Wednesday, May 18, 2011
3 p.m. Eastern Time
What does health reform mean for people in recovery from addiction, consumers of mental health services, and their families? The National Coalition for Mental Health Recovery, Faces & Voices of Recovery, and the National Alliance on Mental Illness jointly present a series of five webinars sponsored by SAMHSA to provide information on the Affordable Care Act (ACA) and its implementation in the states to state-based advocates from the mental health and addiction disorders consumer, recovery, and family communities.
Register now for the first webinar, an overview of ACA and how it helps people with mental health and addiction disorders and their families. The webinar will give advocates the tools they need to begin interacting effectively with state legislators, administrators, and others charged with development of mechanisms and regulations for implementation of ACA.
Register Online
Presenters
Alice Dembner, Deputy Policy Director, Community Catalyst
Carol McDaid, Co-Founder and Principal, Capitol Decisions, Inc.
Ron Manderscheid, Executive Director, National Association of County Behavioral Health and Developmental Disability Directors
Showing posts with label Behavioral health. Show all posts
Showing posts with label Behavioral health. Show all posts
Wednesday, May 11, 2011
Wednesday, March 9, 2011
SAMHSA: Source for Behavioral Health Resources
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Thursday, February 17, 2011
Clearing the Fog in Nursing Homes - NYTimes.com
Image via CrunchBaseBy PAULA SPAN
“What’s people’s biggest fear? Being a ‘zombie’ in a nursing home,” said Laurel Baxter, the Awakenings project manager.
Any visitor can see what she means. Even in quality nursing homes, some residents sit impassively in wheelchairs or nod off in front of televisions, apparently unable to interact with others or to summon much interest in their lives. Nursing home reformers and regulators have long believed that this disengagement results in part from the overuse of psychotropic medication to quell the troublesome behaviors that can accompany dementia — yelling, wandering, aggression, resisting care. For nearly 25 years, federal law has required that psychotropic drugs (which critics call “chemical restraints”) be used only when necessary to ensure the safety of a resident or those around her.
The drugs can cause serious side effects. Since 2008, the Food and Drug Administration has required a so-called black box warnings on their packaging, cautioning that they pose an increased mortality risk for elderly patients. Nevertheless, a national survey reported that in 2004 about a quarter of nursing home residents were receiving antipsychotic drugs. (Among the antipsychotic drugs most commonly used in nursing homes are Risperdal, Seroquel and Zyprexa.)
Though they may be prescribed less frequently following the F.D.A.’s warnings, these drugs are still overused in long-term care, said Dr. Mark Lachs, chief of geriatrics at Weill Cornell Medical College. And once the pills are prescribed, residents keep taking them. “They get perpetualized, like insulin,” he told me, even though the behaviors they’re meant to soothe may wane anyway as dementia progresses.
“If a place is understaffed, if it takes particularly unruly patients, you can see how it happens,” Dr. Lachs added. “Behavioral interventions are far more time-consuming than giving a pill.”
Nevertheless, Ecumen’s Awakenings project emphasizes nondrug responses. “Medications have a place, but that shouldn’t be the first thing you try,” said Eva Lanigan, director of nursing at the Two Harbors facility.
So the home trained its entire staff (housekeepers, cooks, dining room servers, everyone) in a variety of tools to calm and reassure its 55 residents: exercise, activities, music, massage, aromatherapy. It taught people the kind of conversation known as “redirecting” — listening to elders and responding to them without insisting on facts that those with dementia can’t absorb or won’t recall.
“The hands-on, caring part is the most important,” Ms. Lanigan said. “Sometimes, people just want a hug. You sit and hold their hand.”
At the same time, consulting with a geriatric psychiatrist and a pharmacist, the home began gradually reducing the doses of antipsychotics and antidepressants for patients whose families agreed. Among them: the woman with the mysterious cries.
As Dr. Lachs pointed out, behavioral interventions are labor-intensive. Two Harbors hired an additional nurse to oversee those efforts, and Ms. Lanigan was available to answer staff questions around the clock. Ecumen estimates that introducing the program to a 60-bed nursing home cost an additional $75,000 a year for two full-time employees.
The results startled even the believers, however. Every resident on antipsychotics (about 10) was able to stop taking them, and 30 to 50 percent of those taking antidepressants also did well without them. When drugs still seemed necessary, “we tried to reduce them to the lowest dose possible,” Ms. Lanigan said.
