I am attending the SAMHSA Grantees conference this week and presenting on the topic of Parity. The theme for the entire conference is “Challenges & Opportunities”. I’ve already prepared my slides and hand-outs but did a bit more thinking on the plane. I did more reading, to be honest. My briefcase is jammed with papers and reports. Here’s what more we can say about challenges and opportunities as we head rapidly towards 2010. I’ll let you draw your own conclusions regarding challenges and opportunities:
Behavioral Health Facts & Figures
- The share of out-of-pocket spending on outpatient MH treatment devoted to prescription drugs has risen from 18% in 1987 to 64% in 2001.
- The vast majority of those prescriptions were written by primary care physicians and are covered at the same levels of coverage as medical prescriptions.
- Two-thirds of primary care physicians (PCPs) report difficulties making referrals to mental health specialists
- De-institutionalization and managed care (policy and economic drivers) have produced a decrease of total psychiatric beds in this country from 525,000 in 1970 to 212,000 in 2002.
- The State and County share of those beds decreased from 80% in 1970 to 27% in 2002.
- Private psych beds decreased from 95,000 in 1990 to 65,000 in 2002.
- ER visits for mental health reasons rose from 1.4 million in 1992 to more than 2.5 million in 2003.
- In 2006, 80% of State Mental Health Directors surveyed reported that their State regularly experienced a shortage in available psych beds.
- In 2006, 60% of all in-patient stays were paid for Medicaid or Medicare. That number continues to rise.
- State Hospital admissions rose 21% between 2002-2005 for the first time in decades.
- In 2006, 20% of all admissions to the hospital involved mental health as either a primary or secondary diagnosis. Most of these (80%) involved a chronic, incurable, disabling disease like schizophrenia or mood disorder.
- Medicare has a 190-day lifetime maximum for in-patient stays.
- Medicaid rules prohibit paying for services rendered in a State Hospital. State Hospitals provide acute, long-term and forensic services for people who often represent a serious danger to themselves and others.
- Managed Behavioral Health Organizations (MBHOs) apply strict medical necessity guidelines that prevent long-term stays in in-patient facilities
- Some would argue that longer stays might prevent re-admissions, suicide, homelessness and criminality
- 7% of inmates are incarcerated for mental health reasons
- Rates of MH diagnosis have doubled between 1996-2006. Those rates are highest in primary care.
- PCPs treat least impaired individuals.
- 1 in 20 children are taking a psychotropic medication – a 50% increase in 10 years
- 1 in 10 adults is taking a psychotropic medication – a 75% increase in 10 years
- 1 in 16 seniors is taking a psychotropic medication – a 100% increase in 10 years
- Psychotropic medications accounted for 51% of all MH treatment in 2006. In-patient stays accounted for 16% of costs.
- MBHOs are not responsible or at financial risk for medication costs
- Evidence-based practices are rarely limited to medications
The Good – 1996-2006
- Out-of-pocket costs remain flat
- Access to diagnosis improved for least impaired
- Prescription drugs producing good outcomes
- Coverage much better for children
- Most States implemented Parity and in 2008, an expanded Federal Parity law went into effect
The Ugly – 1996-2006
- Outpatient treatments other than prescription drugs are not scoring well in NCQA quality measurements
- Relative income for MH sufferers remains flat
- Rates of treatment for most impaired remained flat
- Decline in treatment among elderly
- Managed care diverting resources to less impaired
- Incarceration for MH concerns is on the rise (again)
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