Policymakers and Providers Discuss Medicaid Expansion, Mental Health, Behavioral Health

Mark Ishaug, CEO of Thresholds, addressed mental and behavioral health advocates, policy-makers, providers, and other influencers this morning at the Union League Club of Chicago. Thresholds, along with Janssen of Johnson and Johnson, Together4Health, and NAMI Illinois, presented a policy forum to address the investments that Illinois must make in the mental and behavioral health safety net as Medicaid Expansion and the Affordable Care Act change the healthcare landscape.

Representatives from mental health organizations, housing providers, hospitals, law enforcement, state health agencies and members of the Illinois General Assembly formed two responding panels for the discussion, which is designed to be the first of many on the road to a more unified policy roadmap for the state:

Moderated by Karen Batia, Executive Director, Heartland Health Outreach and Vice President, Heartland Alliance for Human Needs and Human Rights

Josh Evans, Legislative Director, IARF
Maureen McDonnell, Director of Business and Health Care Strategy Development, TASC
AJ French, Executive Director, Sacred Creations
Michelle Thomas, Clinical Director, Northern Region, IlliniCare
John Fallon, Program Director, Reentry, Corporation for Supportive Housing
AJ Wilhelmi, Chief Government Relations Officer, Illinois Hospital Association                                                          

Michael Gelder, Senior Health Policy Advisor to Governor Quinn
Mike Koetting, Deputy Director for Planning and Reform
Implementation, Illinois Department of Healthcare and Family Services
Theodora Binion, Acting Director, Division of Mental Health, and Director, Division of Alcohol and Substance Abuse
Meg Egan, Director of Public Policy and External Affairs, Office of Cook County Sheriff
State Senator Heather Steans, 7th District
State Representative Esther Golar, 6th District
State Representative Robyn Gabel, 18th District


Remarks from Mark Ishaug, Thresholds CEO, at the Opportunities in Mental and Behavioral Health Policy Forum
September 12th, 2013, Union League Club of Chicago: 

Mark Ishaug. Photo by Andrew Collings.Good morning everyone. Nice to see so many friends old and new. Welcome and thanks for joining us this morning for what I know will be great presentations and spirited discussion.

Very special thanks to our Co-Sponsors: Together 4 Health, NAMI Illinois, and Johnson & Johnson.

I’d also like to give a special shout out to our dear friends at the Michael Reese Health Trust for their generous support of Thresholds, in particular our advocacy and public policy efforts through the Behavioral Health Advocates, which many of you participate in.

This is a time of tremendous opportunity. The implementation of Medicaid Expansion and Care Coordination, and health care reform generally, provides the state with an historic opportunity to make the investments in the behavioral health safety-net that enable people to get the care they need at the time they need it.

We can prevent ineffective, high-cost services and settings.

We can better enable health, wellness, and recovery.

And we can save the state a significant amount of money in the process. It’s a win-win.

Medicaid Expansion will enable about 350,000 previously uninsured individuals, who are not able to afford private health care coverage, get access to public insurance. The federal government estimates that nearly a third of this population has significant untreated behavioral health conditions. We must re-build the safety net that works for this population and the state.

This forum is a call to action to state and local policymakers across Illinois. We need you, and them, to approach the behavioral health safety net from a policy perspective, rather than just a Medicaid programmatic approach.

Smart public policy is not just an investment in one or two programs. Smart public policy reflects a government-wide objective that aligns multiple programs to provide high-quality services and supports in a coordinated fashion.

We all know that mental illnesses and substance use disorders, like other medical conditions, are treatable. Individuals living with these illnesses can and do live full, healthy, productive and independent lives when they have access to the right care and support services.

The problem in Illinois to date has been that without: (1) health care coverage, (2) an adequate community-based prevention and treatment infrastructure and (3) housing, quality care – in truth, any care – has been out of reach for thousands of people with mental illnesses and substance use disorders.

This leads to a vicious cycle of homelessness, incarceration, hospitalization and long-term institutionalization in nursing homes. The human cost of this vicious cycle is horrific, and our already cash-strapped state pays a heavy cost financially.

Despite the valiant efforts of many people in this room, and thousands more who are not here, community behavioral health services have been decimated, which has resulted in a number of consent decrees to re-balance our system of care. 

According to a NAMI study, in the span of just three years between 2009 and 2011, the state cut mental health services by more than $113 million. The overwhelming majority of these cuts eliminated services for individuals who were uninsured.

These cuts are directly related to an increase in emergency room visits and hospitalizations: over this period of time, emergency room visits to hospitals across the state for people in psychiatric or behavioral health crisis increased by nearly 20% – by over 35,000 ER visits – due to the lack of access to community-based treatment services. Approximately 25% of these ER visits resulted in in-patient hospital stays of an average length of 6.7 days.

The vast majority of these individuals were still unable to get the treatment they need to get well. Hospitals do not provide ongoing treatment; they only treat the emergency or crisis – that is what they are designed for. Mental health and substance use disorder treatment happens in outpatient, community-based settings, just like most physical medical care.

And far too many individuals with a serious mental illness are inappropriately institutionalized for decades, and even life, because of the lack of community-based care, including supportive housing. According to data provided by DMH, fully 80% of persons hospitalized for a psychiatric crisis who are screened for longer term care are referred to a nursing home because there are insufficient community-based services available. This is unacceptable. The vast majority of these individuals are able to live independently in the community if they only had the chance.

We can change this story. We must change this story.

Illinois policymakers must consider how to smartly rebuild the mental health and substance use disorder safety-net to ensure access to care at the earliest possible sign of illness. We need to prevent individuals from going undiagnosed and without treatment for years.

Access to healthcare coverage alone will not be sufficient for the segment of the population with serious mental illnesses or substance use disorders who are also chronically homeless. Consideration must be given to what set of services is required to stabilize the segment of this population. Stable housing will be critical, as it is nearly impossible for someone living with a mental illness or substance use disorder to focus on recovery and health when they are living on the streets in poverty.

If the state does not make the right kinds of investments in the mental health and substance use disorder safety-net, the state will continue to pay for ineffective, high-cost services far into the future. Given that the state will take on the cost of covering ten percent of the new Medicaid population, which will be phased in between 2017 and 2020, policymakers would be wise to make these investments on the front-end of Medicaid Expansion.

We hope this forum furthers important dialogue, but we really want and need is action! We have invited action oriented people for sure to lead this discussion, including leaders in mental health and substance use disorders, housing, justice and recovery advocate, leaders from hospitals and managed care organizations, and key appointed and elected officials who can turn ideas into policy, programs, and funding.

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