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A Healthy Blog

Massachusetts health care – wonky with a dose of reality

June 6, 2018

The Massachusetts Senate recently approved their version of the Fiscal Year 2019 (FY19) state budget. The Senate version and the House version must now be reconciled through negotiation between the two chambers. Health Care For All (HCFA) has a number of budget priorities related to health care that have made it this far and should continue on to the final budget.

To find HCFA’s full FY19 Conference Committee letter with detailed explanations of our positions, please click here. You can find summaries of each budget priority that HCFA supports below:

  1. Restore Coverage for Periodontal Care For Adults on MassHealth

We urge the Conference Committee to direct MassHealth to reinstate coverage for periodontic services for adult MassHealth enrollees so that they are able to get the appropriate care that they need to maintain good oral, and overall, health.

  1. Establish a strong Office of Health Equity within EOHHS, and provide funds for the Office’s operation

We urge the Conference Committee to include Section 7 and line item 4000-0009 of the House budget, which would establish and fund an Office of Health Equity to reduce the serious racial and ethnic health disparities that exist in Massachusetts.

  1. Provide expanded authority to MassHealth to negotiate for fair prescription drug prices

We urge the Conference Committee to include authority for MassHealth to seek supplemental prescription drug rebates, and require pharmaceutical pricing information from manufacturers if reasonable rebates are not provided to MassHealth. The provision should also allow EOHHS to assess penalties on manufacturers who refuse to provide the required information, or who do not offer fair rebate amounts to MassHealth.

  1. Direct MassHealth to provide information on ACO outcomes and activities addressing social determinants of health

We urge the Conference Committee to include language in the MassHealth line item (4000-0500) directing MassHealth to provide information on ACO outcomes and performance, particularly data on ACO activities addressing the social determinants of health.

  1. Fund critical children’s mental health programs

We urge the Conference Committee to fund the MHAP for Kids program at $50,000 (within line item 4800-0200).

We urge the Conference Committee provide level-funding for Return to School “Bridge” Programs at $250,000 (within the School Health Services line item 4590-0250).

  1. Preserve Sunset on Prescription Drug Marketing Coupons on Rebates

We urge the Conference Committee to maintain the state’s prohibition on drug industry marketing “coupons” by 2019 and direct the Health Policy Commission to engage in a substantive study of the long-term costs and benefits of drug coupons on the Massachusetts health care market.

  1. Provide Unbiased Information about the Cost and Efficacy of Prescription Drugs

We urge the Conference Committee to provide funding for Health Policy Commission to operate the Academic Detailing program (line item 1450-1266 of the Senate budget) at $150,000.

  1. Require data collection on pediatric continuous skilled nursing services

We urge the Conference Committee to include Section 16 of the Senate budget, which directs the Center for Health Information and Analysis and MassHealth to regularly report data about pediatric patients requiring Continuous Skilled Nursing services.

  1. Fund pediatric palliative care programs

We urge the Conference Committee to fund Pediatric Palliative Care Programs (4590-1503) at $3,816,053, to ensure that all children and families who need these services can get them.

  1. Adequately fund DPH’s Office of Oral Health and the successful ForsythKids Program

We urge the Conference Committee adequately fund the general operations of DPH’s Office of Oral Health, and continue to earmark $300,000 for the ForsythKids program (line item 4512-0500).

Each of these provisions serve important purposes in supporting health care in Massachusetts. As always, HCFA is committed to advocating for affordable and quality health care coverage. All ten of these proposals do just that.

-Brian Rosman and Davis Jackson

May 23, 2018
In the worlds of health care policy and delivery, there is increasing recognition that addressing the social determinants of health (SDOH) –access to nutritious foods, affordable housing, safe neighborhoods, dependable transportation, well-paying jobs and safety from violence—is essential to improving health outcomes, containing health care costs and addressing health inequities across race and income. In other words, health care is about even more than having insurance coverage and receiving traditional medical care. 
 
