Financial Accountability

Individuals with a neurobiological disorder need employment and income to support themselves; yet, only ‘one in three’ is employed  according to the President’s New Freedom Commission on Mental Health (2003, p.29). Furthermore, the report indicates that the “indirect cost of mental illnesses is estimated to be $79 billion, and most of that amount – approximately $63 billion - reflects the loss of productivity as a result of illness” (President’s New Freedom Commission on Mental Health, 2003, p.3). What’s more the article Changes In US Spending On Mental Health And Substance Abuse Treatment (2011) reports that the United States spends $113 billion on mental health treatment which is approximately six percent of the national health budget; which according to some experts isn’t enough, because most communities lack sufficient infrastructure, adequate facilities and trained professionals, to provide care to individuals that need it (Cummings, Wen, & Druss, 2013).

            Another area of concern is the rise in completed suicides. There were 38,364 suicides in 2010, and suicide is the tenth leading cause of death in the United States (CDC, p.1). The number of suicides has increased since previous years. The Center for Disease Control (CDC) (2010) reports that “Suicide results in an estimated $34.6 billion in combined medical and work loss costs” (p.1). The National Institute of Mental Health (NIHM) (2005), reports that ninety percent of people who die by suicide in the United States suffer from a debilitating neurobiological disorder or substance abuse disorder (often combined with neurobiological disorder).  

            There have been several efforts to increase access to community-based mental health services through legislation; such as, the Mental Health Parity Act (MHPA) of 1996, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, and the Affordable Care Act (ACA) of 2010. MHPA legislation halted large group health plans (51 or more employees) from imposing annual or lifetime dollar limits on mental health benefits; however, discriminating health insurance practices placed limits on insurance coverage for mental health and addictions treatment (SAMSHA, 2013). These insurance practices affected millions of Americans with neurobiological and/or substance disorders; so the implementation of the MHPAEA was signed into legislation to even the playing field, it required insurance groups to provide the same level of benefits for Americans with neurobiological and/or substance disorders as Americans with other general medical conditions (Humphreys & McLellan, 2010).

            After January 1, 2014, the ACA will be implemented. This federal law will significantly extend the reach of the MHPAEA's requirements (SAMSHA, 2013). It will require all small group health plans (50 or less employees) and individual plans to comply with the ACA requirements (SAMSHA, 2013). It is predicted that the ACA will cover 32 million uninsured Americans; of which, approximately eight million are presumed to have neurobiological and/or substance disorders (Congressional Budget Office, 2010).  In addition, the ACA will contain escalating costs by phasing out higher co-pays for mental health and substance use disorders (Buck, 2011; National Council for Community Behavioral Healthcare, 2010); it will address the needs of individuals with chronic physical and behavioral health conditions (National Council for Community Behavioral Healthcare, 2010); it will incorporate care in health homes (National Council for Community Behavioral Healthcare, 2011); and it will give states the resources that they need to advance SAMSHA’s Recovery-Oriented models. SAMSHA’s goal is to transform the entire mental health and substance use disorder system to a recovery-oriented system. In order for these policies to increase access to community-based mental health services; there needs to be an increase in adequate facilities and trained mental health professionals, which can be justified by showing the cost benefits of recovery services and supports (Cummings, Wen, & Druss, 2013).

Problems with the economy, over the last few years, have led to budget cuts. Since recovery is multifaceted and hard to measure, one question that has been raised is: With the advancement in technology, is it possible to measure recovery and justify financial resources? According to the Mental Health Center of Denver (MHCD), they have developed four instruments to measure recovery and the information gathered by the instruments are helping them to develop effective programs and policies to help individuals in recovery (Olmos-Gallo & DeRoche, 2010). In addition, a few effective approaches to reducing recidivism and relapse in hospital readmission are the Assertive Community Treatment (ACT), the Opening Doors to Recovery (ODR), and the Illness Management and Recovery (IMR); these programs strive to reduce recidivism while partnering multiple agencies to improve the standard of care for individuals with a neurobiological diagnosis. The Self-Directed Care (SDC) model was created so that the money would follow the consumer through the recovery process; as the researchers report, “Compared with the year before entering the program, in the year after enrollment, participants spent significantly less time in psychiatric inpatient and criminal justice settings, and showed significantly higher levels of functioning in social, work, and family roles” (Cook, Shore, Burke-Miller, Jonikas, Ferrara, Colegrove, & Hicks, 2010, p.139). In the long run, the aforementioned programs provide an opportunity for the organizations to cut cost (Compton, 2011; Salyers et. al., 2010).

            In terms of financial accountability and health services, WHO is striving to make sure that people have access to quality medical products and technology. They are doing this by improving "governance, financing, staffing and management;" thus, increasing the availability of evidence based practices, the quality of evidence, and research that will guide future policy making (WHO, Budget, 2012). Research indicates that early identification and intervention can greatly improve outcomes for individuals with a neurobiological diagnosis; consequently, the school systems are in a position to provide mental health services along with the educational services that they provide (President’s New Freedom Commission on Mental Health, 2003, p.57-64). Perhaps the United States is trying to address some of these issues through government health care policies like the ACA; if this is the case, then studies show that the policies will enhance the health and wellness for individuals with a neurobiological disorder and impact the community by providing a healthier environment (WHO, Budget, 2012).