Behavioral Health Changes
Behavioral health, rehab, and detox diagnoses: Reimbursement and treatment philosophy
Although mental and physical health statuses are clearly interrelated, mental health diagnoses are treated differently both on a social and institutional level. According to the AHA Task Force on Behavioral Health (2007) one-fifth of patients who suffer a heart attack are also found to suffer from major depression. Depression after a heart attack significantly increases the likelihood of a patient dying from a second attack and mental health issues and heart problems are often co-morbid (Behavioral health challenges, AHA2007:1) However, despite this 'mind-body' connection, reimbursement services have been problematic, particularly for case management services and services provided by non-physicians, but also for more standard forms of mental health care for many patients (Mauch, Kautz, & Smith 2008:2).
Patients with all forms of health insurance have faced considerable obstacles in accessing high-quality mental health care. The privately-insured often have strict limitations on the types of services and number of services that will be reimbursed. Managed care has further fragmented psychological and mental-health-based care, given the need to justify mental healthcare through what can be a complex and bureaucratic referral system (Behavioral health challenges, AHA2007:3). As a result, there is often a greater emphasis placed upon psychopharmacological treatment vs. talk-based therapy. Since the rise of managed care fifteen years ago, there has been a corresponding rise in the prescription of psychotropic medication for both severe and mild conditions despite no evidence that there has been a corresponding rise in the actual existence of mental
Many patients with very limited plans do not have psychological services covered at all, causing them to rely upon general practitioners for mental health care that these physicians are ill-trained to provide. This creates an overreliance upon and over-prescription of drugs for conditions like antidepressants which are not necessarily the most effective treatment for mild depression. Amongst the poor, who often have mental health conditions exacerbated by poverty, Medicaid programs offers low rates of reimbursement, causing mental healthcare providers to be reluctant to take on such patients (Behavioral health challenges, AHA2007:3). This causes a vicious cycle, given that untreated mental illnesses can lead to patients becoming further mired in poverty and joblessness.
Institutions such as general hospitals often act as 'stop-gap' facilities, providing services which they are unequipped to prove for the mentally ill on a long-term basis. ERs should not be regarded as the primary care facility for mental health treatment but that is the de facto outcome for many patients who lack access to care for financial or logistical reasons (Behavioral health challenges, AHA2007:6). In response to the need for specialized mental health care, specifically in the field of drug treatment, Massachusetts General Hospital has…