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Friday, February 4, 2011
Spending on Behavioral Health is a Shrinking Portion of Overall Health Expenditures
Image via WikipediaSAMHSA News Release
Spending on psychiatric drugs grew by 5.6 percent from 2004 to 2005, down from the 27.3 percent growth from 1999 to 2000 according to a study published today in the February issue of Health Affairs. The study conducted by the Substance Abuse and Mental Health Services Administration analyzed healthcare costs from 1986 to 2005 to determine patterns in expenditures for behavioral health services. SAMHSA is publishing the full report entitled National Expenditures for Mental Health Services and Substance Abuse Treatment, 1986 - 2005 that can be found at the SAMHSA web site.
In 2005, the latest year comparable data is available, behavioral health spending accounted for 7.3 percent ($135 billion) of the $1.85 trillion spent on all health care services in the U.S. During the 20-year study period, both mental health and substance abuse spending grew more slowly than all other health spending: 4.8 percent annually for substance abuse, 6.9 percent annually for mental health, and 7.9 percent annually for all health care services. The same pattern held in the most recent 2002-2005 period, in which spending for substance abuse grew slowest (5.0 percent), followed by mental health (6.4 percent), and all health (7.3 percent).
SAMHSA Administrator Pamela S. Hyde, J.D., commented, "Behavioral health services are critical to health systems and community strategies that improve health status and they lower costs for individuals, families, businesses, and governments. The value of behavioral health services is well documented. Studies have shown that every dollar invested in evidence-based treatments yields $2.00 to $10.00 in savings in health costs, criminal & juvenile justice costs, educational costs, and lost productivity. Yet, too many people don’t get needed help for substance abuse or mental health problems and health care costs continue to skyrocket."
The study found that private insurance spends about 5 percent on behavioral health treatment. Spending on behavioral health treatment (mental health and substance abuse) comprised 4.8 percent of private health insurance expenditures in 2005 and grew by 7 percent from 2004 to 2005. This estimate provides an important baseline for evaluating the impact of the Mental Health Parity and Addictions Equity Act and Affordable Care Act. In contrast, Medicaid behavioral health was responsible for 11.5 percent of total spending by Medicaid. Thus the study indicates that the level of public spending on behavioral health issues may be related to lack of private insurance benefit for many with mental health needs and that these problems may be addressed with parity.
The study’s key findings included:
- Unlike overall health spending, the vast majority of behavioral health services is publicly funded. In 2005, public payers accounted for the 79 percent of spending on substance abuse treatment services and 58 percent of spending on mental health services. In contrast, public payers accounted for less than half (46 percent) of all-health spending.
- Psychiatric drug spending growth is declining. In the past psychiatric drugs were a major driver of overall mental health spending - contributing almost half of the increase in mental health spending between 1998 and 2002. However, because of the wider use of less-expensive generic drugs and reduced numbers of new people using psychiatric medications, the growth rate in spending for these drugs actually slowed from 27.3 percent from 1999 to 2000 to only 5.6 percent from 2004 to 2005.
- Spending on addiction medications is increasing but still remains relatively small. As a result of the introduction of new medications to treat substance dependence, spending on addiction medications has grown rapidly -- from $10 million in 1992 to $141 million in 2005. More recent data from IMS Health shows continued rapid increases up to $780 million in 2009. However, it remains only a small fraction of the entire amount spent on substance abuse treatment (0.6 percent of $22 billion in 2005).
- Private insurance spends about 5 percent on behavioral health treatment. Spending on behavioral health treatment (mental health and substance abuse) comprised 4.8 percent of private health insurance expenditures in 2005 and grew by 7 percent from 2004 to 2005. This estimate provides an important baseline for evaluating the impact of the Mental Health Parity and Addictions Equity Act and Affordable Care Act. In contrast, Medicaid behavioral health was responsible for 11.5 percent of total spending by Medicaid in 2005.
For those seeking the Health Affairs summary article, the citation is Mark TL, Levit KR, Vandivort-Warren R, Buck JA, Coffey RM. Changes in U.S .Spending on Mental Health and Substance Abuse Treatment, 1986 2005, And Implications for Policy. Health Affairs 30, No 2. (2011) (abstract available at : http://content.healthaffairs.org/content/30/2/284). The full report is available at the SAMHSA Website under financing in the health care reform section.
Data files from the National Expenditure report are available at http://store.samhsa.gov/product/SMA10-4612.
SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.
Spending on behavioral health is a shrinking portion of overall health expenditures
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