Behavioral Healthcare 2016 Policy Survey

At times, the delivery of behavioral health services seems as much a policy discipline as a health discipline. Behavioral Healthcare recently polled more than 600 industry leaders to gauge their views on the nature of today’s politics and the key issues relevant to mental health and addiction. In general, respondents to the 2016 Policy Survey seemed largely optimistic and significantly engaged in tracking federal and state strategies.

For example, 59.8% say they’re following many policy issues or consider themselves a policy wonk, and about half have helped a state or federal policymaker by offering expert perspectives. Additionally, more than 37% have authored a position paper with recommendations for change or work for an organization that has.

“It’s really promising to see how just many people closely follow policy news of relevance to them and are engaging with lawmakers by providing perspectives from the industry,” says Rebecca Farley, senior director of policy and advocacy for the National Council for Behavioral Health. “It gave me optimism because lawmakers are not necessarily experts in mental health and addiction treatment issues. They don’t know what it’s like to run an organization and to treat people with those issues.”

Hill days

While more than 60% of respondents say they have never participated in a Hill Day, the one-on-one interaction is often the best opportunity for providers to build their influence. It’s true that Hill Day events typically involve meetings with staff members rather than the lawmakers themselves, but it’s important to note that the staffers function as the legislators’ key information sources, Farley says. They are exactly the right people to establish relationships with.

She says one behavioral health leader operating in one state might feel powerless to influence Capitol Hill, but his or her ideas are often welcomed because they provide a real-world perspective. And the personal interaction makes a difference when trying to get a lawmaker’s attention.

“When you participate in a Hill Day, you realize folks on the Hill are desperate for resources, support and information on what they’re doing that affects the people who live and breathe these issues,” she says.

If you’re meeting with staff, it’s important to provide clear, unified messages on specific issues. Leaving behind a printed sheet with your contact information and your talking points also can help the staff members convey the message forward after the meeting.

“You’re not someone who just signed your name on a petition or posted an angry Tweet,” Farley says. “You care so much, you invested your time and money to come to Washington, D.C., and made your case to them in person, and that matters.”

She says National Council sees an uptick in the number of legislators that come on as supporters of legislative priorities in the weeks following a Hill Day. Participants might also be called on in the future as resources for Congressional leaders seeking information updates.

Last year, National Council and its partners organized more than 600 people for an industry Hill Day, representing 39 states and resulting in more than 300 personal meetings. The 2016 Hill Day takes place June 6 and 7.

State support

While not all states were represented in the Policy Survey, 53% of respondents believe their respective state governors are supportive of their views on behavioral health policies. It seems clear that there is a general feeling that as a party, the Democrats are seen as more supportive: Nearly 70% of respondents believe so, followed by Republicans (9%) and Independents (11.2%).

“What’s not surprising is the political orientation of this group, which is heavily Democratic,” says Michael S. Shafer, PhD, professor in the School of Social Work and director of the Center for Applied Behavioral Health Policy at Arizona State University. “It speaks to some of the issues the Republican party in general deals with—or does not deal with—in that it doesn’t come across as a particularly caring, compassionate side.”

Likewise, government agencies and their appointed leaders are not always embraced by the tax payers who fund their budgets or the constituents they are assigned to help. In spite of recent policy proposals that would essentially dismantle the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly two-thirds of survey respondents have a favorable view of the current work being done by SAMHSA with 72.8% rating it as excellent or good.

SAMHSA offers more than 40 consumer-facing and industry-facing campaigns, such as National Prevention Week, May 15 to 21, 2016, and drug-free workplace programs.

Across the entire $3 trillion healthcare system, prevention efforts typically see minimal spending compared to the dollar amounts spent on treatment. Too often the U.S. system is referred to as “sick care” rather than “healthcare.” When asked how prevention efforts for SUD should be funded, nearly 67% of survey respondents said either federal or state programs should shoulder the greatest financial responsibility.

“Health systems are called out by less than 10% of respondents,” Shafer says. “This reflects the pre-Affordable-Care-Act thinking. Over time, we would hope to see the health plans and healthcare providers take a more direct role in SBIRT-related (screening, brief intervention, referral to treatment) activity that I see catching on like wildfire in my state of Arizona and in other communities.”

