MHA Society for Behavioral Health

FDA panel votes against black box for epilepsy meds

For a long time now, it's looked like the FDA was gearing up toward putting a black-box warning on epilepsy drugs, since it was discovered that they can potentially increase the risk of suicidal thoughts and behaviors in patients who take them. However, in a surprise move, an FDA-convened panel has ruled 14-4 against imposing a black-box warning on this class of drugs, which includes Pfizer's Lyrica and Johnson & Johnson's Topamax.

The committee concluded that though the risks were real, they weren't high enough to merit a black-box warning. And some panel members noted that imposing a black-box on epilepsy drugs might discourage some patients from taking them, even when the merits of the drug outweigh these risks.

Instead of recommending the black-box warning, the panel is suggesting that the FDA send a medication guide to doctors outlining the drugs' risks. To learn more about the FDA panel's decision, read this Wall Street Journal blog item.

[ via Fierce Healthcare ]

Medicare Mental Health Parity Approved

Just a few days after reconvening from the July recess, the Senate joined the House in passing the Medicare Improvements for Patients and Providers Act of 2008 (H.R. 6331) by a veto-proof 69-30. Less-publicized than the provision that would halt a payment cut for physicians providing treatment to Medicare patients is new equity between mental health and medical coverage.

When enacted, the bill will end a longstanding requirement that affects Medicare beneficiaries who need outpatient mental health services. Currently, they face a discriminatory 50% co-insurance for outpatient psychotherapy and services furnished by non-physician mental health professionals (20% for prescription and monitoring of medications to treat mental illness). In contrast, other outpatient health services require only a 20% co-payment.

The present outdated and unfair higher co-payment for mental health services has served as an incentive to use inpatient or institutional care instead of outpatient services. It has also led seniors and people with disabilities who rely on Medicare to forgo needed mental health treatment.

The bill would establish mental health parity within the Medicare program, phasing in a reduction of the higher co-payment over six years, to 20% in 2014.

The passage of H.R. 6331 is a significant accomplishment and makes great strides in modernizing Medicare. A thank-you call, email or letter to your Senators would be welcomed. See how they voted on H.R. 6331.

The House passed H.R. 6331 by a vote of 355-59 on June 24th. The overwhelming majority in both chambers makes a veto override likely, should the Administration carry out its earlier threat.

For more information, see the summary of H.R. 6331 provided by the House Ways and Means Committee.

[ via Bazelon Center for Mental Health Law ]

Study examines parity in state health coverage initiatives

While more than one in four uninsured U.S. adults has a mental illness or substance-use disorder, many state initiatives to cover the uninsured neglect those conditions, according to a new study by the National Alliance on Mental Illness and National Council for Community Behavioral Healthcare. Eleven of the 18 states examined included parity in mental health coverage in at least one program or proposal for the uninsured, while only five included parity for substance-use disorders, the study found.

Among other concerns, few states included mental illness and substance-use disorders in their wellness and chronic disease management programs, the groups said.

[ via AHA News Now ]

Panel to advise HHS on mental health preparedness

The U.S. Department of Health and Human Services has convened an expert panel to recommend ways to help protect and restore individual and community mental health during and after public health emergencies. The Disaster Mental Health Subcommittee plans to submit recommendations within six months to HHS’ National Biodefense Science Board, which in turn will make recommendations to the HHS secretary.

“We all can experience psychological consequences during and after a disaster, and there are things that can be done to mitigate these effects and improve our overall response and recovery,” said NBSB Chair Patricia Quinlisk. The recommendations will address communication, education and other interventions.

The NBSB advises the secretary regarding chemical, biological, nuclear and radiological health emergencies.

[ via AHA News Now ]

People With Mental Illnesses Wait Longer in Emergency Departments as Hospitals Close Psychiatric Units

Nearly 80% of hospitals say mentally ill patients who need to be hospitalized sometimes must wait four hours or longer to be admitted because of a shortage of psychiatric beds and mental health staff, according to a survey by the American College of Emergency Physicians, USA Today reports. By comparison, 30% of hospitals said patients not seeking mental health services had to wait four hours or more before being admitted.

For the study, ACEP officials surveyed 328 emergency medical directors. The survey also found:

• About 10% of the directors said psychiatric patients wait more than one day on average;
• 84% of directors said ED wait times would decrease for all patients if their hospitals offered better psychiatric services;
• Half of the hospitals surveyed had psychiatric units, while the rest transferred patients to other facilities; and
• 61% of hospitals surveyed do not have psychiatric staff caring for ED patients while they wait, but those patients do receive care for other medical problems.

The number of psychiatric beds in U.S. community hospitals has declined 12% since 2000, compared to a 4% decline in overall hospital beds, according to ACEP. According to James Bentley of the American Hospital Association, hospitals have begun closing their psychiatric units because of low payments from government programs and health insurers, uncompensated care for uninsured patients and a shortage of psychiatrists willing to work in hospitals.

[ via Kaiser Daily Health Policy Report ]

Suicide risk may be higher for MDs

While many inside the profession don't like to discuss the issue, it's getting publicity nonetheless: Doctors are killing themselves at comparatively high rates. While exact statistics are hard to come by, researchers think that the suicide rate among physicians is higher than that of the general population, averaging 300 to 400 U.S. doctors per year. A 28-state study from the 80s found that female doctors were more than twice as likely as women in the general population to suicide, while male doctors were 70 percent more likely to kill themselves.