The Massachusetts Budget and Policy Center (MassBudget) recently released issue briefs on the health effects of the Earned Income Tax Credit (EITC) and Paid Family & Medical Leave (PFML). MassBudget presents research showing that both policies improve the health of individuals, families and communities by addressing economic hardship and promoting the family and social support that contribute to better health. 
 
These are live issues now. The Senate budget being debated this week includes an increase in the state EITC, as did the House budget and Governor’s Baker’s budget proposal. In addition, PFML is a proposed initiative to be before state voters this fall.
 
Each year over 400,000 Massachusetts tax filers claim the EITC, a refundable tax credit that goes to families and individuals, primarily workers with children, who have income from paid work. The Massachusetts EITC partially matches the EITC at the federal level which “keeps administrative costs and complexity to a minimum, while rewarding and encouraging work.” MassBudget found that increases in EITC payments are associated with:
 
Reduction in occurrences of low birthweight
Increased gestation time for pregnant women
Increased educational attainment for children – which is linked to better health outcomes
Improvements in children’s behavioral index scores which measure behaviors such as peer conflict, anxiousness and depression
Avoidance of the early onset of disabilities and other illnesses associated with low family income
Increased in the self-reported health of mothers  and improved blood pressure, heart rate, cholesterol and inflammation levels for these mothers
Increased prenatal care
Increased spending on healthy foods such as fruits and vegetables
Increased economic  activity in neighborhoods with a high concentration of households receiving the credit
 
A policy that allows workers to take paid time off from work to care for themselves, a new child, or a family member with a serious illness or injury, PFML influences the ability of individuals and families to live healthy lives. The MassBudget report shows that access to PFML can have both short-term and longer term health benefits across the lifespan, including:
 
A decline in infant mortality
Increased rate and duration of breastfeeding
Improved physical, cognitive and behavioral outcomes for children – including higher rates of vaccination
Decreased likelihood of behavioral and adjustment problems for adolescents and adults
Faster recovery from both inpatient and outpatient procedures for children
Fewer depressive symptoms for new mothers in the short-term and the long-term
Reduced  nursing home utilization by elders
 
Tackling the complexities of social determinants of health is essential to realizing our vision of a Massachusetts in which everyone has the equitable, affordable, and comprehensive care they need to be healthy. While we must always stand firm in protecting and expanding coverage and care, we must also identify and champion policy solutions that extend beyond this classic framework to address the multitude of factors that so powerfully affect the health of the Commonwealth.
 
-Natalie Litton
May 17, 2018

Just last week, the Massachusetts Senate released their budget proposal for fiscal year 2019, which begins on July 1 of this year. Senators will be debating and voting on many amendments in the short term, including a number of important health care related amendments. 

HCFA is supporting a number of amendments that will improve access to affordable and quality health care coverage; there are also some proposed amendments we oppose that would move our state backwards.

With debate in the Senate starting, it is critical that your Senator knows how constituents feel about these critical health care related amendments. To find your State Senator's contact information, click here. A summary of these key amendments is below:

[For full explanations of each amendment, see our complete budget amendment fact sheet here]

 

HCFA Supports:

Health Insurance:

Amendment #599 (Monitoring Accountable Care Organization Use & Efficacy of Non-Medical Services): Sponsored by Senator Welch, directs MassHealth to work to report data on ACO activities to address social determinants of health.

Amendment #491 (Office of Health Equity): Sponsored by Senator Lewis, allows existing EOHHS funds to support activities of an Office of Health Equity.

Amendment #580 (Academic Detailing): Sponsored by Senator Lewis, increases funding for a physician education program on cost-effective utilization of prescription drugs to $500,000.

Amendment #515 (Smoking Prevention & Cessation Program): Sponsored by Senator Lewis, restores funding to the FY2007 level of $8,500,000 to provide adequate funding for this vital tobacco control program.

Children's Health:

Amendment #620 (Protecting Medically Fragile Children): Sponsored by Senator Friedman, provides an additional $16 million investment in the Continuous Skilled Nursing Program.

Amendment #414 (Mental Health Advocacy Program for Kids): Sponsored by Senator Crighton, increases funding by $150,000 for the Mental Health Advocacy Program for Kids, providing $200,000 to support this valuable program.

