Health care providers discuss mental illness, addiction

Legislators attend event addressing mental health needs

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WEST ORANGE, NJ — Mental health providers, advocacy organizations and elected officials gathered to express continued support and increased awareness of topics related to mental illness and substance abuse services as the Essex County Mental Health Coalition held its 16th annual Legislative Breakfast at the Mayfair Farms in West Orange on Oct. 7.

The event was sponsored by the Mental Health Association of Essex County and co-sponsored by more than 20 local agencies that provide both mental health and substance abuse services in the community.

Elected officials who offered a welcome to event attendees included Assemblyman John F. McKeon of District 27, Assemblywoman Shavonda Sumter of District 35, and Congressman Donald M. Payne Jr. of the 10th Congressional District.

“What I do for the Legislature is bring to Trenton the issues that those who cannot are facing,” Sumter said during her opening remarks. “We are competing with numerous shortfalls and numerous issues, and we need to be a little but more squeaky and do a little bit more complaining.”

McKeon, who co- sponsored the Special Needs Housing Trust Fund Act, which creates provisions for supportive community housing for special needs populations, including the mentally ill, praised those in attendance for the work they were doing.

“Heroes don’t only wear capes, and if they did, each and every one of you would be wearing one,” he told those gathered.

During his opening remarks, Payne reflected on the work of his father, the late Congressman Donald Payne Sr., and taking note of his commitment to community.

“In watching my father’s work, I understand what it means to make sure that people get the services and help that they need,” he said. “I’ve been frustrated by the increase in opioid addiction over the past 10 to 12 months. It’s been an issue for the past 20 to 30 years, as you all know, but now that it has become a national problem, it’s an issue.”

Before introducing the other two speakers for the day, Mental Health Association Executive Director Robert Davison had a few thoughts of his own to share with the crowd about the changing landscape for treatment services.

“Untreated mental illnesses and addiction cost society more than $300 billion a year in lost productivity,” Davison said. “Nothing contributes more to lost talent.”

Davison also addressed the Gov. Chris Christie’s announcement during his 2016 State of the State and Budget addresses that $127 million would be invested in enhanced behavioral health services rates for providers. Under this plan, the state will shift to a fee-for-service model with the goal of standardizing reimbursement for mental health and addiction services across the state. Fee-for-service is a payment model in which services are unbundled and paid for separately. Davison explained what the state funding shift to a fee-for-service model will look like for providers and patients alike, and the outcomes that can result from it.

“I’m going to give you the good, the bad and the ugly about the new funding. The good: The governor and Congress are increasing spending to $127 million for mental health and substance abuse services. The fee-for-service model holds agencies accountable; it means that we are going to have to sing for our supper. We have to provide the services if we want to get paid,” Davison said. “The bad is that at Mental Health Association of Essex County, as of July 2017, approximately $3 million of our state contract funding will be pulled back. The ugly is that, while some of the rates are fair, many are not and the main one is the reimbursement rates for medication management.

“Agencies that have big outpatient programs will have a difficult time under the transition to fee-for-service,” Davison continued. “Without access to a doctor, the system is going to crumble, because we need doctors to be able to see patients and for them to be paid appropriately for seeing them. Medication management is the backbone of that system. We only get paid for the patients that we see and those who are most impaired will drift away from the system. There are two solutions to this: The state needs to seriously look at the medication-management rate, because if they don’t, they will get the services they paid for. The other thing that needs to be looked at is a way to continue to provide a safety net in the state budget for treatment providers.”

Linda Rosenberg, president and CEO of the National Council for Behavioral Health, spoke about some of the implications that federal law has had on the treatment of mental illness and substance abuse.

“Good policy can at times have unintended consequences, but that doesn’t mean that it needs to be thrown out, it means that we need to be more aware of possible outcomes,” she said. “The Affordable Care Act is supposed to do two things: give more coverage to those who had little or none, and also improve the cost of care and quality of care for those who received fragmented care in the past. However, we know that people with mental health and substance-abuse issues are often the ones that cost the system the most money.”

Rosenberg said that the way to ensure that patients are receiving efficient and comprehensive care for both medical and behavioral illnesses it to champion greater collaboration between the two arenas.

“With collaborative care, we can pay a primary care physician treating a behavioral health diagnosis to do more than just write a prescription,” she said. “Mental health and substance-abuse providers have been siloed, and federally qualified health centers and hospitals are receiving more money. Some strategic initiatives to achieve greater collaboration are for mental health providers to join hospitals, expand their growth through mergers, and also market care management to health care providers and hospitals.”

The final speaker at the event was Dr. Denise Rodgers, vice-chancellor for interprofessional programs at Rutgers Biomedical and Health Services. Rodgers served as the fifth and final president of the University of Medicine and Dentistry, as well as the executive vice president of the university prior to that. She is a board-certified family care physician.

The crux of Rodgers’ remarks referred to the importance of integration between behavioral health and primary care, a philosophy that she staunchly advocates for in her own practice. Rodgers then shared a number of recent statistics regarding suicide among various demographics of the U.S. population.

“We have enormous impediments to doing one-stop shop for primary care and behavioral health care,” she said. “All primary providers need to be aware of these suicide statistics and do a better job of screening for depression. Depression is second only to neck and back pain as the biggest reason for disability in the United States.”

Rodgers went on to discuss the fact that most antidepressants are prescribed by primary care physicians, and that many cases of opioid-addiction stem from the prescribing of pain medication by primary physicians.

She said, “70 to 80 percent of antidepressants in this country are prescribed by PCPs. People who do what I do need to do a better job with this. It is also those in my profession who have contributed to the opioid epidemic, and now we have a significant issue with addiction,” she continued. “We in the medical profession need to do a better job at finding alternatives to treating chronic pain, but we all also need to make noise about marrying physical health and mental health.

“Continue dreaming the dream of having a better life for everyone, regardless of illness, regardless of color, regardless of class.”