REAL SOLUTIONS FOR OUR MENTAL HEALTH CRISIS by Steve Bullock (Presidential Candidate)

Presidential candidate Steve Bullock is the two-term, Democratic Governor and former Attorney General of Montana. The following is his plan for mental health/illness care. It’s published on his website. https://stevebullock.com/mental-health/

Governor Steve Bullock’s plan touches on the prioritized issues addressed in the *2020 GRASSROOTS FIVE-PART PLAN FOR SERIOUS MENTAL ILLNESS (SMI) developed by dozens of SMI individuals, families, professionals, and journalists from across the country. Sooner Than Tomorrow welcomes mental health/illness plans from all 2020 presidential candidates.


REAL SOLUTIONS FOR OUR MENTAL HEALTH CRISIS

Addressing our Mental Health Crisis

Every year, over 40 million adults in America will experience a mental illness,1 yet over half of those who have an illness don’t receive treatment.2 That’s unacceptable and we must do better. Steve will prioritize expanding access to and ensuring affordability of mental health care.

As a Governor, Steve knows how just how challenging it can be to change the culture around mental health, particularly in our rural and tribal communities. That’s why Steve made record investments in Montana’s mental health system, expanding crisis intervention and treatment and doubling the number of Medicaid substance use treatment providers.

Providing Coverage for Mental Health
─ Ensure ​funding for treatments ​so mental health options are available to every American living with a mental illness.

*2020 GRASSROOTS FIVE-PART PLAN: PROVIDE A FULL CONTINUUM OF CARE

  • ─  Individual circumstances often warrant different treatments. Steve will ​provide a range of housing options for those who need support to remain as healthy as possible. ​These housing options include:

    • ─  Independent living with case management.

    • ─  Small congregate group living homes where individuals can socialize

      and learn skills for independent living.

    • ─  Clubhouse models.

    • ─  Ensure services at multiple levels of care at psychiatric assisted living

      campuses on mental health institutes, from secure and acute facilities to

      independent living apartments.

    • ─  Supported housing with onsite case management.

    • ─  Scatter site housing with periodic case management.

  • ─  The government should also not withhold funds for potentially life-saving medical options. That is why Steve will also work to increase the ​number of beds available for hospitals for patients with mental illnesses.

─ Alarmingly, the number of beds available for mental health patients has declined significantly. This not only diverts resources but has forced patients to wait in emergency rooms, or even jails, which are not equipped to handle these individuals.3

1 ​https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
2 ​https://health.usnews.com/conditions/mental-health/articles/what-mental-health-statistics-can-tell-us

3https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/08/02/amid-shortage-of-psychiatric-beds-mentally-ill-face-long-waits-for-treatment.

  • ─  In 2016, 10x more people with serious mental illnesses were in jails or prisons instead of state mental hospitals. That needs to change.4

  • ─  Steve will work with Congress to allocate the funds necessary to fully equip hospitals with the beds they need.

*2020 GRASSROOTS FIVE-PART PLAN: REPEAL MEDICAID’S INSTITUTES FOR MENTAL DISEASE EXCLUSION (IMD)

─ Steve will enable ​Medicaid funds to be used for in-patient mental health treatments​, repealing the Medicaid Institutions for Mental Diseases (IMD) exclusion to help ensure mental health parity.

  • ─  HHS has moved towards a waiver system that allows some states to get a limited exception to this rule. This is not enough as it still requires significant work to get a waiver and can be reversed.5

  • ─  Removing this waiver would allow more individuals to access mental health treatment.6

  • ─  Steve will direct HHS to update regulations to make it easier to have a waiver on IMD in the short-term, and work with Congress to repeal the IMD exclusion permanently.

  • ─  Part of adequately addressing mental health needs is ensuring that people have access to comprehensive and affordable insurance. ​That is why Steve has released a full plan to increase healthcare coverage. Highlights of the plan include:

    • ─  Provide a ​public option to improve access and ensure competition in the marketplace and for those Americans who live in states without Medicaid expansion.

    • ─  Ensure more families can access care by ​automatically enrolling those who are Medicaid eligible or eligible for a 100% cost subsidy on the ACA exchange.

  • ─  Establish ​Mental Health Parity for Medicaid​.
    ─ Steve will work with Congress to ensure mental health parity in Medicaid by

    expanding the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.

    Ensuring Adequate Funding

  • ─  Increase ​funding to mental health providers, medical schools and universities, and ​other medical education institutions (e.g., those issuing psychiatric certifications) ​that are graduating psychiatrists, family practitioners, and other medical professionals who can help address mental health issues in our country.

    ─ Improve directed financing for allied mental health professionals and encourage pipeline programs at community colleges as well as in structured programs for layperson training.