Amendment #614 (Return to School "Bridge" Programs): Sponsored by Senator Friedman, provides $250,000 to maintain and expand these Bridge programs.

HCFA Opposes:

Amendment #484 (Health Connector Coverage For Non-Disabled Adults): Opposing this amendment, sponsored by Senator Tarr, would prevent disruptions in coverage for 140,000 adult MassHealth enrollees.

Amendment #496 (Moratorium on Mandated Benefits): Opposing this amendment, sponsored by Senator Tarr, excludes a blanket moratorium on new mandated benefits from the FY18 budget.

Amendment #422 & #488: (Prescription Drug Copay Coupons): Opposing these amendments, sponsored by Senator Demacedo and Senator Tarr, prevents pharmaceutical companies from using rebates and coupons to influence consumer choice and drives up health care spending. 

 

Again, we strongly encourage each of you to contact your State Representative regarding each of these amendments. Make sure that your voice is being heard by those making the decisions!

-Davis Jackson

May 11, 2018

By Jake Murtaugh, Public Affairs Associate

Massachusetts Society for the Prevention of Cruelty to Children

 

The Children’s Mental Health Campaign began as a call to action to inspire mental health reform in Massachusetts and has evolved into a leading voice- so that children and youth get the right care, at the right time.


In 2006, The Massachusetts Society for the Prevention of Cruelty to Children (MSPCC) and Boston Children’s Hospital (BCH) published “Children’s Mental Health in the Commonwealth: The Time is Now.” The study highlighted that the mental health system in Massachusetts was not providing appropriate care to children and teens and that “for too long the healthcare system, including its reimbursement structures, has minimized mental health as a core component of health care”. To answer the call for systemic reform, the Children’s Mental Health Campaign was born, and children’s health advocates created a broad-based mechanism to respond to an inadequate system of care for children and teens with mental and behavioral health needs.

 

On May 7th, 2007, the Campaign testified on increasing access to mental health services for children and teens before a State House audience. You may recognize some familiar faces!

The Campaign quickly gained support from providers, educators, consumers, and organizations, becoming an important driver for the passage of landmark legislation in the Commonwealth; Chapter 321, An Act Relative to Children’s Mental Health & Chapter 256, An Act Relative to Mental Health Parity. The Campaign grew from a collaboration of 34 organizations into a dynamic advocacy network of over 160 organizations dedicated to creating a system in which every child in the Commonwealth receives the highest quality mental health care, in the right place, at the right time.



The Children’s Mental Health Campaign continues its fight for mental health parity and for access to compassionate, effective care for children and teens in Massachusetts. Despite significant gains over the last decade, children and families continue to experience barriers to community-based behavioral health services in Massachusetts. The Campaign advocates for legislation and state budget funding in order to improve access to behavioral health care for children and teens across the Commonwealth.

The Campaign believes that Massachusetts must:

1. Support children in the community.

Because of the Children’s Behavioral Health Initiative (CBHI), children and teens in Massachusetts who have MassHealth coverage now have greater access to community-based treatment than their peers with commercial health insurance coverage.

 

Private insurers are not required to cover community and home-based care. This is a violation of mental health parity. Children and teens seeking mental and behavioral health support should have access to, and health coverage for, appropriate care, including community-based services. An Act to Increase Access to Children’s Mental Health Services in the Community (S.547) would mandate commercial insurers to cover community and home-based care, and would help strengthen parents’ ability to navigate the mental system and then access appropriate care for their children.

 

2. Make sure children and families know where to get care.

Too often health provider network directories are outdated and inaccurate. An Act to Increase Consumer Transparency About Insurance Provider Networks (S.538) will make sure parents know where to get the right services for their children. Provider directories should be tools for accessing the right care, and not a barrier.

3. Support young children- don’t expel them.

May 10, 2018

By Kate Ginnis, MSW, MPH, Director of Behavioral Health Advocacy & Policy, Boston Children’s Hospital

 

Children in Crisis

One in five children suffers from a diagnosable mental health disorder.  Half of all lifetime cases of mental illness are diagnosed by age 14.[i]  The prevalence of mental health disorders among children and adolescents indicates the need for a robust treatment system that allows families to access appropriate care for their children when and where they need it.  Any parent who has tried to get care for their child knows that it is not that simple.

