Can Obamacare Save U.S. From Gap in Mental Health Care? Philadelphia Hospitals Counting on It

Many hospital leaders have shared with me a common scenario that demonstrates unfortunate gaps in the way we care for people with behavioral health conditions. All too often, people who struggle with these conditions, but who do not have insurance, turn in desperation to hospital emergency rooms when mental health issues escalate to crises.

In some cases, these patients languish for months in an inpatient setting because they have nowhere to go. But without this safety net, where would these individuals receive any type of care?

About one in four adult Americans suffer from a mental illness each year. According to the U.S. Department of Health and Human Services, in 2012, there were 5.4 million adults suffering from a mental illness who did not receive any mental health services. Many of these individuals are negatively impacted by a fragmented system, insufficient funding for services, too few providers, restricted insurance coverage, and personal financial barriers.

Now, more than ever, we have an opportunity to improve the quality of these lives through greater access to better coordinated care.

Beginning in 2014, mental health and substance abuse services are classified among the ten "Essential Health Benefits" under the Affordable Care Act. The new health insurance marketplaces cannot apply yearly or lifetime dollar limits on coverage of these benefits. Nor can insurers deny anyone coverage or charge more for pre-existing conditions.

The Affordable Care Act supports new health care delivery models that will better serve behavioral health patients by coordinating and managing all the health care needs of an individual.

Payment incentives will encourage providers to better manage patients' transitions among care settings.

Across the country, there is recognition that we cannot separate behavioral and medical health care. The "mind-body" linkage is critical. Behavioral health conditions exacerbate physical illnesses, and physical illnesses worsen behavioral disorders.

Several promising initiatives to improve the integration of physical and mental health care are already under way in the Philadelphia area. The Delaware Valley Healthcare Council of HAP serves on the Community Behavioral Health Kitchen Cabinet to improve care delivery. The Philadelphia Coalition is transforming its purpose to focus on identifying and sharing best practices for the design and implementation of integrated care and health home models for people living with serious mental illness and substance use disorders.

As we work to improve access to care for patients with mental illness, we must add behavioral and physical health integration to the list. The hospital community looks forward to being part of this important discussion.