As each of us prepares to go out with family and friends to celebrate the arrival of 2015 on New Year’s Eve, I hope that we also will reflect upon our unfinished national agendas from 2014 and then set a very bold course for the New Year. If we do so, I think that we will realize very quickly that the eventualities of 2015 will depend in large measure upon our willingness as a field to take action rather than wait for others to do so.
What are some of our unfinished 2014 agendas?
The mental health reform bills introduced by Representatives Barber and Murphy have languished in the Congress throughout the year. Neither received broad-based consensus support, and both suffered from major deficits. With the arrival of a new Congress, we have the opportunity to start over with a clean slate. We must propose a Bill that moves our reform agenda, and then we must build a consensus around this proposal. We definitely should not wait for others to seize or pervert our agenda.
The Supreme Court announced late in the year that it will hear a case to decide whether the Affordable Care Act (ACA) permits federal tax subsidies when the state health insurance exchange actually is operated by the federal government through HHS. What will hang in the balance in this case is health insurance coverage for millions of poor and near-poor citizens whose only opportunity to acquire insurance is through the exchange when a subsidy is available to them. Earlier work suggests that at least one in four of these persons have a prior behavioral health condition. We must develop an opinion about this case, and then we must speak up and act. Clearly, we must support the affirmative position: the ACA does permit such federal tax subsidies.
The ACA promotes service integration of behavioral and primary care services through the creation of accountable care organizations—ACOs--that operate medical and health homes. This transformation represents a foundational change from prior behavioral health practice. To undertake his change, we must not falter through fear of failing. Fear will not be our friend on this journey. Rather, we must decide to move ahead with the assurance that behavioral health will not disappear in this transformation. Within a decade, behavioral healthcare is expected to grow to twice the size it has today.
What new agendas are emerging for us with the advent of 2015?
Gnawing recognition has finally reached the point of action that we must address the tragedy of the incarceration of persons with mental, substance use, and ID/DD conditions--a national problem of major proportions. We do know how to do this through two decades of trial and error work. Success will take bold local partnerships and concerted effort. As the National Association of Counties and the Council of State Governments organize to address this problem in 2015, we must reach out and become their lead partner in this effort.
Outside of behavioral healthcare, the “culture of health” is beginning to blossom everywhere--in business settings, in health settings, and even in self-organizing neighborhood groups. We must bring these community and personal health promotion practices into behavioral healthcare. They will help us accelerate our efforts to develop person-centered and whole-health care. These practices are very close cousins to the work that we already do every day. Let’s make the introduction of health promotion a specific agenda for our field in 2015.