National Coalition of Mental Health Professionals and Consumers, Inc.

an educational foundation and advocacy organization serving mental health consumers and professionals

White Paper – Essential Elements of Mental Health and Substance Abuse Care

• No discrimination against those who self-pay; no insurance contract, or government regulation should prohibit people from private purchase of mental health and substance abuse services.

• If people use insurance to help cover the cost of mental health and substance abuse services the provisions of those insurance contracts should be explicit and have full medical parity, i.e. not subject to reviewers’ definitions of "medical necessity" or any management, limitation or restriction that does not also apply to other medical benefits under that contract. To prevent discrimination between physical and mental health services, there should not be any separation in terms of annual or lifetime limits.

• Third party payments to providers of mental health and substance abuse services should be equitable for the services rendered. Driving down payment for mental health and substance abuse services results only in limiting consumer choice when practitioners and facilities either leave third party payment systems or are driven out of business. Payments based on diagnoses without regard for their severity often lead to under-treatment. A system that does not allow for extended treatments based on severity of diagnoses hurts the consumer.

• Strategies to inform consumers about mental health and substance abuse treatment alternatives; the effectiveness and limited risk of talk therapies and psychosocial interventions; effectiveness and risks of prescription medications.

• Consumer choice over all aspects of mental health and substance abuse services including the treatment setting, the type and length of treatment and the treating practitioners and facilities.

• Consumer choice about whether to seek mental health and substance abuse services.

• Provisions that, when mental health and substance abuse services are mandates of courts, government agencies or the criminal justice system, the involuntary consumer should have as much choice as possible over the treatment setting, the type of treatment and the treating practitioners and facilities.

•  Treatment methods and processes that are informed by qualified professional education, training and research, not invasively regulated by legislators or third party payers.

•  Availability of a range of clinicians qualified by appropriate training in mental health and substance abuse specialties and sub-specialties.

•  Recognition that payment systems that are based on clinician’s degrees reward those who end formal training and punishes those who continue to improve their skills and knowledge base. A system that discourages advanced training eventually hurts the consumer. A relatively fair system to encourage clinicians to continue advanced training would set reimbursement by health plans at a fixed amount for specific services with co-pays negotiated by clinicians and patients on a sliding scale basis.

•  No "fail-first" requirements or excessively high co-payments before consumers can use the newest or most effective medications. (This can be dangerous for people with serious mental illnesses.)

•  Availability of inpatient and intensive-outpatient settings appropriate to the care of those who cannot function safely in the community; separate units or programs for adults, children, adolescents, the elderly, and those with addictions and physical disabilities which complicate treatment. Such settings should be situated locally, to facilitate support of family and friends.

•  Availability of the full range of mental health and substance abuse treatment methods, without restriction to artificially brief, symptom-focused or problem-focused models. As with innovations in medical care, quality of mental health and substance abuse services requires respect for new understanding in human development, behavior and functioning.

•  Policies that encourage innovation and improvement of services and service delivery.

•  Recognition that claims for specific treatments as "evidence based" frequently fail meta-analytic scrutiny and may be biased by their source of funding and the limitations of the research process itself. (For decades, the brief, solution-focused therapies have gotten grants for research since those therapies fit into the most used research protocols while several forms of therapy supported by patients and the community of therapists are not given grants because they cannot be manualized or standardized and because they would require long-term studies.)

•  All funding sources for research, authors, and journals that support claims for the benefits of specific treatments must be fully disclosed.