    4 ​https://www.treatmentadvocacycenter.org/key-issues/bed-shortages
    5 ​https://www.ajmc.com/newsroom/hhs-lifting-imd-exclusion-for-medicaid-payment-for-inpatient-mental-health-treatment 6 ​https://www.healthaffairs.org/do/10.1377/hblog20190401.155500/full/

  • ─  Steve will also work to increase the number of people graduating with a dual degree in psychiatry and internal medicine. This enables primary care physicians to be qualified to provide mental health treatment as well.

  • ─  He will also set aside funding for ​psychiatric certification programs for advanced registered nurse practitioner (ARNP’s) and physician assistants (PA’s).

  • ─  Steve will work with Congress to increase funding.
    ─ Create the “Rural Practitioner Loan Forgiveness Program” to provide ​student loan

    forgiveness for mental health professionals who work in rural communities for five years.

  • ─  Similar to the Teacher Loan Forgiveness Program, mental health professionals who practice in rural communities for 5 years would have their student loans forgiven.

  • ─  In particular, outreach will focus on students who are from rural communities and left for education.

  • ─  The lack of mental health professionals in rural areas is an urgent crisis, with an estimated 65% of rural counties not having a psychiatrist.7

  • ─  Steve will work with Congress to pass this priority.

  • ─  Raise Medicare ​reimbursement rates for mental health treatments.

    • ─  If we want to get serious about addressing mental health, we need to raise reimbursement rates for psychiatric services so Americans can get the help they need.

    • ─  Steve will work with Congress to allocate additional funds.

  • ─  Increase funding for ​school-based mental health​, including through the expansion of School-Based Health Centers (SBHCs) to ensure trained professionals are available to

    assist existing staff.8
    ─ Steve will seek Congressional funding for additional programs.

*2020 GRASSROOTS FIVE-PART PLAN: RECLASSIFY SERIOUS MENTAL ILLNESS (SMI) FROM A BEHAVIORAL CONDITION TO WHAT IT IS, A NEUROLOGICAL MEDICAL CONDITION

  • ─  Push the National Neurologic Conditions Surveillance System (NNCSS) to reclassify serious mental illnesses as a neurological medical condition, enabling more research funding and eliminating discrimination in treatment and insurance reimbursment.

    • ─  Currently, serious mental illnesses are classified as a behavioral condition, an outdated classification that ignores science.9

    • ─  This would enable the CDC to spend more money on this research, particularly from the 21st Century Cures Act.

    • ─  Steve will support efforts to have the WHO reclassify this.

      7 ​https://www.cnn.com/2018/06/20/health/mental-health-rural-areas-issues-trnd/index.html 8 ​https://www.hrsa.gov/our-stories/school-health-centers/index.html
      9 ​https://www.politico.com/story/2019/01/05/schizophrenia-brain-disease-1059386

Creating the Right Culture for Prevention and Treatment
─ Bolster early intervention efforts to prevent or delay the development of more serious conditions and the need to focus on children through school-based screenings and treatment.
─ Steve will work with HHS, the Department of Education, and advocates to introduce more school-based programs to improve mental health. Long-term, he will work with Congress to allocate necessary funds for this vital program.

  • ─  Support the Federal Communications Commission’s efforts to ​create a new

    three-digit hotline number, similar to 911, for suicide prevention resources.

    ─ Steve will ask HHS and the Domestic Policy Council to prioritize this initiative and ensure it is completed within his first year in office.

  • ─  Increase ​suicide prevention efforts ​in the United States through improved training, creating suicide prevention programs for vulnerable populations, and reducing the stigma of suicide through public information campaigns.

    • ─  Suicide is at its highest level, with 47,173 deaths by suicide in America in 2017. 10 We need to take immediate action to address this.

    • ─  This is particularly alarming for our veterans, ​active-duty service members, guardsmen, and reservists​, where every day, approximately 20 veterans lose their life to suicide.11

    • ─  Steve would have the HHS convene advocates and industry experts to develop policy recommendations that HHS and Congress can act on. He will also have HHS and the VA coordinate on a solution to this.

    • ─  To read more about Steve’s efforts to combat veteran suicide, visit Steve’s veterans plan here​.

  • ─  Expand the existing Report on the Impact of Programs Serving Patients with Mental Illness ​under the 21st Century Cures Act to make recommendations to Congress on how best to improve care for patients with mental illness and avoid fragmentation and duplication of services.

    ─ Steve will direct HHS to broaden the report to include these elements.

    Supporting Treatment

  • ─  Invest in ​community treatment centers for mental health. ​One solution will not

    work for every community in our country, which is why we need to ensure that we expand and fund more Community Health Centers around the country.

