By BETSY TAYLOR
The nation needs a far-reaching culture change in its response to mental health care and to combating addiction, and Catholic health care systems have an important role to play in that shift, said Patrick Kennedy, the former Rhode Island congressman and longtime advocate for mental health parity.
The founder of the Kennedy Forum, which advances the national effort to improve the country's approach to treating mental illness, addiction and other brain diseases, Kennedy was the lead sponsor of the Mental Health Parity and Addiction Equity Act of 2008. The law, which Kennedy says has yet to be adequately enforced, requires insurers to cover care for diseases of the brain as they would diseases of the body.
At the 2017 Catholic Health Assembly in New Orleans, he'll discuss the critical, ongoing need for comprehensive reforms including:
- Work to overcome stigma related to mental illness and addiction.
- Better screening, intervention and collaboration to provide seamless, comprehensive treatment for people with mental illness and addiction, including with supportive wraparound social services.
- Policy and funding changes to support effective therapies and services.
These are issues of life and death. Suicide rates in the United States increased steadily from 1999 through 2014, according to the Centers for Disease Control and Prevention. And overdose deaths hit a new all-time high in 2015.
"If we want to reduce the disability and mortality that comes from mental illness, then we need to address it like we would cancer or diabetes, with that same urgency," Kennedy said.
A common struggle
Together with Stephen Fried, Kennedy authored A Common Struggle: A Personal Journey through the Past and Future of Mental Illness and Addiction. In the 2015 book, Kennedy describes what it's been like for him to be a public figure — a member of a famous political dynasty — while grappling with depression and bipolar disorder and drug and alcohol addiction. He writes about achieving sobriety after several relapses.
Kennedy, a Democratic congressman from 1995 to 2011, is the son of Joan Kennedy and the late Sen. Edward "Ted" Kennedy and the nephew of President John F. Kennedy and Sen. Robert "Bobby" Kennedy. During his senate career, Ted Kennedy championed quality, affordable health care for all Americans.
Kennedy said CHA's members who treat patients struggling with mental health issues or addictions are on the front lines. "They are the MASH units. They get it," he said.
As major stakeholders in communities, health care systems can work to bring together other stakeholders — including local businesses and community-based organizations, and local or state governments and people with mental illness and their advocates — to work toward comprehensive, community-based approaches to mental health services, he explained.
"I came from a family that suffered tremendous addiction issues," Kennedy said. His parents, for instance, struggled at times with alcohol, which he writes about in his book. He said in the past doctors never asked him about his family history related to substance use before writing him prescriptions. "Those days have to be behind us," he said. "We all say that's obvious, but we don't do it in practice." Such a step could allow doctors to better identify those at higher risk for addiction.
He suggested the adoption of the American Society of Addiction Medicine protocols by health care systems, though he noted that work is ongoing to discover effective new protocols to screen for and treat addiction.
Environment and mental health
Kennedy said systems should address the social determinants that impact mental health. He strongly supports community collaborations to advance this work and offered the example of providing stable housing to people who suffer "disabling mental health conditions," saying that can give them a chance to allow therapies to take hold. Funding wraparound and supportive services for the mentally ill makes good economic sense; and, by demonstrating that, communities can advance policy changes to scale the solutions more broadly, he said.
Kennedy advocates for collaboration to meet the needs of patients. Without additional partnerships, communities will not "get the medical treatment we expect from population health to be sustainable," he said.
When President Kennedy signed the landmark Community Mental Health Act of 1963, he said: "The mentally ill and the mentally retarded need no longer be alien to our affections or beyond the help of our communities." According to his nephew, insufficient progress has been made in reducing the stigma of mental illness and addiction in the ensuing years. He underscored President Kennedy's emphasis on the role of communities in supporting people with mental illness: "He didn't say, beyond the help of our Catholic hospital systems, nor beyond the help of our psychiatric hospitals, nor beyond the help of our psychiatrists and so forth. He said communities."
Tracking parity concerns
The Kennedy Forum works with several other organizations on Parity Track, a forum to record and pool examples of instances where providers or patients have struggled or failed to get insurance reimbursement for behavioral health or addiction recovery services. He said the forum is gathering information in the hopes that state attorneys general will pursue consent decrees to change patterns of insurance reimbursement that run afoul of parity laws. "The provider community knows better than anyone where the deficits are in the payer accountability," Kennedy said, and added he would welcome their recording specific examples at parityregistry.org.
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