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Challenges & Opportunities: What’s Ahead for the Psychiatric-Mental Health Nurse?

Challenges & Opportunities: What’s Ahead for the Psychiatric-Mental Health Nurse?. Virginia Trotter Betts, MSN, JD, RN, FAAN Commissioner/TDMHDD National Nurses Week May 6 - 12, 2010. THE BIG WOW!.

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Challenges & Opportunities: What’s Ahead for the Psychiatric-Mental Health Nurse?

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  1. Challenges & Opportunities: What’s Ahead for the Psychiatric-Mental Health Nurse? Virginia Trotter Betts, MSN, JD, RN, FAAN Commissioner/TDMHDD National Nurses Week May 6 - 12, 2010

  2. THE BIG WOW! • The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) • The Patient Protection and Affordable Care Act (PPACA)

  3. U.S. Health Delivery System • The dominant models of providing health care in the United States separate the mind and body. • Separation has a negative impact on health care access, health care costs, and quality of care with a disproportionate share of the burden falling on women, the elderly, racial and ethnic minorities, and rural and immigrant populations. -Health Care for the Whole Person Statement of Vision and Principles, American Psychological Association

  4. Goals for a Transformed System • Americans understand that mental health is essential to overall health. • Mental health care is consumer and family driven. • Disparities in mental health services are eliminated. • Early mental health screening, assessment, and referral to services are common practice. • Excellent mental health care is delivered and research is accelerated. • Technology is used to access health care and information, including within the mental health field, and privacy is protected.

  5. Agencies and providers operate in partnership rather than in “silos” Policies and providers must act on the concept that good mental and physical health are an integral part of individual well being. Transformation of the Health Care System Will Require…

  6. Implementation of Parity • Law became effective in October 2009, to be implemented “in good faith” in all plans whose plan years began on or after January 1, 2010. • Law applies to employers with 50 or more workers and whose health plans offer mental health or substance abuse benefits. • Must now offer those mental health/substance abuse benefits at the same level as their medical/surgical benefits. • The deductible, co-pays, and maximum out-of-pocket amounts must be unified.

  7. Implementation of Parity Concerns: • Nothing in the law that requires plans to cover mental health or substance abuse benefits • Plans are free to exclude any particular mental health or substance abuse condition/diagnosis from coverage. • However, health care reform—when fully implemented in 2014— mandates inclusion of basic behavioral health benefits in most insurance plans (which relieves much of these concerns).

  8. Implementation of Parity Impact on psychiatric nurses: • Passage of parity will lead to increased utilization of reimbursable mental health and substance abuse services • Public mental health/substance abuse service systems will experience less burden for underinsured persons • Likely increased demand for psychiatric mental health nurses in a variety of specialty sites: • Inpatient • CMHC/SA agencies • Private practices – for assessment, counseling, med management, symptom management

  9. Health Care Reform Patient Protection and Affordable Care Act • Facilitates more affordable health insurance for over 32 million Americans. • Eliminates pre-existing condition exclusion for children and youth immediately and for all by 2014 • Expands Medicaid up to 133% of FPL and includes childless adults. • Allows young adults to remain on parents’ health plan through age 26. • Creates a temporary high risk pool to provide health insurance to uninsured adults with pre-existing conditions • Delivery system redesign, “pilots” by grants/waivers

  10. Health Care Reform Provisions related to behavioral health: • Substance use disorder and mental health (SUD/MH) services required in base benefit packages of individual and small group markets. • All plans in insurance exchanges must adhere to Parity Act. • All newly eligible Medicaid enrollees will receive basic benefits including SUD/MH services at parity. • SUD/MH included in health promotion and chronic disease prevention initiatives. • SUD/MH workforce included in workforce development initiatives. • SUD and MH providers are eligible for community health team grants to support medical homes.

  11. Health Care Reform Provisions that directly affect nurses: • Increased funding for nursing workforce development programs • Advanced Education Nursing • Workforce Diversity Grants • National Nurse Service Corps • Support for Nurse-Managed Clinics • Increased funding for nurse home visit programs • Nondiscrimination provision that includes nurse practitioners; provider neutral language

  12. Health Care Reform Possible impacts of reform on nurses: • Increased work load as millions of Americans become insured and have access to behavioral health benefits • Increased opportunities for enhanced nursing education • Increased opportunities for nursing leadership in health care

  13. What’s ahead for the PMH Nurse? • Integration of mental health and substance abuse treatment models • Mental health promotion, substance abuse prevention, screening, and referral as basic services • Increased care services for mental health and substance abuse in primary care and FQHCs • Expectation of use of evidence-based practices • Philosophy = full recovery even from serious illnesses

  14. Integration • Integration of mental health and substance abuse services to treat co-occurring disorders • Integration of mental health/substance abuse services with primary care

  15. Best Practices A responsive mental health system must provide a continuum of services utilizing the best practices of health and science and should include the following: • Prevention/Early Intervention • Active and effective treatments and care • Follow up care/relapse prevention • Social Supports • Recovery/rehabilitation

  16. Role of Nurses 2009 Opinion Leader Survey by the Robert Wood Johnson Foundation and Gallup • Nurses are trusted sources of information and care • Nurses should have more influence in • Improving care and reducing errors • Helping healthcare system adapt and change • Nurses need a unified voice to be heard • Society and nurses should have higher expectations about what nurses can achieve and the health leadership they can provide

  17. What Should Nurses Voice? • Universal Access • Cost effective services • Services delivered timely and with accuracy • Full utilization of qualified providers • Balance of services between health and illness • Integration of physical and mental health

  18. 2010: Not-To-Be-Missed Opportunities • Parity • Health Care Reform • Integration as the key to health care delivery reform • Build upon increased awareness that mental health is essential to health

  19. Health is likely the most important element in life.

  20. Mental health is fundamental to health.

  21. Health Care Reform Resources • Healthreform.gov • Nursingworld.com > Health Care Policy tab • Kaiser Family Foundation http://healthreform.kff.org • http://www.thenationalcouncil.org

  22. Enjoy Nurses Week 2010“Nurses: Caring Today for a Healthier Tomorrow”

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