It’s the Head AND the Heart

tt57.jpgIt’s a quiz that most people would fail. Ask someone what they think healthcare “covers,” and they’ll probably reply that it refers to physical health, something related to our five senses. It’s an obvious and warranted association, but there is a larger connected issue here to which we pay far less attention: behavioral health. On its own, it’s critically important, and when combined with the physical side of the healthcare discussion, it takes on even greater dimensions.

While the connective tissue between physical and behavioral health isn’t new, a recent report from The Rutgers Center for State Health Policy: Role of Behavioral Health Conditions in Avoidable Hospital Use and Costs:, clear about the costs and the negative effects on New Jerseyians because we lack an integrated approach to both physical and mental health.

A bit of context helps explain where we are today. In 2008, Congress passed the Mental Health Parity and Addiction Equity Act. In simple English, it required that insurers give parity — that is, attention and equal treatment — of benefits to those who suffer from mental health issues and substance abuse as they do for people with physical problems. There was reluctance by states to enforce the law, because the federal government failed to issue guidelines interpreting the law until five years later. Some states are waking up to the lack of insurers giving equal attention to people with behavioral health problems. New York Attorney General Eric Schneiderman is taking vigorous action to “take on those who ignore the law and reinforce the false and painful stigma often associated with [mental health] ailments.” His state is apparently the first one to take a lead role in defending the rights of equal mental health coverage.

Coupled with this dormant approach for appropriate coverage on the part of most insurers is the influx of people entering the health care system because of the success of the Affordable Care Act. We will have many more people accessing and straining the healthcare system under this new model.

And as this occurs, we simply can’t ignore the number of people affected with behavioral health and addiction issues and its consequences on the entire healthcare system. One in four adults experiences a mental health problem in any given year. One in 17 lives with serious, chronic illness.  The Rutgers report notes that 75 percent of people who visited hospitals frequently — their defacto primary care option — suffer from one or more behavioral health issues. While we can’t dismiss the personal sufferings of these individuals, the corresponding costs for this lack of integrated health is staggering. After studying 13 low-income New Jersey communities cited in the Rutgers report, one-third of costs associated with these repeated hospital visits result in more than $880 million annually for inpatient expenses. The report further noted that hospitals might have been able to reduce admission by 40 percent if there had been a suitable alternative for behavioral health treatment.

Thus, we have a two-sided issue. Improved and more convenient patient care dealing with behavioral health on one side, and the huge costs incurred by these issues on the other. By convenient, I’m referring to the separation of these two health issues created in part, by either a lack of facilities or the need for those afflicted with behavioral health issues to make repeated visits that becomes burdensome, indeed often impossible for those of modest or little means.

The silver lining for a solution is that by addressing the behavioral health issue holistically, we can begin to ameliorate if not solve the problem.  We have to remove the barriers that separate behavioral health issues from physical issues.

In an Op-Ed article written by my colleagues, Sen. Joseph F. Vitale (D-Middlesex) and Sen. Robert Singer (R-Ocean), they offered a remedy. They wrote: “The need to comprehensively treat the whole individual could not be clearer. The good news is that by adopting evidence-based models of care that integrate mental health and substance abuse into the primary care settings, we can improve patient outcomes and reduce overall health care costs.”

We all suffer wounds. The wounds of the body are sometimes visible to us all: a limp, leaning on a cane, being led by a seeing-eye dog or someone wearing a neck brace.  But the wounds that reside in our mind are every bit as real, just different. Let’s ensure that we treat both groups with equal and fair consideration.

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  • Daniel O'Connell
    commented 2015-04-16 14:56:24 -0400
    Interesting article. Thanks for posting it. I remember when HMO’s were first introduced that was part of the rationale. If one could afford to go to the doctor more often we would be healthier and health care costs would slow or maybe go down. That didn’t happen. Unfortunately as you point out mental health issues aren’t as apparent as someone with cancer, diabetes, broken limbs and on and on. Some people think those with mental health issues are malingering or worse just making it up. They become stigmatized and may avoid treatment, if they can get it, only making matters worse.