Mental Health Overview Chuck Ingoglia Senior Vice President Public Policy and Practice Improvement National Council for Behavioral Health Contact: ChuckI@thenationalcouncil.org

The National Council’s Vision *Expand access to care *Integrate behavioral and physical health *Raise Awareness of the need for help Expand Americans’ access to care by bringing timely, high-quality services to every community. Raise awareness of the need for mental health help and available community resources. Integrate mental and physical health to address the drivers of morbidity and mortality among people with serious mental illness; and Support these initiatives through increased federal funding. $$$ *Spend money to accomplish these goals!

patients couldn’t access lifesaving chemo or radiation. Imagine a world… Where Only 40% Of people who suffered from a heart attack were able to get the medical care they needed. Where 6 in10 Breast Cancer patients couldn’t access lifesaving chemo or radiation. Imagine a world in which only 40% of people who suffered a heart attack were able to get the medical care they needed. Imagine if six out of ten breast cancer patients couldn’t access lifesaving chemo or radiation. Does that seem ludicrous?

People in the United States Face Many Obstacles to Receiving Behavioral Health Services.

The sad reality is… 1 in 5 people only 40% Two-Thirds of inmates Will experience a mental health condition over the course of a year…but only 40% Will receive treatment Two-Thirds of inmates Meet the criteria for Substance Use Disorder Unfortunately, it’s the sad reality for millions of Americans living with a mental health condition. Data from the Substance Abuse and Mental Health Services Administration shows that 1 in 5 Americans will experience a mental health condition over the course of a year – but only 40% of them receive treatment. The lack of ready access to behavioral health services has a profound impact across American life. Two-thirds of inmates in our jails and prisons meet the criteria for a substance use disorder. Law enforcement agencies report growing numbers of encounters with individuals experiencing acute psychiatric symptoms – leading directly to a “boarding” crisis in community hospital emergency rooms in cities large and small.

The problem is getting worse… Non-heroin opiates/synthetics admission rates are growing across the US.

1999 2001 2003 2005 2007 2009

Facts: More than 33,000 suicides a year. 1 every 16 minutes. Mental illness is the most common reason for going on Social Security Disability. Seven year delay before young person developing serious mental illness gets specialty services Mental illness most common reason for going on social security disability More than 33,000 suicides; one suicide every 16 minutes 2nd leading cause of death among 15 to 34 year olds after unintentional accidents

But wait… How did we get here?

1854 The 12,225,000 Acre Bill Should mental health care be the responsibility of the federal government?

Mental Health Center Construction Act 1963 Mental Health Center Construction Act

1965 Medicaid Medicare +

1972 SSI Supplemental Security Income

1981 Omnibus Budget Reconciliation Act Grants to States 1981 Omnibus Budget Reconciliation Act

2014 Excellence in Mental Health Act Senators Roy Blunt and Debbie Stabenow Representatives Leonard Lance and Doris Matsui

But caring for adults & children with serious behavioral health needs is… Complex and Expensive & Payers and hospitals struggling to lower costs, improve quality among populations with comorbidities and high behavioral health needs

Caring for complex, costly patients Our niche: Caring for complex, costly patients Socially vulnerable patients (income, language, race/ethnicity, health disparities) Clinically vulnerable patients (complex, difficult healthcare needs) You Are Here Source: Health Affairs: VA Lewis, et al. “The Promise and Peril of Accountable Care for Vulnerable Populations: A Framework for Overcoming Obstacles.” 2012.

Two Roles of Behavioral Health Providers in new health care delivery system Behavioral health inside medical homes — deeply embedded in primary care team, prevention and early intervention, addressing behaviors as well as disorders Behavioral health specialty centers of excellence —partnering with medical homes to provide high-value, whole-health care to people with complex conditions

National Landscape Demand for outpatient services is increasing significantly in all regions. Psychiatric coverage is limited and the shortage of psychiatrists is projected to become increasingly challenging. Telepsychiatry is the cost effective solution to providing timely consistent access.