Worry: Health reform’s reliance on promising, but unproven approaches. “We’re doing a lot of things right now in the belief that they will improve health—health homes, accountable care organizations, managing dual eligibles, or managed care—and we’re optimistic that these will do three things: improve access, control costs, and improve care. These are all ideas that were developed, that were going to be pilots, but now they are policy instead,” says Rosenberg.
“None of these are bad ideas—and the National Council is deeply involved in supporting education for states, counties, and communities who are implementing them—but I worry about what the outcomes will be, because they’re untested. We need to be careful not to overstate what they will do, what they might contribute until we really find out whether they can improve access, control costs, and improve care all at the same time.
“In our very complex world, even good policy can have unintended consequences—and some of those may not be good ones,” she maintains. “So, we’ve got to watch this carefully and be ready to make midcourse corrections if necessary. We can’t just ‘drink the kool-aid’ and think that everything is going to be perfect.”
Opportunity: Broader adoption of Mental Health First Aid. “We helped bring Mental Health First Aid (MHFA) to the U.S. and the National Council is building up an infrastructure around it, but it’s bigger than us,” says Rosenberg. “It’s been a very effective way to educate—to move the needle on public awareness of mental health. Someday, I think that it will be known the way CPR is known,” she concluded. MHFA is certainly on its way, aided by President Obama’s call for $20 million in federal support for expanding MHFA across the country, partly in response to the tragic shootings in Connecticut.
Worry: Getting integration right. “The National Council has been working in support of integration, running technical centers for years on behalf of mental health and addiction treatment. We know that it—bidirectional integration with primary care—is the right answer, but we have to make sure that we don’t throw the specialty sectors under the bus,” Rosenberg explains.
So, she adds, “we can’t do integration the way we did deinstitutionalization—implement it wholesale without watching carefully that newer services are really available, really meeting the needs in that new setting. We do want to get specialty care integrated with primary care, but we are still going to need that specialty sector. We still have to nurture it and support it for those people who need more intensive care—things that only the specialty sector can provide. That’s one reason why developing FQBHCs is so important.”
Opportunity: Excellence in Mental Health Act. This Act, which would provide $1 billion to establish national standards and oversight for Federally Qualified Community Behavioral Health Centers (FQBHCs), was introduced Feb. 8 in the US Senate and has a dozen, bipartisan cosponsors: Debbie Stabenow (D-MI), Roy Blunt (R-MO), Jack Reed (D-RI), Susan Collins (R-ME), Barbara Boxer (D-CA), Marco Rubio (R-FL), Patrick Leahy (D-VT), Lisa Murkowski (R-AK), Mark Begich (D-AK), Jay Rockefeller (D-WV), Jon Tester (D-MT), and Chris Coons (D-DE).
The reintroduction of the bill—this time with significant bipartisan support—marks a big change. “This year, we have a moment in time, an opportunity to bring good out of recent tragedies like Newtown,” Rosenberg explains. “We have a House, a Senate, and a public that are focused on mental health issues and willing to look at the questions, ‘Why is mental health funded differently than other safety net services? Why aren’t there national standards? Why isn’t there national reporting of mental health measures?’” She adds that “FQBHCs can provide these answers and the bill is getting support that we wouldn’t have thought possible even six months ago.”
The momentum behind the EIMH is attributable to luck. “You know, when preparation meets opportunity? When the spotlight shifted so suddenly to concerns about mental health, we [the National Council] had a bill. And our members were instrumental in pressing their Senators to sponsor and introduce it.”
Worry: Making the field “attractive to younger people.” Rosenberg worries aloud that,” with so much being said about all of the problems in healthcare, why would the best and brightest want to go into healthcare? I believe that this is why many younger people today are more interested in policy than in practice. Practice is hard, and we don’t pay that well, and we’re always criticizing the work.” All this comes at a time when our population is getting older and we need more help than ever.