Will mental-health provisions of ACA swamp the system?


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Big changes to mental health-care in NEPA (Northeastern Pennsylvania) are ahead as the Affordable Care Act (ACA) takes hold.
The ACA builds on existing legislation — the Mental Health Parity and Addictions Equity Act — which expanded mental health and substance abuse disorder benefits. ACA requires new health plans to cover preventive services for mental illness, such as depression screenings for adults and behavioral assessments for children, at no additional cost. Additionally, beginning in 2014, insurance companies will no longer be able to deny health-care coverage to anyone because of a pre-existing mental health condition, and individual insurance policies will require mental health treatment to be covered.
Concurrently, a regional expansion of mental health services is taking place.  
Commonwealth Health is opening a crisis response and recovery center, which is being billed as a community-based mental health program on the campus of Wilkes-Barre General Hospital.
Commonwealth is promoting the facility as the first center in the region that will provide rapid stabilization for individuals who are experiencing mental health or substance abuse crises, depression and anxiety, mood disturbance, medication non-compliance, cognitive impairment, intellectual disability, and the consequences of drugs and alcohol abuse. An eight-bed unit and crisis triage area highlights the facility.

Policy consolidations

Marie C. Gray, Ph.D., serves as CEO of Cornerstone Counseling & Consulting Specialists. She confirms the ACA will not allow separation between mental and physical health needs, even though previous laws used to allow separate and individual policies.
She does not believe the mental-health provisions of ACA will overload America’s mental-health system. Dr. Gray has found that many people who genuinely need mental-health care will never use pursue treatment, primarily because of the stigma that still attaches to admission that a patient needs mental-health care.
“In my experience, 40 percent to 50 percent of hospital visits have some form of mental-health connection,” says Dr. Gray. Additionally, the overall future of mental-health care is cloudy. Dr. Gray says that large numbers of providers need proper credentialing and psychiatrists, as a profession, are a dying breed because of malpractice costs. This scenario is especially true in Pennsylvania.
“Today, family physicians often prescribe medications for mental-health problems, but  may do so without the necessary expertise,” says Dr. Gray.
As she looks ahead, Dr. Gray forecasts that needs for mental-health problems are sure to grow. Substance abuse probably will continue to soar, along with the associated physical health ramifications, and incidences of anxiety and mood disorders will increase.
In addition, patients with PTSD and complex iterations of the disorder, particularly among  military veterans, plus their families who must cope with the disease, will be looking for help. Substance abuse commonly accompanies PTSD, and must also be treated.
“Paranoia and schizophrenia also are very real problems, and we need more awareness of these illnesses,” says Dr. Gray.

Additional burdens

Medicaid expansion through the ACA is also likely to create burdens for mental-health providers, warns Allen Minor, D.B.A., assistant professor and director of the health care management program at Misericordia University. As individual insurance policies add a mental-health component, patient loads for providers are sure to increase, particularly in regard to patients with Alzheimer’s disease and drug and alcohol counseling, which are badly needed in NEPA.
“A huge concern involves is whether these patients are taking their medications, especially if they are bipolar,” says Minor. He also warns that pay for psychiatrists has lagged, especially from Medicaid, creating incentives for medical students to avoid this path. This trend may actually be true for all mental health providers, adding to a shortage of qualified caregivers.
Increased numbers of patients with insurance may translate into skyrocketing co-payments  and deductibles, according to Brooke Egbert, Ph.D., an independent psychologist based in Wilkes-Barre. This will be especially common with  addiction recovery, as well as the dual diagnoses of depression and addiction.
Dr. Egbert adds that depression and anxiety are the most common adult ailments she  treats, and that media advertisements of prescription drugs as quick fix fuels improper treatment.
“NEPA also lacks mental-health providers, — existing therapists often have to turn new patients away,” says Dr. Egbert. “Imagine this scene as ACA takes hold.”
Celeste Curley, senior director of product management with Blue Cross of NEPA (BC NEPA), points out that the changes to mental-health care demanded by ACA have roots in previous legislation. She says BC NEPA already offers applicable coverage  to all groups and ACA won’t cause any notable policy changes.
“The real change will now be the offering of essential mental health insurance benefits, by law, across the board,” says Curley. “This will probably cause costs to rise, but not as  much as we will deal with from other ailments.”
Colleen Morris, senior product specialist with Blue Cross, supports identifying and treating mental health issues as early as possible. “Benefit costs are sure to rise when care is initially postponed,” explains Morris.

Poverty exacerbates situation

Joe Rogan, Ph.D., professor of education at Misericordia University, warns that concerns about increased mental health treatment costs because of the ACA are minimal compared to the onrushing costs for the treatment of obesity. He calls obesity the real line item to be feared because it surely will suck up massive amounts of future health care dollars.
At the same time, Dr. Rogan confirms that mental illness in children definitely has  increased. In his opinion, these cases are often not naturally produced, but are the result of pathological families and dysfunctional communities. “Poverty also amplifies any type of mental health problems and, as school class size has increased, it’s hurting the borderline kids with problems,” says Dr. Rogan.
David Isgan, PA-C., adjunct teaching faculty at Marywood University, boasts a career resume that includes a career in a private medical practice that specialized in gastroenterology. He says that digestive ailments and mental health issues are often connected. Effective treatment for these patients means dealing with inter-related medical problems. Provider shortages may make that difficult. “Effective mental-health treatment requires a multi-faceted approach, often with both medication and therapy,” says Isgan. “In the years ahead, who’s going to do this?”

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