Legislation before Congress could bring a major overhaul of the nation's mental health system. If passed, the "Helping Families in Mental Health Crisis Act" (H.R. 2646) and the "Mental Health Reform Act of 2015" (S. 1945) could increase access to mental health care, clarify rules about disclosure of protected health information, make psychologists eligible for financial incentives for adopting electronic health record systems and more, says Laurel Stine, JD, director of congressional affairs for the APA Practice Organization (APAPO). The "Helping Families" bill was introduced by Reps. Tim Murphy (R-Pa.) and Eddie Bernice Johnson (D-Texas), while the "Mental Health Reform" bill was introduced by Sens. Bill Cassidy (R-La.) and Chris Murphy (D-Conn.).
"It's clear that the mental health system is failing to meet the treatment needs of children and adults with mental health disorders," Stine says. "We have children and adults with serious mental illness who are falling through the cracks."
Convinced that the two bills could help fix such problems, APA and APAPO support both of them, albeit with some caveats. Proposed changes to the Medicaid program, for example, would make care more accessible for some of the nation's most vulnerable patients — low-income adults with serious mental illness.
Specifically, the two bills call for:
Expanding access to care. The Medicaid program currently prohibits federal funds for inpatient psychiatric care for patients ages 21 to 64 in facilities with more than 16 beds, a provision that contributes to health disparities among low-income adults, points out Judith M. Glassgold, PsyD, director of APA's Public Interest Government Relations Office. "It puts adults with serious mental illness who are low-income or who can't work because of their mental illness at risk of receiving no services whatsoever," she says. While the bills don't repeal that exclusion altogether, she explains, both would create exceptions for short-term stays.
Another provision in the House but not the Senate bill would eliminate Medicare's lifetime cap of 190 days for inpatient psychiatric services. "That policy is fundamentally flawed," says Stine. "It's not in line with mental health parity."
In addition, the Senate bill offers incentives for co-locating psychological and behavioral health services in primary-care settings as a way of creating greater and easier access to care.
Clarifying the Health Insurance Portability and Accountability Act (HIPAA). Both bills seek to clarify what health information psychologists and other health-care providers are legally allowed to disclose to an adult patient's family members or other caregivers, says Stine. While protecting patients' privacy is a cornerstone of the patient/provider relationship, she says, giving family members or other caregivers some information can help them help patients — especially those with serious mental illness — adhere to their treatment regimens.
The House bill adds an exception to HIPAA that would allow caregivers of patients with serious mental illness to gain access to information about diagnoses, treatment, appointments and medication in certain situations — if the absence of such information would worsen the patient's condition or prognosis or if such information were needed to protect the person's or the public's health, safety or welfare. The Senate bill simply clarifies that HIPAA already allows providers to share information when patients are incapacitated or they believe such disclosure is in patients' best interests.
APA and APAPO support the Senate provision's educational approach, says Stine.
Promoting electronic health record use. The Health Information Technology Act was based on the idea that patient care improves when health-care providers can share patient information. But when Congress passed that act in 2009, it excluded psychologists from an incentive program designed to encourage providers to adopt electronic health record systems. The House bill — but not its Senate counterpart — would fix that oversight and expand the program to include psychologists and other mental health professionals. (Psychiatrists are already eligible.) Making psychologists eligible for the program will enable mental health and addiction providers to work with primary-care providers and integrate care for the benefit of patients, Stine says.
Boosting the number of providers in underserved areas. Recognizing the nation's growing diversity, both bills would permanently authorize the Minority Fellowship Program, a U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) program administered by APA and other organizations. The program is designed to increase the number of culturally competent psychologists and other behavioral health professionals in underserved areas. "We have a real shortage of behavioral health providers who are trained in cultural competence and who are racial and ethnic minorities themselves," says Glassgold. The program has never been permanently authorized, "so it's always in danger of disappearing or being replaced by something else," she says.
The Senate bill would also reauthorize the Graduate Education Program, the only federal program specifically devoted to the education and training of psychologists. That reauthorization would boost the program's authorized funding level from the current $12 million to $14 million. That doesn't necessarily mean that Congress would appropriate $14 million for the program, but it's a step in the right direction, says Karen Studwell, director of APA's Education Government Relations Office, explaining that Congress appropriated just $7.9 million for the program this year.
Creating new leadership for the nation's mental health care. Both bills would shift most of SAMHSA's authority over the nation's mental health care to a newly created assistant secretary for mental health care position at the Department of Health and Human Services (HHS). "The goal is to elevate mental health and addiction treatment services — especially for people with serious mental illness — and mainstream those services more into HHS," says Stine. As a result, the SAMHSA administrator position would cease to exist. APA supports the shift, but wants to ensure that SAMHSA's programs aren't scaled back.
The House bill also includes reauthorization of two key SAMHSA-funded programs: the Garrett Lee Smith Memorial Act, which funds suicide-prevention efforts on college campuses as well as initiatives by states, territories and tribal governments, and the National Child Traumatic Stress initiative, which aims to improve treatment and services for children, adolescents and their families who have experienced trauma.
APA and APAPO are asking their network of psychologists to urge their members of Congress to support or even become a co-sponsor for one of the bills, says Stine.
As the legislative process continues, psychologists can also help ensure that any final legislation meets the needs of people with mental health, substance use or behavioral health issues and addresses psychology's concerns.
"We're going to need people to chime in to voice support for the provisions we want to see in a final bill, if we get to that point," says Stine.
The APA Practice Organization (APAPO), a companion organization to APA, advocates on behalf of practicing psychologists.
For more information or to contact your elected officials, visit Psychology Advocacy Networkopens in new window. See professional psychology's Legislative Action Center.