ACA opens doors for bold new ideas in mental health treatment

Last week, Los Angeles County health officials opened the doors to a mental health urgent care center that will stabilize and treat patients who may otherwise have ended up in the city’s crowded emergency rooms.

Anna Gorman explained the trend in a story for Kaiser Health News: “Mental health urgent care centers, also known as crisis stabilization units, are opening throughout California in response to the shortage of psychiatric beds and the increase in patients with mental illnesses showing up at hospital emergency rooms with nowhere else to go …”

This latest effort is just one way that mental illness is receiving more attention and focus under the Affordable Care Act, say mental health experts. While many of these experimental efforts are still in their nascent stages, health reform has shifted attention to the high number of Americans facing mental illness, and helped spur new models for care delivery.

“Conversations are taking place that never used to take place,” said Rusty Selix, executive director for the California Council of Community Mental Health Agencies. “Am I seeing all the new models emerge yet? No. But we’re having the conversations we never had before, and there’s a lot of hope as we move forward that we are going to change paradigms and give people timely mental health care." 

Among those conversations is the idea of bringing mental health to the primary care level by connecting those in need through their regular doctor’s visit. While these doctors may identify a patient’s mental health needs, few patients follow up with referrals, Selix said.

“There’s a lot of fear and stigma about it and that gets in the way,” he said. “A lot of this can be averted by having conversations happen then and there.”

Oregon is experimenting with putting psychologists in the primary care doctor’s office, in part to reduce that stigma and connect patients more immediately to mental health resources.

Selix is also excited about pilot efforts to address mental health needs in school-aged children, something some California charter schools are already tackling through a relationship with Seneca Family of Agencies. The idea is to have mental health treatment right on campus, so that children in need can easily access it without any real or psychological travel barriers. The hope is that such programs would pay for themselves by reducing special education costs, as well as diminishing county mental health needs.

Similarly, Selix would like to see this integrated approach adopted in the workplace, where early signs of mental illness often surface. And he’d like to see more early intervention models within the criminal justice system since so many offenders struggle with mental health.

Necessity is spurring other burgeoning ideas in the mental health arena.

To address the provider shortages that plague the field – something the new health law’s expanded coverage is only exacerbating — experts are taking a look at technology and its potential uses. For example, an avatar system could help people with schizophrenia control hallucinations.

Project leader Julian Leff, emeritus professor at University College London Mental Health Sciences, described the theory an article last year: “Even though patients interact with the avatar as though it was a real person, because they have created it, they know that it cannot harm them, as opposed to the voices, which often threaten to kill or harm them and their family. As a result the therapy helps patients gain the confidence and courage to confront the avatar, and their persecutor.”

In the United States, the use of avatars as well as the expansion of telemedicine are being discussed this week at the National Alliance on Mental Illness annual convention, said Policy Director Ron Honberg. 

While the ACA isn’t the direct trigger for all of the ideas percolating, the new health law is playing a role, he said. The increased number of Americans who now have mental health coverage is forcing policy makers and experts to take a more critical look at what can be offered. 

“There’s a growing awareness that we have a crisis in mental health in this country,” Honberg said. “That’s stimulating some innovation.”

He emphasized the early success of more comprehensive approaches to mental health, where physical and mental health care are integrated (pdf) in patient-centered medical homes. Honberg also pointed to programs designed to provide early identification and intervention for psychosis. (A pilot effort trying such an approach is summarized in our recent blog post highlighting some of the programs the ACA’s Innovation Center is funding).

To deal with the shortage of mental health workers – particularly psychiatrists, many of whom don’t accept Medicaid’s lower reimbursement rates – Honberg predicts an expanded role for other mental health workers, such as nurse practitioners, psychiatric social workers, and even peer counselors.

Along with the development of new mental health models, Honberg hopes the ACA’s expanded coverage will also result in more data collection and an evidence-centered approach to treating mental health.

Said Honberg, “The ACA is going to put a lot of pressure on providers to show results.” 

Photo by Ian Smith via Flickr.