As mental health benefits expand, a provider hails the changes

As part of an occasional series, this blog will feature various mental health professionals describing the effect of the Affordable Care Act on their patients and practice.

The ACA has extended mental health coverage, providing one of the largest expansions of mental health and substance use disorder coverage in a generation.

The new health law requires that mental and behavioral health be included for patients on Medicaid as well as for new health policies sold on the federal health exchange. Still, vast disparities in coverage remain, depending upon one’s state. Nearly 4 million people with mental health needs won’t be covered because their home state isn’t participating in the Medicaid expansion. And the growing shortage of psychiatrists, especially those willing to see Medicaid patients, adds to the complexity.

Frontline providers throughout the country say they’re already seeing changes because of the new health law, some helpful and others challenging.

According to one counselor in Washington state, the ACA has dramatically changed care for many of her clients. Kathleen Pruitt is an adult counselor for a nonprofit mental health agency as well as a private practice counselor, where she sees adults and youth diagnosed with conditions such as anxiety, depression, and anger difficulties.

One of the biggest impacts of the ACA she’s seen so far is the effect of continuous mental health care. Pruitt is now able to continue counseling with her clients instead of interrupting their progress due to intermittent funding.

“Having to stop treatment in the middle was so disheartening,” she said.

She estimates she has witnessed a 20 percent increase in clients in both of her practices, including adults who have not had insurance for many years. Most of the newly covered clients she now sees in the clinic are there thanks to the Medicaid expansion, while her private practice is seeing a mixture of individuals covered through Medicaid as well as Obamacare plans.

Getting those individuals much-needed counseling and medications has also benefited their children, a group whose progress often has been stymied by their family situation.

Pruitt recalls counseling children in the past who were struggling because of a parent’s battle with mental illness. Some caregivers couldn’t get out of bed to take their children to school. Others were bipolar and wreaked emotional havoc on their households. Some couldn’t keep jobs because of their illness.

“We were treating their symptoms, but they were going right back into the home where the problem was occurring,” she said of her young clients. “It was very difficult. We couldn’t stabilize their home. “

More parents are now eligible for treatment. The impact of the Medicaid expansion on mental health treatment has been significant. For states expanding Medicaid under the ACA, as many as 2.7 million people previously uninsured people with mental illness could be covered, according a report from the National Alliance on Mental Illness.

Having so many more adults eligible for treatment is impacting their families, too, Pruitt said. “We can work with them to have their moods be more stable, and this, in turn helps relationships, jobs and parenting.”

Pruitt recalled one example of how treating a bipolar mother affected her young client. She was working with a teenage daughter, who was close to her mother but struggled with her mom’s tearful, angry mood shifts.

As hard as Pruitt worked, she made little progress in treating the daughter alone. Once the mother received treatment, though, her mood stabilized and her relationship with her daughter became less volatile. In turn, the daughter felt more at ease and ended up concluding her treatment.

Addressing kids’ and teens’ unstable relationships with parents can have a tremendous positive effect on their relationships with peers as well as their success in school, she said.

Pruitt says her clients are also now benefiting from having both mental and physical health coverage. People are taking better care of themselves physically – going to the doctor for ailments they’ve left unaddressed over the years – and feeling psychologically better as a result, she said.

Despite the positive strides, key challenges remain: There’s a shortage of specialists in psychiatric care, especially those willing to see Medicaid patients or those with insurance that pays providers less. Doctors and nurse practitioners in private practice can be selective about which insurance plans they accept, and many of the options for newly-insured aren’t included.

As a result, some newly insured individuals are visiting general practitioners, who don’t specialize in psychiatric therapy or medications.

Pruitt’s concern isn’t specific to Washington state. The country overall is facing a shortage of psychiatrists even as the ACA brings a “deluge of new patients,” a trend explored earlier this year by Amelia Thomson-DeVeaux in The American Prospect. Finding a psychiatrist is hard enough if you have private insurance, but harder still if you have Medicaid, Thomson-DeVeaux finds, with just 43 percent of psychiatrists accepting such plans.

Many psychiatrists predict their practices will change as the ACA enables more people to access mental health in an outpatient setting. Some psychiatrists have suggested the field will move in a more collaborative direction, with psychiatrists and mental health providers working more closely with primary care doctors to address the influx of patients.

Photo by Texas A&M University via Flickr.