promote mental health and wellness including complementary alternative practices.
  • Wellness activities where participants can experience a variety of wellness methods, including exercise such as yoga, tai-chi and zumba, nutrition including cooking demonstrations and preparation of healthy meals, and learning how to master the art of mindfulness.
  • A Wellness Fair where individuals can take screenings for both mental and general health indicators of wellness and not only get a more accurate reading of their own health but also learn about the importance of these indicators and how to use them.  Attendees can build a network of professional contacts to help bring these new ideas and tools to their own communities.
  • Policy Matters Workshops where Mental Health America staff and other experts will dig into how new policies and laws are supporting wellness initiatives.
  • Our annual Capitol Hill Day when attendees reach out to key decision-makers and lobby their Members of Congress to support critical legislative priorities.

More information on the Conference is available at http://www.mentalhealthamerica.net/go/annualconference.

SZ Magazine

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"From Asylums to Recovery": Documenting the Mental Health Consumer/Survivor Movement 

The consumer movement has a rich history. Over the last forty years, many incredible and talented people have made the consumer/survivor movement a central force in policy making and implementation of the nation’s mental health services and supports.

People like Sally Zinman, Gayle Bluebird, Dan Fisher, Joseph Rogers, Howie the Harp and many more have guided us through difficulties and the lack of a united identity to create a movement that now shows incredible promise to reduce the horrors of a system of care that caused so much trauma and damage to the most vulnerable of our fellow citizens. Many of our 240 affiliates are consumer-run and our National staff and board of directors has a number of consumer/survivors directing and implementing our advocacy and education work. Too little has been told or written about their work and accomplishments.

Mental Health America is now producing a documentary, "From Asylums to Recovery," that will tell the stories of old and new movement leaders who stood up for the humanity and dignity of millions of people living with mental illness. The project will create a living history of the mental health Consumer/Survivor community. 

We have recently videotaped 14 consumer/survivor leaders and advocates. These interviews will be included in a one-hour documentary scheduled to be completed by September 2013.  Two Emmy-award winning producers are working with us to assure that we produce a network quality video, and to help us arrange airings on public television and/or cable networks.

For more information, contact Patrick Hendry at phendry@mentalhealthamerica.net.

 

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Membership

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 with tested tools so they can preserve and strengthen their mental health and wellness.
  • And through the programs and services of our 240 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 240 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.