Former U.S. Rep. Patrick Kennedy has led his life in the public eye, for better and worse. His battles with bipolar disorder and alcohol and substance abuse have been fought under a harsh spotlight. But those same battles, combined with his personal passion and political acumen, have made him a champion for improved equal access and treatment for mental illness and substance abuse.
With the passage of the Affordable Care Act, all provisions of the Mental Health Parity and Addiction Equity Act have been equally broadened. How can hospitals respond better to the challenges that expanded mental health and addiction treatment services now present?
KENNEDY: The demand is enormous. Untreated mental illness and addiction are off the charts, and the ACA has brought in many of the previously uninsured. As providers, we are at war, and we have to build an army double-time. We must come up with the best protocols to leverage our existing resources. The “secret sauce” of health care reform is treating mental health effectively. Doing so will reduce the costs of medical care across the board. You will increase successful outcomes for all major physical illnesses and chronic conditions if you screen for depression. Mental health is the most ignored part of health care and, because of that, it offers the greatest potential for reform.
Housing is particularly important for people with mental health issues, making sure they aren’t homeless or living in the emergency department. The Housing First model is one of the best lines of defense for addiction and mental health treatment, and one that providers will want to investigate under the accountable care model. If hospitalizations are reduced, that’s an ACO goal.
How far has mental health parity come since 2008?
KENNEDY: Not far enough. There is still silence and shame that comes with these diseases; the stigma still exists. There’s little to no enforcement of parity — coverage is still unequal. The real challenge is to bring more transparency to utilization management and how behavioral health benefits are deployed, compared with medical-surgical care. If hospitals were equally reimbursed for mental health and addiction care, we wouldn’t have the frequent-flyer population who stay in the ED. These would be recognized as treatable conditions, and hospitals would know they would be paid for. Those with mental health problems rarely get treated before they have a Stage IV illness, and that’s when hospitals are affected. These patients need to be stabilized sooner in their communities.
The Kennedy Forum on Community Mental Health calls for a “common set of principles” for the U.S. health care system and the mental health community, including provider accountability in strengthening behavioral health services within the primary care setting. How can hospitals help?
KENNEDY: What needs to happen is to take what hospitals are good at and bring it to the fragmented and unmanaged mental health care system. Hospitals are the hub for coordinating mental health care services, while doctors are the gatekeepers, and that’s where the future of treating mental health problems and addiction lies. Out of necessity, primary care doctors have provided two-thirds of behavioral health care and write 75 percent of prescriptions for antidepressants, anticonvulsants and antipsychotics. We need to give them more support. One way to do that is to bring noncredentialed behavioral health providers into the health care system, as well as patient peer support, case management support and patient housing support.
Hospitals have the keys to the kingdom to build new infrastructures, but they need partners to achieve parity goals. They have the power and the economic engine to promote a new model that is in the best interests of mental health patients. [Under value-based care], hospitals must measure how often patients are readmitted and, when readmissions drop, the biggest financial benefit goes to them … they have a huge incentive to reduce readmissions by working to onboard behavioral health patients the same way they would any other patient.
Can you explain how the work of One Mind and the Kennedy Forum dovetail and hospitals’ role in their efforts?
KENNEDY: The goals of both One Mind and the Kennedy Forum are to provide optimal care for people with all types of brain illness. One Mind is researching better therapies and cures, and the Kennedy Forum seeks to pay for and implement what One Mind does. There need to be better methodologies for diagnosing different types of brain injuries and illnesses, standardized protocols and common data. The key to all of it is replicability. As an example, One Mind is currently partnering with the National Institutes of Health on a project called Track TBI (traumatic brain injury). We’re looking for universal protocols that start with Level I trauma centers, so we need Level I trauma centers to share their data and allow us to study what they’re doing.
How can the hospitals advocate for improved mental health parity?
KENNEDY: Hospitals can use their political clout and connections with senators and representatives, chambers of commerce and others to advance the understanding of whole health — treatment of the whole person. In doing so, they will lay the foundation for payer recognition, which then trickles down to [benefit] patients.
Hospital leaders need to be literate [about parity] so they can share this new mental health and addiction treatment language with those who run in their same circles. Their access to the powers that be is the best thing that can happen.
What is your vision for the future of mental health care in America?
KENNEDY: We should treat mental health in a ubiquitous way, whether we’re conducting grand rounds or a screening in the ED. Mental health and substance abuse treatment should not be special or separate, but part of basic health care services. Neither patients nor providers would be resistant to [behavioral health] treatment if it were provided across the spectrum, if it were part of the natural continuum of care delivery — and if it were treated further upstream. The prevention model is going to be the future.
Patrick Kennedy will be a keynote speaker at the 24th Annual Health Forum and American Hospital Association Leadership Summit July 17–19 in San Diego. For more information, visit www.healthforum-edu.com/summit.
THE KENNEDY FILE
• Youngest son of Joan Bennett Kennedy and the late Sen. Edward Kennedy.
• Served as a member of the U.S. House of Representatives for Rhode Island from 1995 to 2011.
• Spearheaded passage of the Mental Health Parity and Addiction Equity Act of 2008, his signature congressional achievement, which requires health insurers and group health plans to provide the same level of benefits for mental health and substance abuse treatment that they do for medical-surgical care.
• Co-founded One Mind in 2011, a national nonprofit research organization that seeks new treatments and cures for neurological and psychiatric diseases of the brain, and focused on open-source data and research results that are available to all, and dedicated to collaboration and shared innovation.
• Founded the Kennedy Forum on Community Mental Health in 2013, whose goal is to integrate behavioral health into the primary care setting, and unite the mental health community around a common set of principles.