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• W4235063277 abstract "From the Editor-In-Chief Health AffairsVol. 35, No. 6: Behavioral Health Behavioral HealthAlan R. WeilPUBLISHED:June 2016Free Accesshttps://doi.org/10.1377/hlthaff.2016.0606AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSBehavioral health careDrug useMental healthHealth conditionsChildren's healthAffordable Care ActAccess to careCosts and spendingPharmaceuticalsMental health parity With a raging opioid abuse epidemic under way and renewed concerns over rising suicide rates and underdiagnosed maternal depression, mental health and substance abuse are garnering increased attention in the health policy sphere and the public at large. Yet a vast gap remains between the role behavioral health plays in defining the well-being of the population and the resources dedicated to understanding and addressing behavioral health needs. This month’s Health Affairs is devoted to the topic of behavioral health—our small contribution to increasing the profile of this complex and critical subject. The title of Charles Roehrig’s DataWatch makes the point clearly: “Mental disorders top the list of the most costly conditions in the United States.” Tami Mark and colleagues document that the share of mental health spending covered by public and private insurance grew between 1986 and 2014, but there was no similar increase for substance use treatment services. Among their findings: Between 2004 and 2013, the share of adults receiving inpatient or outpatient mental health services did not grow, but the share taking psychiatric prescription medications did.One group at great risk for excessive medication—children in foster care—is the focus of a paper by Stephen Crystal and colleagues. They find that the rapid growth in the prescribing of antipsychotics to these children that occurred in the early-to-mid-2000s leveled off at the end of that decade. With almost 9 percent of Medicaid-covered children in foster care receiving antipsychotic medication and more than one-third of those children not receiving any psychosocial services, there remains great need for care improvements for this profoundly vulnerable population.Mental Health ParityColleen Barry and colleagues describe the evolution of mental health parity from the narrow provisions of the Mental Health Parity Act of 1996 through broader ones enacted in 2008 and further extensions in the Affordable Care Act (ACA). While noting the limitations of the laws and concerns regarding enforcement, the authors conclude that “federal parity serves as a foundation that other financing and delivery system reforms, such as health homes and accountable care models, can build on.”The ACA’s parity provisions, along with its coverage expansions, should improve access to behavioral health care. Timothy Creedon and Benjamin Lê Cook document sizable growth in mental health treatment among those in serious mental distress in 2014 as the coverage provisions took effect. However, this growth did not close existing racial/ethnic disparities in utilization and was not matched by growth in substance use disorder treatment.Ellen Montz and colleagues examine risk adjustment in the ACA Marketplaces, designed to compensate plans for the higher costs associated with sicker enrollees, as it relates to behavioral health. Their simulation model reveals that the program fails to identify many people with high needs, and it pays less than the actual costs for those it does identify. These two failures leave plans with incentives to avoid people with behavioral health needs or limit the scope of behavioral health services.Substance UseInsurance translates into access only when providers are actually available. This is a particular concern when it comes to substance use disorder treatment facilities, since the number of public and nonprofit clinics is declining while the number of private clinics is growing. Analyzing data from the period 2002–10, Janet Cummings and colleagues conclude: “Counties with a large percentage of black residents were disproportionately burdened by the decline in public facilities, and these losses were not offset by an increased likelihood of gains in private for-profit or nonprofit facilities.”On a more positive note, Yuhua Bao and colleagues find that implementation of prescription drug monitoring programs—databases that, among other things, help identify patients seeking multiple opioid prescriptions—quickly cut opioid prescriptions by more than 30 percent, and those reductions were sustained over subsequent years.Criminal JusticeThe complex relationship among mental health, substance use, and the criminal justice system is the focus of two papers. Brendan Saloner and colleagues find dramatic increases in insurance coverage of justice-involved individuals with substance use disorders in 2014—primarily due to expanded Medicaid coverage. Examining data from two large Florida counties, Jeffrey Swanson and colleagues find that 62 percent of adults arrested for using a gun in a violent crime were legally prohibited from possessing a gun, but in only 20 percent of those instances was a mental health condition a factor in the prohibition.AcknowledgmentsHealth Affairs thanks Benjamin Druss of Emory University for serving as theme adviser. We also thank the California Health Care Foundation; Takeda Pharmaceutical Company, Ltd.; the Leona M. and Harry B. Helmsley Charitable Trust; and the Conrad N. Hilton Foundation for their support of this issue. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 June 2016 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF download" @default.
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• W4235063277 title "Behavioral Health" @default.
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