Checking In With CMH
New Year, New NAM: Health Policy Resolutions from 2021
- February 4, 2022
- Posted by: ss4555
- Category: Uncategorized
By Sonam Saxena
Like many people and organizations, the National Academy of Medicine (NAM) made a few New Year’s resolutions for 2021, and some focused their hopes for the ways America’s behavioral health system needs to improve. With 2022 well underway, let’s see how we did.
Goal 1: Improve access to behavioral health services by meeting people “where they are”
Even before COVID-19, almost 1 in 5 Americans experienced a mental illness per year, but less than half received treatment. Low use of mental health services results from inadequate health insurance coverage, workforce shortages, and stigma. In the case of opioid use disorder (OUD), the X-waiver served as a noteworthy barrier for providers looking to prescribe buprenorphine, a life-saving OUD medication treatment. The X-waiver was removed last January with updated guidelines in April, which removes some (but not all) barriers for physicians to prescribe buprenorphine. While it may not be a panacea, it will help patients with OUD access care.
Another method to increase access to behavioral health services is to increase the use of telehealth. Mental Health America summarized the research exploring telehealth after its rapid adoption during COVID-19, and showed that its effectiveness was similar to in-person care in terms of symptom reduction and improved quality of life. Telehealth may not replace face-to-face therapy for everyone, but it could rapidly expand access to effective care for people disproportionately affected by stressors related to COVID-19. Some people felt more comfortable receiving therapy from home. There are still barriers to adopting telehealth, including disparities in access to technology and trouble with reimbursement rates, but increasing the use of telehealth is a step in the right direction.
Researchers and policy makers increasingly recognize the role of telehealth in value-based care, acknowledging that telehealth services can be less expensive than in-person and offer similar outcomes. The CARES Act passed last year began waiving geographic restrictions that mandated telehealth services be available only at eligible care sites and thus allowing patients to receive services at home. The CONNECT for Health Act of 2021, introduced in April, would permanently remove these telehealth geographic restrictions, allowing patients to access care from a wider range of locations (like their homes). It’s important to note that the COVID guidelines allowed temporary mandates; translating these to more permanent guidelines may be challenging. The “patchwork” of regulations (including state and county rules) makes it difficult to translate these into long-term solutions.
Goal 2: Decriminalize behavioral health crises and improve the crisis response team
The Washington Post Fatal Force Database reported that more than 100 people with mental illness were shot and killed by the police in 2021 alone. Police disproportionately kill people with mental illness. Studies have found that individuals with serious mental illness are 16 times more likely to be killed by police. This year we witnessed the unjust killings of John Earle Barnes (holding a toy when shot), Richard Solitro (unarmed when shot), and Keith Collins (holding a toy when shot). The historic criminalization of mental illness contributes to this problem; in fact, prisons and jails have been referred to as the “largest institutional providers of housing for people with serious mental illness.” Some people with mental illness remain homeless and without treatment due to an inadequate care system that leaves many inappropriately imprisoned or unhoused, lack of funding to improve these systems, and outdated treatment laws.
To make sure that people in need end up with appropriate care and not in the criminal justice system, some cities have developed crisis response teams, which include behavioral health professionals who work alongside or in lieu of police officers. Philadelphia employs a co-responder team, which includes a trained clinician and a police officer, to de-escalate mental health crises and divert people from the criminal justice system. The Modified Crisis Intervention Team (CIT) began responding to events involving people in mental health crisis in June of 2021. The program’s goal for early 2022 is to improve triage for people calling 911 with a behavioral health crisis, de-escalate the situation, and provide follow-up in the community. As of the last update, these officers and teams have begun co-responder training. This program parallels other co-responder programs in Los Angeles and Dallas.
An exciting advance this year is the 988 crisis line, which will start in July 2022. This line was created as an easier way to reach suicide prevention and mental health crisis counselors, rather than the 1-800-273-8255 number currently in use.
Goal 3: Recognize and address the social context that contribute to poor health
NAM’s last resolution focused on the influence of social determinants of health, which encompass social and environmental factors that affect health and quality of life. Examples include access to education, insurance and healthcare, food and housing security, and social support.
COVID-19 dramatically affected social determinants of health for many people through widespread loss of income and service closures, and created disparities in access to COVID-19 tests and vaccines. Specific determinants, such as living in a smaller household or food insecurity, also heightened the risk of contracting COVID-19. These disparities are relevant also to technology, critical to both accessing school/work and telehealth services.
CMS released guidelines for Medicaid to help “better address social determinants of health” under current law in January of 2021, and Medicaid managed care organizations (MCOs) are introducing more and more initiatives targeting these determinants, including expanded coverage for non-medical services like housing and tracking referrals to social services. These changes in policy open the door for rigorous research and vigorous advocacy for increased consideration of the extent to which addressing these factors improves mental and physical health.
While progress has certainly been made across NAM’s resolutions, there is more work to do. Ensuring a successful 988 rollout, making the mandates for telehealth guidelines permanent, and expanding our focus on social determinants of health are just a few of the areas where we need to organize our efforts efficiently and collaboratively. We cannot let 2022 become another “2020, too.”