Kids and Families in Crisis

Children with mental and behavioral health disorders and their families across Massachusetts are in crisis. Nowhere is it more evident than in Emergency Rooms throughout the Commonwealth, where parents and caregivers bring their children when they are having a behavioral health emergency.  As with any patient in the ER, children are evaluated by professionals who make recommendations about the best next step, which may include inpatient psychiatric care, an intermediate level of care, or outpatient care.  The similarity between what happens in the ER for youth with physical health conditions and those with behavioral health conditions stops there.  For children with physical health conditions, more complex conditions with more acute symptoms warrant the most immediate and most intensive care.  For children with behavioral health conditions, the most complex patients are more likely to spend days or even weeks in the ER awaiting care.[ii]  Psychiatric “boarding,” was first observed in 2000,[iii] and has been a problem for youth and their families ever since.  Most days in Massachusetts, there are children sleeping in EDs because they cannot access the care that they need.

Why is there a boarding crisis?

Psychiatric boarding is the most severe and apparent symptom of the inadequacies in access to behavioral health care that the Children’s Mental Health Campaign (CMHC) has prioritized for more than a decade.  In 2006, the CMHC was launched with the publication of a paper entitled, “The Time is Now,” which laid out a set of recommendations to improve children’s mental health care in Massachusetts.  Since that time, the CMHC, a coalition of advocates led by the Massachusetts Society for the Prevention of Children, Boston Children’s Hospital, the Parent-Professional Advocacy League, Health Care for All, Health Law Advocates and, more recently, the Massachusetts Association for Mental Health, has advocated with leaders in Massachusetts to make substantial policy changes to improve access. 

Though we understood that boarding was indicative of a larger system failure, the CMHC leadership realized that in order to advocate for much-needed change, we needed to better understand what was driving the problem. Over the past three years, the CMHC embarked on a research project funded by the CF Adams Charitable Trust to look at boarding from the perspective of hospitals, families, and the community.  We knew that this problem was multi-faceted and that we needed a multi-pronged solution.  We wanted to make sure that we understood both the data and the family experience in order to identify essential policy changes that would have real impact. 

Our research elucidated a trend that we knew existed but for which we previously had mostly anecdotal evidence: youth with more complexity board longer.  In December 2016, the CMHC brought together key stakeholders at a pediatric boarding “summit,” to present project outcomes and to get feedback from key stakeholders which enabled us to develop a plan for next steps in legislative, administrative, and budget advocacy to eliminate boarding.  At the same time, the Executive Office for Health and Human Services, with the leadership of Secretary Marylou Sudders, embarked on a statewide workgroup to solve the boarding problem for both children and adults.  CMHC leaders have been delighted at the attention paid to this critical issue and have been engaged at every step of the way.  Perhaps the most immediate result of our collective work is the creation of inpatient units to treat youth with Autism Spectrum Disorders who are in psychiatric crisis, the first of which will open later this year.

What’s next?

Boarding as a symptom allowed the CMHC leadership to unpack several other advocacy priorities that we believe will improve access at all levels of the mental health care system, and that you can read about on the CMHC website or by subscribing to our monthly newsletter. New issues are brought to our attention by the advocacy of our engaged providers and families, and we depend on your insight, expertise, and activism to combat the inequities that exist in the children’s behavioral healthcare system. Contact the CMHC or you may contact me directly at kate.ginnis@childrens.harvard.edu.

 

May 9, 2018

  

By Marisol Garcia, Esq., Director/Managing Attorney,

Mental Health Advocacy Program for Kids, Health Law Advocates

On a spring day in 2017, elementary school staff called an ambulance to transport Ashley—a fourth grader experiencing an acute mental health crisis—to the emergency room. In the ambulance, Ashley hit an EMT in the face. As a result, charges were pressed against Ashley for assault and battery. Ashley’s mother was shocked when she received court documents instructing her that her nine year old daughter had a clerk’s magistrate hearing. Ashley would have to appear in court in a delinquency proceeding for behavior that happened while her family and providers were actively seeking treatment for her mental health needs.

