Joint bulletin from CMS & SAMHSA paves the way for a systems of care approach
May 09, 2013
May 09, 2013
A remarkable development took place on Tuesday at the SAMHSA National Children’s Mental Health Awareness Day kickoff. The Centers for Medicare and Medicaid Services (CMS), along with the Substance Abuse and Mental Health Services Administration (SAMHSA), issued a Medicaid bulletin to states regarding “their options for structuring mental health benefits as part of an agency-wide effort to draw attention to behavioral health services.” The bulletin “encourages states to design benefits that allow many young patients with mental health needs to live at home and get services in the community rather than be institutionalized.”
This is really important Network faithful, and here is why:
Let’s let this sink in for a moment
For those of you reading this who have been involved with the Child Mental Health Initiative you know how important this document is. In the over 25 years I have been involved with this movement there has always been a brutal conundrum facing those trying to implement a system of care approach to improving services and supports for children, youth and families – how the heck do you pay for what has been shown to work once the demonstration grant ends? Sustainability of “proven” effective service delivery approaches unfortunately often falls just outside of what is considered Medicaid billable – hence the conundrum and the often predictable slide towards “usual care,” a term coined by Garland, et al. in a recent journal article titled Improving Community-Based Mental Health Care for Children: Translating Knowledge into Action (see our review here). The journal article lays out some sobering statistics regarding quality in traditional mental health services. They note that 68% of the care in the studies reviewed was clinic based. A sobering reminder of how fragile our current mental health services are is the finding that “a third of the directors with site-specific budget data indicated that their agency ran at a budget deficit.” This is so important for advocates to understand. For us, “what works” goes far beyond usual care. It involves the active participation of community groups and families and the use of services and supports like those mentioned in the joint bulletin released on Tuesday. If we allow policy makers to just fund what we do now, (i.e., usual care) then we are doomed to a mediocre at best mental health service delivery system. We need a system that evaluates and supports services beyond usual care if we are going to make significant improvements. This bulletin is a huge step in helping to make that happen.
So what should you do? We are so glad you asked!
Okay, that’s a start. Let us know what your ideas are for promoting services that work and enable children with complex mental health needs – many of whom have traditionally been served in restrictive settings like residential treatment centers, group homes and psychiatric hospitals – to live in community settings and participate fully in family and community life.
President & CEO
Children’s Mental Health Network