1. Challenges & Opportunities: Whats Ahead for the Psychiatric-Mental Health Nurse? Virginia Trotter Betts, MSN, JD, RN, FAAN Commissioner/TDMHDD National Nurses Week May 6 - 12, 2010

2. THE BIG WOW! oThe Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) oThe Patient Protection and Affordable Care Act (PPACA)

3. U.S. Health Delivery System oThe dominant models of providing health care in the United States separate the mind and body. oSeparation has a negative impact on health care access, health care costs, and quality of care with a disproportionate share of the burden falling on women, the elderly, racial and ethnic minorities, and rural and immigrant populations. -Health Care for the Whole Person Statement of Vision and Principles, American Psychological Association

4. oAmericans understand that mental health is essential to overall health. oMental health care is consumer and family driven. oDisparities in mental health services are eliminated. oEarly mental health screening, assessment, and referral to services are common practice. oExcellent mental health care is delivered and research is accelerated. oTechnology is used to access health care and information, including within the mental health field, and privacy is protected. Goals for a Transformed System

5. o Agencies and providers operate in partnership rather than in silos o Policies and providers must act on the concept that good mental and physical health are an integral part of individual well being. Transformation of the Health Care System Will Require…

6. Implementation of Parity oLaw became effective in October 2009, to be implemented in good faith in all plans whose plan years began on or after January 1, 2010. oLaw applies to employers with 50 or more workers and whose health plans offer mental health or substance abuse benefits. oMust now offer those mental health/substance abuse benefits at the same level as their medical/surgical benefits. oThe deductible, co-pays, and maximum out-of-pocket amounts must be unified.

7. Implementation of Parity Concerns: oNothing in the law that requires plans to cover mental health or substance abuse benefits oPlans are free to exclude any particular mental health or substance abuse condition/diagnosis from coverage. oHowever, health care reformwhen fully implemented in 2014 mandates inclusion of basic behavioral health benefits in most insurance plans (which relieves much of these concerns).

8. Implementation of Parity Impact on psychiatric nurses: oPassage of parity will lead to increased utilization of reimbursable mental health and substance abuse services oPublic mental health/substance abuse service systems will experience less burden for underinsured persons oLikely increased demand for psychiatric mental health nurses in a variety of specialty sites: –Inpatient –CMHC/SA agencies –Private practices – for assessment, counseling, med management, symptom management

9. Health Care Reform Patient Protection and Affordable Care Act oFacilitates more affordable health insurance for over 32 million Americans. oEliminates pre-existing condition exclusion for children and youth immediately and for all by 2014 oExpands Medicaid up to 133% of FPL and includes childless adults. oAllows young adults to remain on parents health plan through age 26. oCreates a temporary high risk pool to provide health insurance to uninsured adults with pre-existing conditions oDelivery system redesign, pilots by grants/waivers

10. Health Care Reform Provisions related to behavioral health: oSubstance use disorder and mental health (SUD/MH) services required in base benefit packages of individual and small group markets. oAll plans in insurance exchanges must adhere to Parity Act. oAll newly eligible Medicaid enrollees will receive basic benefits including SUD/MH services at parity. oSUD/MH included in health promotion and chronic disease prevention initiatives. oSUD/MH workforce included in workforce development initiatives. oSUD and MH providers are eligible for community health team grants to support medical homes.

11. Health Care Reform Provisions that directly affect nurses: oIncreased funding for nursing workforce development programs –Advanced Education Nursing –Workforce Diversity Grants –National Nurse Service Corps oSupport for Nurse-Managed Clinics oIncreased funding for nurse home visit programs oNondiscrimination provision that includes nurse practitioners; provider neutral language

12. Health Care Reform Possible impacts of reform on nurses: oIncreased work load as millions of Americans become insured and have access to behavioral health benefits oIncreased opportunities for enhanced nursing education oIncreased opportunities for nursing leadership in health care

13. Whats ahead for the PMH Nurse? oIntegration of mental health and substance abuse treatment models oMental health promotion, substance abuse prevention, screening, and referral as basic services oIncreased care services for mental health and substance abuse in primary care and FQHCs oExpectation of use of evidence-based practices oPhilosophy = full recovery even from serious illnesses

14. Integration oIntegration of mental health and substance abuse services to treat co-occurring disorders oIntegration of mental health/substance abuse services with primary care

15. Best Practices A responsive mental health system must provide a continuum of services utilizing the best practices of health and science and should include the following: oPrevention/Early Intervention oActive and effective treatments and care oFollow up care/relapse prevention oSocial Supports oRecovery/rehabilitation

16. Role of Nurses 2009 Opinion Leader Survey by the Robert Wood Johnson Foundation and Gallup oNurses are trusted sources of information and care oNurses should have more influence in –Improving care and reducing errors –Helping healthcare system adapt and change oNurses need a unified voice to be heard oSociety and nurses should have higher expectations about what nurses can achieve and the health leadership they can provide

17. What Should Nurses Voice? oUniversal Access oCost effective services oServices delivered timely and with accuracy oFull utilization of qualified providers oBalance of services between health and illness oIntegration of physical and mental health

18. 2010: Not-To-Be-Missed Opportunities oParity oHealth Care Reform oIntegration as the key to health care delivery reform oBuild upon increased awareness that mental health is essential to health

19. Health is likely the most important element in life.

20. Mental health is fundamental to health.

21. Health Care Reform Resources oHealthreform.gov oNursingworld.com > Health Care Policy tab oKaiser Family Foundation http://healthreform.kff.org ohttp://www.thenationalcouncil.org

22. Enjoy Nurses Week 2010 Nurses: Caring Today for a Healthier Tomorrow