Why are these rates so high? For one thing, many don't get the help they need - fearing that any admission of mental illness could ruin their careers, given the profession's stoic culture. What's more, physicians have easy access to lethal drugs, as well as detailed knowledge of how to overdose effectively. On top of everything else, doctors often have extremely high workloads and make high-stakes decisions under intense pressure.

Hoping to stem this ugly trend, the American Foundation for Suicide Prevention has launched an educational campaign that hopes to make troubled doctors feel more comfortable seeking help. Also, fellow professionals are making changes to help de-stigmatize mental illness. For example, in Arkansas, one psychiatrist managed to get the state's medical license application process changed; previously, a doctor who admitted mental illness had to get a pass from a psychiatrist before they could practice, but now they only need to disclose treatment.

To learn more about this issue, read this USA Today piece.

[ via FierceHealthcare ]

Study: Mental Illness Costs U.S. Billions in Lost Earnings

Mental illness costs the United States an estimated $193 billion yearly in lost earnings, according to a new study examining the consequences of mental disorders.

The study, funded by the National Institutes of Health’s National Institute of Mental Health (NIMH), found that lost earning potential in workers with mental illnesses accounts for a large part of the financial burden the illnesses create – more so than obvious expenses such as medications, hospitalizations and clinic visits.

The study used data from a 2002 survey of 4,982 Americans ages 18-64 to calculate lost earnings among sufferers of serious mental illness, a broad category including mood and anxiety disorders that impair the ability to function and mental disorders associated with suicidal or violent behavior.

Of the 86 percent of survey respondents who reported earning income, those with serious mental illness averaged $22,545 in yearly wages, compared with healthy workers’ average income of $38,852. Men with serious mental illnesses took a more significant financial hit than women.

Researchers estimated the $193 billion annual cost by extrapolating the survey results to the general population.

The survey did not evaluate people who were hospitalized, incarcerated or affected by autism or schizophrenia, and researchers warn that actual costs could be higher than the estimate.

[ via Megan Sowder-Staley, CQ HealthBeat News ]

CMS announces RY 2009 payment update for inpatient psych facilities

The Centers for Medicare & Medicaid Services on May 1 announced that inpatient psychiatric facilities would receive a 2.5% increase in payments - about $120 million- for rate year 2009, which begins July 1. RY 2009 is the first year these facilities will be completely reimbursed under a prospective payment system rather than a cost-based system.

CMS said the increase is based on a full market basket update of 3.2% and a “stop-loss” provision designed to protect IPFs from significant losses as they transitioned to the new PPS, among other adjustments. CMS estimates a per-diem payment rate (per case) of $637.78 in RY 2009, compared to $614.99 in RY 2008.

The agency phased in the IPFs’ transition to a PPS over the past three years.

[ via AHA News Now ]

Scientific Evidence of Biological-Neurological Connection Could Help Efforts To Pass Mental Health Parity Legislation, Columnist Writes

A "critical moment has been reached in a 15-year debate in statehouses and in Congress over whether treatment for problems like depression, addiction and schizophrenia should get the same coverage by insurance companies as, say, diabetes, heart disease and cancer," New York Times columnist Sarah Kershaw writes. According to Kershaw, although "[d]ecades of culture change and recent scientific studies have blurred the line between" mental and physical disorders, mental health parity "raises all sorts of tricky questions," such as, "Is an ailment a legitimate disease if you can't test for it?"

Kershaw writes that "as federal parity legislation has wobbled along over the years, 42 states have adopted their own versions of parity." However, "many providers have complained that insurance companies have often found it easy to deny benefits by ruling that claims are not 'medically necessary,' a potentially tough standard when it comes to ailments of the mind," she writes.

According to Kershaw, "scientific advances may go a long way to help the parity cause" because the "biological and neurological connection lends strength to the notion that mental illnesses are as real and as urgent as physical illnesses and that there may, at long last, even be a cure in this lifetime, or the next." She continues, "And if you can cure something, you can treat it and there is a finite quality to that treatment - and its costs" - which could make insurers "more willing to pay for it."

According to Kershaw, supporters and opponents of mental health parity legislation approved in the House and Senate "both expect the negotiations over how to reconcile the two bills to be protracted." She writes that "in the halls of Congress, at least, the mind-body problem is far from resolved, particularly when it is uncertain who the next president will be."

[ via Kaiser's Daily Health Policy Report ]

Mental Health Parity Bill Passes House, But Differs From Senate Bill

The US House of Representatives has passed a bill requiring group health plans to provide coverage for mental illnesses that is more comparable to that for physical illnesses.

The Paul Wellstone Mental Health and Addiction Equity Act, HR 1424, which was passed March 5 by a vote of 268 to 148, extends the parity in annual and lifetime dollar limits for mental healthcare provided by the Mental Health Parity Act of 1996 to include parity in cost-sharing requirements such as copays and deductibles and treatment limitations such as day and visit limits.

"We commend the House of Representatives for making the sound decision to pass HR 1424 and for its continued effort to enact legislation that will end discrimination against patients with mental illnesses," American Psychiatric Association (APA) president Carolyn Rabinowitz, MD, said in a statement from that organization.

In an interview with Medscape Psychiatry , James Scully, MD, medical director and CEO for the APA, called the passage "historic." "We're very pleased and applaud finally that, after many years — indeed decades — of trying to end discrimination against people with mental illness in the insurance world, this bill passed the House. It's long overdue, but we know it's been a long struggle to educate people that mental illnesses are real and diagnosable and treatable the same way as other medical illnesses."

For the full story, click here.