Written by: Matthew Hile 2/11/2008 6:10 PM
In my continued report from NRI's State Mental Health Agency Services Research, Program Evaluation and Policy in DC I am listening to the plenary presentation, Mental Health Policy 2008: Winners Curse?, by Richard G. Frank, PhD, Professor of Health Economics in the Department of Health Care Policy at Harvard University. The presentation was mostly taken from his book with Sherry A. Glied entitled Better But Not Well: Mental Health Policy in the United States Since 1950. Starting with "scripture" from JF Kennedy from a 1996 presentation on mental illness and early diagnosis in the community, minimizing reliance on institutions, "restore and revitalize" their lives. The issues of the 60s are than same as today Mental Health care and the well being of individual has improved notably There is a long way to go The forces that helped this happen are now presenting create new challenges and threats Institutions aimed at creating a new stewardship of mental health represent a new frontier What research needs to be done to underpin these new relationships Things have gotten better Access to care - across various levels of mental health problems there has been a 62-66% increase in the rates of treatment. Quality of care - Individual getting appropriate medication related treatments have increased from to 20% to 50% range. Independent living - substantially more people with severe and persistent mental disorders are living in the community (about 75-92%). However there has been a large increase in the number of these people in correctional facilities and homeless. There has been a shift in financing Change in costs - Have peen spending about 1% on public health care while we have moved private care 12% to 20%. So we have fallen behind because the costs have increased but the coverage has not. Changes in policy have not been driven by mental health policy but by social programs that are not designed for mental health (Medicaid, TANF, SSI, SSDI, child welfare) but they have been driving the changes. If you want to do a good job supporting mental health you need to understand all of these other programs. This means that there is often a lack of good mental health expertise, voice, and accountability in these various non mental health related programs. How do we create new policy-leadership Consolidate under a single agency that deals across agencies. New Mexico is ding this. Very difficult! Create a matrix organization consulting versus action function (Mass) Bring MH into program agencies. Tends to quickly marginalize the MH folks. Research What are the incentives and how might we change them to support the alignment. What organizational, financial and programmatic features are likely to work in different state political models. Which will be different for each state. Need qualitative research to understand "what the rules of the game really mean." Investment need to me made in data systems so that we can understand what is happening. This suggests that the information MUST be shared across a variety of agencies. It seems to me that the underlying message is that the changes in financial and policy have left the mental health field behind. We need to address this problem by developing systems and expertise that allow us to work within these new policies and to make mental health a "player" to share our experience to improve these policies.
In my continued report from NRI's State Mental Health Agency Services Research, Program Evaluation and Policy in DC I am listening to the plenary presentation, Mental Health Policy 2008: Winners Curse?, by Richard G. Frank, PhD, Professor of Health Economics in the Department of Health Care Policy at Harvard University. The presentation was mostly taken from his book with Sherry A. Glied entitled Better But Not Well: Mental Health Policy in the United States Since 1950.
Starting with "scripture" from JF Kennedy from a 1996 presentation on mental illness and early diagnosis in the community, minimizing reliance on institutions, "restore and revitalize" their lives. The issues of the 60s are than same as today
Things have gotten better Access to care - across various levels of mental health problems there has been a 62-66% increase in the rates of treatment. Quality of care - Individual getting appropriate medication related treatments have increased from to 20% to 50% range. Independent living - substantially more people with severe and persistent mental disorders are living in the community (about 75-92%). However there has been a large increase in the number of these people in correctional facilities and homeless.
Things have gotten better
There has been a shift in financing Change in costs - Have peen spending about 1% on public health care while we have moved private care 12% to 20%. So we have fallen behind because the costs have increased but the coverage has not. Changes in policy have not been driven by mental health policy but by social programs that are not designed for mental health (Medicaid, TANF, SSI, SSDI, child welfare) but they have been driving the changes. If you want to do a good job supporting mental health you need to understand all of these other programs. This means that there is often a lack of good mental health expertise, voice, and accountability in these various non mental health related programs. How do we create new policy-leadership Consolidate under a single agency that deals across agencies. New Mexico is ding this. Very difficult! Create a matrix organization consulting versus action function (Mass) Bring MH into program agencies. Tends to quickly marginalize the MH folks. Research What are the incentives and how might we change them to support the alignment. What organizational, financial and programmatic features are likely to work in different state political models. Which will be different for each state. Need qualitative research to understand "what the rules of the game really mean." Investment need to me made in data systems so that we can understand what is happening. This suggests that the information MUST be shared across a variety of agencies.
There has been a shift in financing
How do we create new policy-leadership
Research
It seems to me that the underlying message is that the changes in financial and policy have left the mental health field behind. We need to address this problem by developing systems and expertise that allow us to work within these new policies and to make mental health a "player" to share our experience to improve these policies.
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