Just like Ashley, many children involved in—or at risk of entering—the juvenile justice system end up there because of unmet mental health needs. Health Law Advocates’ Mental Health Advocacy Program for Kids (MHAP for Kids) has a proven track record of significantly improving the lives of these children and their families while also reducing unnecessary costs for the Commonwealth.

MHAP for Kids embeds staff attorneys in Family Resource Centers (FRCs) in Lowell, Lynn and Boston. The state created the statewide network of FRCs in 2012 with the goal of increasing children’s access to mental health care, special education and other services that play a significant role in diverting children from juvenile court. Our attorneys are trained in overcoming systemic barriers to mental health services by working with young people and their families to begin or improve special education services, secure and/or coordinate community-based mental health services, collaborate with the Department of Children and Families, the Department of Mental Health and the Department of Developmental Services, advocate for general education accommodations and assist with health insurance coverage.

MHAP for Kids serves young people and parents who have a “significantly elevated risk profile.” Of the children served:

  • 83% diagnosed with one or more mental illness (average of 3.5 mental health related conditions)
  • 89% experienced a barrier to mental health treatment
  • 63% accessed crisis or emergency mental health care services in the past year
  • 44% hospitalized for psychiatric care in the past year
  • 37% admitted to a residential mental health facility in the past year
  • 28% did not attend school at all or missed almost every day in the past three months
  • 61% missed school more than one day per week in the past three months

MHAP for Kids works. The Boston University School of Public Health conducted a two year study on the efficacy of MHAP for Kids. The study found that when MHAP for Kids intervenes in a child’s life, children experience:

  • Improved school attendance (31% missing more than one day per week, reduced to 6%)
  • Decreased use of emergency mental health services (70% with recent need, reduced to 24%)
  • Lowered use of overnight hospital stays (44% with recent need, reduced to 14%)
  • Reduced use of emergency shelters (10% with recent need, reduced to 0%)
  • Improved families’ self-reported mental health (children and parents/guardians), family conflict and family difficulties

In Ashley’s case, her therapeutic providers contacted the MHAP for Kids staff attorney immediately. The attorney felt strongly that Ashley was being punished for her unmet mental health needs. The attorney explained the entire juvenile court procedure to both Ashley and her mother so that they would know exactly what to expect. At the hearing, the attorney explained to the magistrate that Ashley is working with MHAP for Kids to get her the mental health treatment that she needs. The magistrate dismissed the charges. The MHAP for Kids attorney helped Ashley find placement in a therapeutic day school. Today Ashley is attending classes successfully and learning new coping skills.

MHAP for Kids is a lifeline – out of the juvenile justice system and into the treatment and care that creates brighter futures. As MHAP for Kids expands, it is our hope that one day soon, this program will be available to every Massachusetts child in need of its services and support.
 

This blog is part of HCFA’s Children’s Mental Health Week series.

May 8, 2018

  

By Danna Mauch, PhD, President & CEO, Massachusetts Association for Mental Health

Early childhood mental health care matters. One out of every seven children, ages two to eight years, was reported to have a diagnosed behavioral or developmental condition (e.g., depression, anxiety, behavioral or conduct disorder, autism spectrum disorder, developmental delay, etc.) in the National Survey of Children’s Health.[i] Reaching children and families early is critical to optimizing opportunity over the life course, and the pediatric medical home is an effective point of entry for behavioral health as it is a non-stigmatized and trusted source of care.[ii] The Massachusetts Association for Mental Health (MAMH) advocates for widespread adoption of evidence-based models of early childhood mental health (ECMH) integration in pediatric primary care to improve access and outcomes for children and families.

How does ECMH integration in primary care work?