    • ─  Not only do these centers meet the needs of the Americans in their community, but can be a significant savings to the taxpayer as well.12

    • ─  Steve will work with Congress to further fund these initiatives.

*2020 GRASSROOTS FIVE-PART PLAN: REFORM THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

  • ─  Allow doctors to ​provide the right treatment to patients with severe mental health illnesses by modernizing the Health Insurance Portability and Accountability Act

    10 ​https://www.nytimes.com/2019/03/07/us/deaths-drugs-suicide-record.html
    11 ​https://www.stripes.com/news/us/va-reveals-its-veteran-suicide-statistic-included-active-duty-troops-1.533992 12 ​http://www.nachc.org/about/about-our-health-centers/what-is-a-health-center/

─  Allow doctors to ​provide the right treatment to patients with severe mental health illnesses by modernizing the Health Insurance Portability and Accountability Act (HIPAA) to ensure the best treatment options for patients. (Aligning 42 CFR Part 2 with the HIPAA Privacy Rule to allow sharing of information in critical circumstances.)

  • ─  HIPAA is important to protect patients’ privacy. But for some patients with serious mental health illnesses, it can make it difficult for families and caregivers to determine the right treatment for their loved ones.13

  • ─  Changing this would also make tele-health more effective for Americans with mental health illnesses as it would allow doctors to communicate with loved ones if deemed necessary.

  • ─  Steve would work with legislators to change HIPAA law to enable mental health professionals to share and receive critical diagnostic criteria and treatment information with/from parents and caregivers of Americans with serious mental illnesses.

  • ─  Expand use of ​Assisted Outpatient Treatment (AOT) ​to ensure all treatment options are available and patients can receive assistance wherever they need it.

    ─ Steve will work with Congress to incentivize corrections to apply for AOT for mentally ill prisoners who are being released and allow families to petition the court for this.

*2020 GRASSROOTS FIVE-PART PLAN: DECRIMINALIZE SERIOUS MENTAL ILLNESS (SMI)

  • ─  Decriminalize schizophrenia so that treatment is available to Americans who need it.

    • ─  Right now, treatment is available if there is a “danger to self or others,” which prevents help from being given when people need it most. Earlier treatment can prevent illnesses from ever getting to a “danger” level.

    • ─  Steve will work with Congress to change the criteria for getting help.

  • ─  End​ ​solitary confinement ​for people with serious mental illnesses.

  • ─  Reform civil commitment laws ​to ensure they protect patient rights but also enable

    Americans who need help to get it.

    • ─  Some serious mental illnesses affect the frontal lobe, so people may not know

      they need assistance. In some of these situations, being able to work with civil

      courts and hospitals to identify these people and get them assistance is critical.

    • ─  In many situations, judges cannot even consider patients’ prior history when

      making a ruling.

    • ─  Steve will have the HHS convene leaders on this issue to provide guidance for

      states looking to modify laws.

  • ─  Conduct ​random audits for parity requirements ​for mental health coverage​.

    ─ Steve will direct the secretary of the Department of Labor (DOL) to conduct random compliance audits to identify system-wide themes in noncompliance to help increase global compliance.

  • ─  Promote ​Workforce Training Programs ​through direct and indirect subsidization of training programs at the federal and state level.

    ─ Steve will work with HHS to focus funds on this.
    13 ​https://www.asam.org/advocacy/advocacy-principles/standardize-it/confidentiality-(42-cfr-part-2)-new

─ Ensure federal funding ​is available for standalone mental health facilities.

Accomplishments
As Governor, Steve has prioritized policies to improve mental healthcare access for all

Montanans.

  • -  After passing the Health and Economic Livelihood Partnership (HELP) Act, an innovative approach to Medicaid expansion, an additional 96,000 more Montanans now have healthcare. Montana’s uninsured rate has dropped from a staggering 20% in 2013 to 7% today (DPHHS).

  • -  Made record investments in Montana’s mental health system, expanding crisis intervention and treatment, and doubling the number of Medicaid substance use treatment providers (DPHHS).

  • -  Set up the nation’s first multi-payer Project ECHO for behavioral health, to dramatically increase access in rural communities to integrated behavioral health treatment by providing front-line clinicians with the knowledge and support they need to manage patients with mental health and substance use treatment needs (DPHHS).

  • -  Provided mental health parity to give equal treatment for physical health, mental health conditions, and substance use disorders in insurance plans. This will leverage the private insurance market to help integrate behavioral and physical health care in Montana.

  • -  Invested in suicide prevention efforts for veterans, American Indians, and youth.

  • -  Opened opportunities for all Montanans who served in uniform to receive mental health

    counseling.

PAID FOR BY BULLOCK FOR PRESIDENT

Printed in House

Steve Bullock

Steve Bullock