Achieving Mental Health Parity: 2013 MMS Public Health Leadership Forum

Experts estimate that nearly half of Americans will experience and mental health or substance abuse issue in their lifetimes, yet mental health services remain far less accessible than medical and surgical care.

The pressing crisis in mental health care brought together more than 125 physicians, public officials, and patient advocates this week for the  Massachusetts Medical Society’s 2013 Annual Public Health Leadership Forum, “Mental Health: Achieving Parity in Principle and in Practice.”

“Since the passage of our health care insurance reform law in 2006, Massachusetts has been a national leader in health care access. But despite these gains, access to mental health care services has continued to lag. That should concern all of us,” said MMS President Richard Aghababian, MD, in his welcoming remarks.

The forum, now in its ninth year, featured faculty presentations from physicians, policymakers, economists and educators. It was moderated by Harold Cox, associate dean, Boston University School of Public Health.

Jeffrey Wisch, MD, acting chief of Hematology/Oncology at Newton- Wellesley Hospital, spoke about patient advocacy in the face of a mental health care system that is “unequivocably broken.”

“Triage systems don’t work. The confusion and isolation for family members is remarkable. There is no discharge planning of coordinated care,” said Dr. Wisch, describing his frustrated efforts to help a severely depressed 19-year-old family member. “We don’t see these problems with medical patients.”

Kathryn Power, Regional Administrator for the federal Substance Abuse and Mental Health Services Administration, offered historical  and political context on a mental health care systems that had evolved quote separately from  the modern medical infrastructure.

The Massachusetts health care reform law, passed in August, requires insurers to comply with federal laws to demonstrate federal mental health parity laws. Mental health is considered an “essential” condition that must be insured under new federal rules, set to go into effect in 2014. These changes, Power said, will have a dramatic impact on patients.

Suicide now kills more people annually than traffic accidents and HIV combined, Power said. “No other medical condition is so prevalent, yet lacking in resources,” she said.

The coverage expansion, expected next year, will affect more than 60 million Americans, said Harvard University Medical School Economist Richard G. Frank, another forum presenter. It has the potential to be the most significant public health development since the establishment of Medicare in 1965, he said.

Until then, the disproportionate burden of caring for mentally ill patients will continue to fall on hospital emergency departments, said Mark Pearlmutter, M.D., chair and vice president of Emergency Network Services at Steward Health Care.

Studies show that on average in Massachusetts, more than 100 patients are “boarding,” or waiting in a hospital emergency room at any given time, often for many hours or even days, for a mental health placement.

This is costly, inefficient, and poor care, Pearlmutter said.  “We call this boarders without doctors,” he said.

The forum also featured Peter Metz, MD, professor of psychiatry and pediatrics at University of Massachusetts Medical School, who spoke about advances in children’s mental health systems, and National Alliance on Mental Illness Medical Director Ken Duckworth, MD, who spoke about the mental health needs of teens.

At the start of the forum, MMS presented its Henry Ingersoll Bowditch Award for Excellence in Public Health to Linda Sagor, MD.  Dr. Sagor, director of the Division of General Pediatrics at UMass Memorial Health Care, was honored for her pioneering work in addressing the unmet medical needs of Massachusetts children in foster care.

Erica Noonan

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