LAUNCH/MYCHILD is one example of an evidence-based model of early childhood mental health (ECMH) integration in pediatric primary care. This model includes both a mental health clinician and a family partner (an adult experienced in navigating the health and social services systems for his/her own child) embedded in the primary care team. The behavioral health clinician and family partner attend regular team meetings and case conferences, participate in daily huddles, receive children and families by way of warm hand offs from primary care clinicians, and are integral in the development of care plans. The goals of this model are to promote healthy relationships between parents/caregivers and their children, prevent concerning behaviors, reduce stress on families, identify behavioral health concerns early and make referrals for therapeutic intervention.

What is the evidence for LAUNCH/MYCHILD?

In my former role as Senior Fellow/Principal Associate at Abt Associates, I led an evaluation of MYCHILD; likewise, the Institute for Urban Health Research at Northeastern University led an evaluation of LAUNCH. As measured by evidence-based tools, LAUNCH/MYCHILD resulted in statistically significant reductions in parental stress and depression symptoms, as well as improved child mental health and social emotional wellness. The Abt research team additionally used Medicaid data to compare health care expenditures for children enrolled in MYCHILD with a matched comparison group in the MassHealth population. Looking at all MassHealth costs over a 12 month period following the index date, we found that MYCHILD costs were $164.21 less per child per month versus children in the control group. Likewise, children enrolled in MYCHILD were also more likely to receive appropriate, non-stigmatizing diagnoses.[iii] Accurate diagnoses are essential to developing effective care and treatment plans.  

Are there other evidence-based models of ECMH integration in primary care in Massachusetts?

Yes, there have been additional investments in ECMH integration in pediatric primary care that have further contributed to a body of knowledge in this field. The MetroWest Health Foundation, for instance, supported the Southborough Medical Group in implementing pediatric integrated behavioral health care. The result was improved access to behavioral health services (both timeliness of care and engagement in care). Southborough was also able to address language and cultural barriers to care and document improved communication between families and providers.

Related, the Pediatric Physicians’ Organization at Children’s (PPOC) has successfully integrated mental health care throughout its practices. PPOC also received a grant from the Blue Cross Blue Shield of Massachusetts (BCBSMA) Foundation to integrate substance misuse services in pediatric primary care through a partnership with the Adolescent Substance Abuse Program (ASAP) at Children’s; the Foundation has secured John Snow, Inc. to analyze the impact of the model on access to care. Furthermore, the Richard and Susan Smith Family Foundation’s TEAM UP for Children Initiative is supporting transformation to integrated pediatric primary care at three federally qualified health centers. The Smith Family Foundation is partnering with the Robert Wood Johnson Foundation and Boston University on an evaluation of the initiative to assess real-time cost and quality outcomes.

How can these models be brought to scale?

Despite support for ECMH in primary care from diverse stakeholders, public and private investments in practice transformation and a growing evidence base, integrated pediatric behavioral health care is far from universal. The promotion of widespread adoption, implementation and sustainability requires a multifaceted approach including addressing policy and regulatory barriers; investing in training and technical assistance for practice transformation; promoting sustainability through delivery and payment reform efforts (such as reimbursement for core elements of integrated care and review of ACO certification/reporting requirements); and enforcing state and federal parity laws.

May 8, 2018

Health Affairs study: Meal Delivery Programs Reduce Health Costs

 

Good health for Massachusetts families is about more than access to traditional medical care. The social determinants of health (SDOH) – factors such as food insecurity, lack of affordable housing, transportation barriers, limited access to well-paying jobs, and exposure to violence – contribute to poor health outcomes, drive up health care costs, and create health inequities across race and income.

Food insecurity – the lack of consistent, dependable access to enough food for active, healthy living – affects approximately thirteen percent of U.S. households and is associated with $77 billion in excess health expenditures annually. In a Massachusetts-based study recently published in Health Affairs, researchers found that addressing food insecurity through meal assistance programs can improve outcomes and reduce costs because program participation was associated with lower medical spending.

Seeking to determine the impact of meal assistance programs on recipients’ health care use and spending, researchers looked at two types of programs, both of which served adults who are dually eligible for Medicaid and Medicare and are members of Commonwealth Care Alliance, the Massachusetts  non-profit, community-based health plan.

