Challenges & Opportunities: Whats Ahead for the Psychiatric-Mental Health Nurse? Virginia Trotter...
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![Page 1: Challenges & Opportunities: Whats Ahead for the Psychiatric-Mental Health Nurse? Virginia Trotter Betts, MSN, JD, RN, FAAN Commissioner/TDMHDD National.](https://reader036.fdocuments.in/reader036/viewer/2022062417/55156314550346a1418b4ba3/html5/thumbnails/1.jpg)
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
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THE BIG WOW!
o The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA)
o The Patient Protection and Affordable Care Act (PPACA)
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U.S. Health Delivery System
o The dominant models of providing health care in the United States separate the mind and body.
o 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
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o Americans understand that mental health is essential to overall health.
o Mental health care is consumer and family driven.
o Disparities in mental health services are eliminated.
o Early mental health screening, assessment, and referral to services are common practice.
o Excellent mental health care is delivered and research is accelerated.
o Technology is used to access health care and information, including within the mental health field, and privacy is protected.
Goals for a Transformed System
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o Agencies and providers operate in partnership rather than in “silos”
o 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…
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Implementation of Parity
o 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.
o Law applies to employers with 50 or more workers and whose health plans offer mental health or substance abuse benefits.
o Must now offer those mental health/substance abuse benefits at the same level as their medical/surgical benefits.
o The deductible, co-pays, and maximum out-of-pocket amounts must be unified.
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Implementation of Parity
Concerns:
o Nothing in the law that requires plans to cover mental health or substance abuse benefits
o Plans are free to exclude any particular mental health or substance abuse condition/diagnosis from coverage.
o 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).
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Implementation of Parity
Impact on psychiatric nurses:
o Passage of parity will lead to increased utilization of reimbursable mental health and substance abuse services
o Public mental health/substance abuse service systems will experience less burden for underinsured persons
o 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
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Health Care Reform
Patient Protection and Affordable Care Act
o Facilitates more affordable health insurance for over 32 million Americans.
o Eliminates pre-existing condition exclusion for children and youth immediately and for all by 2014
o Expands Medicaid up to 133% of FPL and includes childless adults.
o Allows young adults to remain on parents’ health plan through age 26.
o Creates a temporary high risk pool to provide health insurance to uninsured adults with pre-existing conditions
o Delivery system redesign, “pilots” by grants/waivers
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Health Care Reform
Provisions related to behavioral health:o Substance use disorder and mental health (SUD/MH) services
required in base benefit packages of individual and small group markets.
o All plans in insurance exchanges must adhere to Parity Act.
o All newly eligible Medicaid enrollees will receive basic benefits including SUD/MH services at parity.
o SUD/MH included in health promotion and chronic disease prevention initiatives.
o SUD/MH workforce included in workforce development initiatives.
o SUD and MH providers are eligible for community health team grants to support medical homes.
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Health Care Reform
Provisions that directly affect nurses:o Increased funding for nursing workforce development
programs – Advanced Education Nursing– Workforce Diversity Grants– National Nurse Service Corps
o Support for Nurse-Managed Clinicso Increased funding for nurse home visit programso Nondiscrimination provision that includes nurse
practitioners; provider neutral language
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Health Care Reform
Possible impacts of reform on nurses:
o Increased work load as millions of Americans become insured and have access to behavioral health benefits
o Increased opportunities for enhanced nursing education
o Increased opportunities for nursing leadership in health care
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What’s ahead for the PMH Nurse?
o Integration of mental health and substance abuse treatment models
o Mental health promotion, substance abuse prevention, screening, and referral as basic services
o Increased care services for mental health and substance abuse in primary care and FQHCs
o Expectation of use of evidence-based practices
o Philosophy = full recovery even from serious illnesses
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Integration
o Integration of mental health and substance abuse services to treat co-occurring disorders
o Integration of mental health/substance abuse services with primary care
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Best PracticesA responsive mental health system must provide a continuum of services utilizing the best practices of health and science and should include the following:
o Prevention/Early Intervention
o Active and effective treatments and care
o Follow up care/relapse prevention
o Social Supports
o Recovery/rehabilitation
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Role of Nurses
2009 Opinion Leader Survey by the Robert Wood Johnson Foundation and Gallup
o Nurses are trusted sources of information and care
o Nurses should have more influence in
– Improving care and reducing errors
– Helping healthcare system adapt and change
o Nurses need a unified voice to be heard
o Society and nurses should have higher expectations about what nurses can achieve and the health leadership they can provide
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What Should Nurses Voice?
o Universal Access
o Cost effective services
o Services delivered timely and with accuracy
o Full utilization of qualified providers
o Balance of services between health and illness
o Integration of physical and mental health
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2010: Not-To-Be-Missed Opportunities
o Parity
o Health Care Reform
o Integration as the key to health care delivery
reform
o Build upon increased awareness that mental
health is essential to health
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Health is likely the most important element in life.
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Mental health is fundamental
to health.
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Health Care Reform Resources
o Healthreform.gov
o Nursingworld.com > Health Care Policy tab
o Kaiser Family Foundation
http://healthreform.kff.org
o http://www.thenationalcouncil.org
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Enjoy Nurses Week 2010
“Nurses: Caring Today for a Healthier Tomorrow”