Fully integrate mental health services in health care reform

by Government Relations Staff
February 2009

Congress should pass comprehensive health care reform legislation that ensures that mental health and psychologists' services are central to primary care and prevention initiatives and that mental health benefits are included in all plans offered in a national insurance pool.

Primary Care. Psychologists and their services should be fully integrated in initiatives that strengthen the role of primary care in the health system. In addition, in any primary care initiative adopted in reform:

  • Full collaboration should be emphasized among physician and non-physician providers, where providers autonomously deliver services within the full scope of their licensure and without unnecessary physician supervision.

  • Careful consideration should be paid to the role of psychologists and non-physician providers in the medical home model, which should be more appropriately named the "health home model."

  • Community health teams — which would include psychologists — should be encouraged, particularly in rural/underserved areas where the medical home model may not be viable.

  • Payment and other incentives to promote provider primary care collaboration and accountability should be available to all providers, not just physicians.

Psychologists are in primary and integrated care settings today. Psychologists provide vital mental and behavioral health services as part of primary and chronic care management today. They work in a variety of primary care settings with physicians and other health care professionals, often serving as members of multidisciplinary treatment teams and taking a lead when a patient has a primary mental health or substance abuse diagnosis. As team members, psychologists provide patient-centered mental and behavioral health services, such as prevention, diagnosis, assessment, treatment and management services.

As primary care providers, psychologists are vital in treating and preventing a range of health and mental health concerns in children, teens and adults. These treatment and prevention services address the range of chronic illnesses, including depression, diabetes, cardiovascular disease and cancer. Mental health services are key primary care services, especially in rural and underserved areas where primary care physicians carry the burden of patients who often have mental disorders. Primary care physicians increasingly rely on the vital and unique mental and behavioral health services that psychologists provide to patients in primary care, and no other provider is so highly trained to work with primary care physicians in addressing these patient needs.

Preventive services. Provisions that focus on prevention and wellness should include and ensure access to quality mental and behavioral health promotion, screening and referral, prevention, early intervention and wellness services for persons across lifespan. Psychological and behavioral factors in health promotion and disease prevention are essential to preventing disease, maintaining functional capacity, promoting adherence to treatment and supporting healthy lifestyles.

As experts in human behavior, psychologists work individually and in interdisciplinary teams to prevent disease and promote the health and wellness of individuals across lifespan. Psychologists identify practices that contribute to disease as well as those behaviors that enhance healthy behaviors and lifestyles. Psychologists are at the forefront in developing effective health promotion and chronic disease initiatives that address healthy behaviors and lifestyles, chronic illness and a range of physical and mental and substance abuse conditions.

Depression screening should be included in prevention services due to the prevalence of depression and its impact on health care in general:

  • Depression affects 5 percent to 9 percent of adult patients presenting in primary care in the United States. In a given year, 18.8 million American adults (9.5 percent of the adult population) will suffer from a depressive illness.

  • Depression is a major cause of disability, absenteeism and productivity loss among working-age adults. In addition to its direct medical and workplace costs, depression also increases healthcare costs and lost productivity indirectly by contributing to the severity of other costly conditions such as heart disease, diabetes and stroke.

There is clear precedent for including depression screening as part of prevention services:

  • The U.S. Treasury Department categorizes screening, counseling and immunizations for mental health and substance use disorders as preventive care under high deductible health plans in the tax code.

  • The U.S. Preventive Services Task Force (HHS) recommends screening all adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment and adequate follow-up.

  • The Medicare Prescription Drug, Improvement & Modernization Act of 2003 expanded the preventive benefits that are covered in a patient's initial preventive physical examination visit, to include screening for depression.

Benefits package. Any national insurance pool (a National Health Insurance Exchange) for the uninsured and underinsured must provide for comprehensive mental health and substance use services at parity with physical health services. Psychological studies show that the mind and body are strongly linked. For example, two-thirds of all office visits to family physicians are due to stress-related symptoms. We agree with the President that all health plans in the Exchange must include mental health benefits. Congress should also build on its 2008 parity laws that require equal benefits coverage for mental health and substance use services in the private healthcare system and in Medicare by requiring parity coverage in the Exchange.