Shafer cites the February recommendation from the U.S. Preventive Services Task Force for universal screening for depression as an indicator that more attention is being focused on early detection of behavioral health issues.

Medication assisted treatment

Respondents overwhelmingly believe the list of 10 essential health benefits outlined by the Affordable Care Act should be expanded to include medication assisted treatment (MAT). While behavioral health treatment and prescription drugs are on the list of 10 benefits, restrictions on the use of MAT under other federal laws are posing a barrier. With industry groups such as the National Association of Addiction Treatment Providers stating their support for MAT and the Obama administration currently working on new efforts to expand its use, 2016 could be a pivotal year.

“It’s wonderful to see that kind of turn in the industry,” Shafer says. “Historically the addiction community has been steeped in the 12-Step tradition and has been somewhat resistive to use of pharmacology in that process. It’s gratifying to see this trend, and it reflects a growing acceptance and recognition for parity in spirit and in practice.”

Community issues

Assisted outpatient treatment (AOT) remains a contentious issue. Clearly, behavioral health stakeholders are acutely aware of the delicate balance between earnestly helping someone in distress and forcing someone into treatment as a matter of policy. No one is taking the principles of personal freedom lightly. However, the calls for policy change to help avoid mass shootings at the hands of an individual who is in a mental health crisis also can’t be ignored by lawmakers.

The original mental health bill authored by Rep. Tim Murphy (R.-Pa.) in response to the Sandy Hook Elementary School tragedy included an AOT mandate for states. In the more recent version—still making its way through the halls of Congress—the mandate has been massaged into a funding incentive for states that use the policy.

States using AOT report that it reduces hospitalization, homelessness, arrests and violent episodes, while increasing long-term voluntary compliance, according to the Treatment Advocacy Center. Only five states do not have AOT: Connecticut, Maryland, Massachusetts, New Mexico and Tennessee.

More than 75% of the Policy Survey respondents indicate that they support proposals to increase the use of AOT. Also among respondents, 33.3% have formal arrangements to work with judicial systems on programs to facilitate treatment in lieu of jail for nonviolent offenders, and another 29.1% have similar informal arrangements.

“These community partnerships between behavioral health and judicial systems occur at a critical window of opportunity when a person can either be incarcerated or get treatment in the community,” says Farley. “It’s wonderful to see over 60% have formal or informal arrangements with judicial systems. We’re going to see more and more communities move toward those arrangements.”

Gun Control

Nearly 66% of respondents to the Policy Survey say they support legislation that would further limit the ability of people with mental health disorders to purchase a firearm. In January, President Obama issued an executive order that was meant to encourage the reporting of red flags for inclusion on databases used for background checks and to reduce the risk of harm and self-harm with firearms. It included a clarification stating that HIPAA does allow a clinician to report the fact that an individual had an involuntary treatment experience, which could be added to the database. The order did not change any existing laws.

“On gun control, the devil is in the details,” Shafer says. “Where do you draw that line and where do you erase that line?”

He says the details to watch in future legislation are whether new restrictions would classify individuals by diagnoses and if there might be a statute of limitations for those who are in recovery and have achieved good management of their behavioral health issues. Most cases of mass shootings, for example, are carried out by individuals who have no prior behavioral health diagnosis, so casting a wide net might not produce the results communities are asking for, he says.

“Conceptually, everybody agrees that we want to make sure certain individuals don’t have access to guns,” he says. “Our discussion is not about restrictions to gun access or a registry, however, it’s about isolating one group of individuals.”

As the presidential candidates vie for position in the coming months, the issues on the minds of Americans will fluctuate. According to a consumer poll released in January by the Legal Action Center, 57% of Americans would support a candidate who aims to provide additional investment in education, prevention and treatment of drug and alcohol addiction.

Not surprisingly, only 2% of the Behavioral Healthcare Policy Survey respondents indicate that they have ever held an elected public office. Often the biggest policy champions are those who have personal stories.

“I would love to see more mental health and addiction providers, consumers, family members and stakeholders run for public office,” says Farley. “That would be wonderful.”

Julie Miller is Editor in Chief of Behavioral Healthcare.