The first program was “medically tailored,” meaning it served adults with specific dietary needs due to a chronic condition such as diabetes or renal insufficiency. This program delivered enough lunches, dinners and snacks for five days. The second program was not tailored – more like the well-known “Meals on Wheels” program—and it delivered five days’ worth of lunches and dinners each week. Researchers randomly selected a group of CCA members who, during the same period, did not receive either meal program, to serve as a control group.

Compared with the control group, individuals who participated in the tailored meals programs were:

  • Significantly less likely to visit the emergency department
  • Significantly less likely to be admitted to the hospital
  • Significantly less likely to use emergency transportation services

Likewise, compared with the control group, individuals who participated in the non-tailored meals programs were also significantly less likely to visit the emergency department or use emergency transportation but no significant differences were found for inpatient admissions.

While the researchers acknowledge the importance of confirming these results in larger samples and in different settings, they posit that their results “support the overall approach of increasing the integration between health care and social services sectors.” With the recent implementation of MassHealth Accountable Care Organizations (ACOs), the Commonwealth has a unique opportunity to make progress in the integration of these interconnected – but too often divided – elements of true health.

HCFA was chosen by MassHealth to participate in their Social Services Integration Work Group, which advises MassHealth on how best to leverage the value of social services to improve the health of MassHealth members enrolled in their ACOs. HCFA also is one of the leaders of the Alliance for Community Health Integration, which was founded by  the Massachusetts Public Health Association to advance policies that focus on the underlying social determinants of health.  The Alliance is supporting a requirement that MassHealth collect comprehensive data on the impact of the social supports being provided to members enrolled in ACOs, to help identify the most effective activities of the program on social determinants.

 

                                                                                                                                                                             -Natalie Litton

May 7, 2018

     

By Liz Belfield, Program Manager, Parent/Professional Advocacy League

Children’s Mental Health Week (CMHW) was started in 1991 by a group of families in Missouri, now called Missouri Families 4 Families, who wanted to fight discrimination and stigma in their community. The Parent/Professional Advocacy League (PPAL) supported these families and this idea, bringing CMHW to Massachusetts in 1996 to do the same –fight stigma and promote family wellness in communities.

We use this metaphor of ‘fighting’ stigma because for a lot of our families, it is a fight. When parents come to us for help, we tell them we will train them to be advocates, but what is an advocate but a fancy word for fighter? Advocates push issues forward, advocates support policies that help them, advocates fight for their causes. The parents who come to us for support already know how to fight. They’ve been fighting for their children since day one. What we teach them is how to channel their parental instincts, their internal protective mamma and papa bear- ness, into meaningful action that causes positive change for their children.

And a lot of what these parents are fighting is stigma. Stigma is so harmful in so many different ways. It has been shown to have a profound effect on a person’s sense of self and can diminish their self-esteem and confidence. Children and young people have been shown to experience higher levels of stigma than adults. Stigma is so pervasive. It doesn’t just affect the individual, but their family and friends, their school teachers and peers, their community leaders and health care professionals. Stigma can restrict access to services and the services themselves. In fact, the former US Surgeon General, Vivek Murthy, stated that stigma is one of the most important problems facing the entire mental health field.

On average, individuals wait 8-10 years from when mental health symptoms emerge to when they seek help. Can you imagine someone waiting 10 years for cancer treatment or 10 years for a heart transplant? This lag in help isn’t due to not needing help, but not knowing how to get help or being afraid to get help. When those struggling with mental health challenges are portrayed as violent, unpredictable, or ‘crazy,’ it’s not hard to imagine why they wait so long to get help. Unfortunately, those individuals are more likely to be the victims of violence, rather than the perpetrators. Stigma is preventing individuals from getting help, which could cost them their life.

Mental health stigma is literally killing people. Not through the tragedies broadcast on the news, but through suicide. Suicide is the 10th leading cause of death in the US, the 3rd leading cause of death in children aged 10-14, and the 2nd leading cause of death for youth aged 15-24. In fact, more young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease COMBINED. And rates in minority and LGBTQ communities are worse. Native American teens have a suicide death rate that’s twice the rate of Caucasian teens and for LGBTQ aged 10-24, suicide is one of the leading causes of death.

