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Efforts Must Not Squander Positive Momentum Towards Mental Illness Treatment Reform

(Sept. 20, 2017) Discussions are currently taking place on a proposal in the US Senate that would make significant changes to our nation’s health care system. We are deeply concerned that this proposal would have a negative impact on those with the most severe mental illnesses and their families and would squander the positive momentum on mental illness reform created by the previous Congress including, the recent passage of the 21st Century Cures Act.The Republican-led 114th Congress recognized that our nation was in the midst of a mental health treatment crisis, passing landmark legislation to finally focus federal attention on those with the most severe mental illnesses. As Congress faces the urgency of a September 30 budget reconciliation deadline, we encourage decision makers to remember the magnitude of our nation’s mental illness treatment crisis and caution against any efforts that would cause us to lose our hard-fought momentum.

The current proposal contains a number of provisions that have been concerns in previous Senate proposals. We are concerned with the proposal’s treatment of Medicaid services -- in particular, those provisions that would seek to create per capita caps, end Medicaid expansion and otherwise greatly reduce the availability of Medicaid funding. As numerous Republican Senators have noted, Medicaid is the largest payer of mental health services in the United States and nearly one-third of individuals covered under Medicaid expansion have a mental health or substance abuse disorder. Provisions that would reduce such coverage or end opportunities for enrollment guarantee that those in need of treatment will suffer and related societal costs will rise.

The proposal would also allow states to eliminate mental health as an essential health benefit (EHB), and with it the requirements to provide parity between mental health and other medical and surgical benefits. We have heard some members of the Senate speak positively of the potential for eliminating EHBs as a means of reducing premium costs. Such discussions evidence a deep misunderstanding of the realities of mental illness care. We know that such requirements are necessary to ensure that individuals with mental illnesses have access to the treatment they need to live full and functional lives. Provisions limiting or eliminating mental health as an essential health benefit will only serve to raise costs, as individuals without access to mental health care deteriorate and become sicker. Research and experience show us that without access to appropriate care, these individuals receive more expensive and less therapeutic care in the only remaining systems that cannot refuse them -- crisis centers, emergency rooms, homeless shelters and jails.

We strongly encourage members of Congress to recognize that all decisions about health reform are taking place in the midst of an unprecedented mental illness treatment crisis. We must consider and provide for the needs of those with severe mental illness. Failing to do so will forfeit the momentum we are finally seeing at tremendous human and financial cost.