This is happening all over the country, all over the world, and our little Commonwealth is not immune. Massachusetts is higher than the national average at 11% of youth reporting experiencing at least one major depressive episode in the past year, and suicides in Massachusetts increased 40% from 2004 to 2014. In 2014, there were 608 recorded suicides, more than homicides and motor vehicle deaths combined. And that number is only rising.

Another concerning statistic is that while 55% of people who died by suicide in 2015 were in the middle of a mental health problem, only 39% were receiving services or treatment for mental health or substance use. Why aren’t individuals getting treatment for their mental health? Why is there a 10 year lag between symptoms and treatment? Why are we letting this issue hurt our families, friends, and neighbors?

We need to change the way we think about mental health and talk about mental health. Books and articles don’t have as much impact on the way we think as the people around us do. When you stand up and say something, you give permission to others to say something too. We need to create a culture where mental health can be talked about productively and openly. We need to create places that people can go to receive help without judgement or shame. We need to talk about how mental illness is not a sign of weakness but how seeking and accepting help is a sign of strength.

Families fight stigma because they are fighting against institutions and red tape that prevent their children from getting the care they need. They are fighting against negative connotations that cause their children actual harm. They are fighting against whispered words and dirty looks that make their children feel like mental illness is shameful. They are fighting against fear, against prejudice, against discrimination, against hate. But mostly important, they are fighting for something – for access to care, for a safe place in their communities, and for their children to have a chance to change their futures for the better.

 

This blog is part of HCFA’s Children’s Mental Health Week series.

May 4, 2018

In just a few days, children and youth, families and advocates will light up the Commonwealth in green to celebrate Children’s Mental Health Week (CMHW). This year’s theme is Supporting Families, Changing Futures. The Parent/Professional Advocacy League (PPAL), the Massachusetts Family Voice for Children’s Mental Health, explains the crucial interconnection between supporting families and improving children’s futures: data shows that children do better when they are with their families, in their communities and that supported families have access to more resources, advocate for their children’s needs more effectively, and enhance their skills as unique and talented caregivers. Finally, PPAL reminds us that by treating and keeping children in their communities, we can support families more effectively and change children’s futures for the better.

Improving access to mental health care for children and youth is a central component of Health Care For All’s work to create a Commonwealth in which everyone has the equitable, affordable, and comprehensive care they need to be healthy. While we can be proud that Massachusetts has the highest rate of children enrolled in health insurance coverage of any state in the nation, too often children and adolescents remain unable to access the mental health care they need when and where they need it. As a result, barriers to effective and appropriate treatment and care persist:

  • One in five youth (ages 13-18) have, or will have, a serious mental illness.
  • About 50% of students age 14+ living with a mental health challenge drop out of high school. This is the highest dropout rate of any disability group.
  • 71% of youth and young adults with substance use disorders also experience a co-occurring mental health disorder
  • African Americans and Hispanic Americans use mental health services at about half the rate of whites in the past year and Asian Americans at about 1/3 the rate

Health Care For All (HCFA) is proud to serve on the Executive Committee of the Children’s Mental Health Campaign (CMHC), working alongside the Massachusetts Society for the Prevention of Cruelty to Children (MSPCC), Boston Children’s Hospital (BCH), the Parent/Professional Advocacy League (PPAL), Health Law Advocates (HLA) and the Massachusetts Association for Mental Health (MAMH) to reform the children’s mental health care system in Massachusetts and lay the foundation for a comprehensive and coordinated system of evidence-based mental health prevention, diagnosis and treatment that is accessible to all children, adolescents and families.

To mark CMHW 2018 next week, HCFA will welcome a guest blogger from each of these organizations to highlight the challenges and opportunities in children’s mental health and the work we are doing individually and collectively to increase access, support families and change futures.

Please join us as we promote awareness about children’s mental health and work together to reduce stigma!

 

This blog is part of HCFA’s Children’s Mental Health Week series.

By Natalie Litton, Policy & Project Coordinator, Health Care For All

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