Mental health is defined in Healthy People 2020 as encompassing the ability to engage in productive activities and fulfilling relationships with other people, to adapt to change and to cope with adversity (USDHHS, 2010). In the United States nearly 57.7 Million adults (18 years and above) suffer from a mental health disorder in a given year and 6% of the population suffers from a serious mental illness (NIMH, 2010). The purpose of this paper is to look into the perspective of how best one can advocate for mental health disorder as a population health issue through various strategies including policy change. Population Health Issue and Population Affected
Mental health disorders have no boundaries and affect all people without regard to gender, race or age. They are the leading cause of disability in North America (WHO, 2008b). Despite the staggering number of people with mental health disorders, only 25% obtain help in any part of the health care system, while the majority receives no specialty mental health care. It is unrealistic to have a goal of “decreasing the prevalence of mental illness” because mental illness by its nature is a complex bio psychosocial disorder and any stressful event in life may be the cause of mental health problem and everyone is susceptible to it.
According to Byers et al. the number of people age 55 and above suffering from mood or anxiety disorders has been increasing for the last two decades and it has a trend of doubling itself every five years. This alarming trend will soon become a public health crisis as a large number of “baby boomer” generation ages. The increasing number of returning veterans is also another dimension to this crisis. A study conducted by RAND Corporation found that nearly twenty percent of servicemen and women returning from recent wars have some form of mental health condition (RAND, 2008). The estimated societal costs for the veterans based on prevalence and two years of treatment is estimated between $4.0 to 6.2 million. Advocacy Programs Researched in This Area
The impact of mental illness on overall health and productivity in the US is often under recognized. There are many reasons for this under recognition; mainly the misunderstanding of the illness itself, lack of resources, stigma, or lack of social support can be cited. The World Health Organization (WHO) in recognition of the need for adequate resources launched a mental health initiative called Mental Health Global Action Program (mhGAP) to raise awareness and address a variety unmet needs.
Other than WHO, consumer advocacy groups such as the National Alliance for the Mentally Ill (NAMI) deserve the credit for the advances made in the treatment of mental illness. The Paul Wellstone and Pete Domenici Mental Health Act otherwise known as the Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law in 2008. The main goal of this Act is to eliminate unequal health treatment practice that has kept individuals from seeking mental health care for a long time. The way this law works it that it does not force group health plans to cover mental health benefits, however when plans cover mental health, it requires that they provide full and equal benefit in a way that is no more restrictive than all other medical and surgical procedures covered by the plan. Effective Attributes of the Programs
MHPAEA has had quite an impact on the population since it went in effect in 2010. For starter, the statute does not require for employers to buy mental health benefits and employers with less than 50 employees are exempt of this statute. The second important point is that MHPAEA stipulates that any State law that provides greater protections than MHPAEA may continue to remain in effect. The last stipulation is great because it stops the Federal law (MHPAEA) from overriding a State law assuming that it protects its constituents better.
Unfortunately some employers have taken MHPAEA as an excuse to drop mental health benefits in its entirety. The Screen Writers Guild was the first employer to announce its decision to drop mental health coverage for its 12000 employees. Some employers followed suit citing rising cost of insurance and burden on employers. NAMI argues cutting mental health benefits has higher cost to employers. According to NAMI most mental illnesses are highly treatable. For example, the most common mental illness in the United States is depression.
The prevalence of depression is estimated to be 1 in 10 individuals of which 75% do not get the diagnosis nor the treatment. 72% are estimated to be in the workforce. NAMI estimates the indirect loss to employers amounts to 79 billion per year out of which 63 billion reflect loss of productivity due to mental illness. Mental illness causes more days of work loss and work impairement than chronic conditions such as hypertension, diabetes, asthma, arthritis, back pain and heart disease (NAMI, 2012). NAMI also claims that within two weeks of treatment 70 to 90% of individuals with depressions see a significant reduction of symptoms with and improved quality of life therefore it would be wise for employers to provide employees mental health coverage than incur costs for absenteeism. Health Advocacy Plan and Objectives for the Policy Implemented
The very first step of making a health advocacy plan is to review and understand the existing health plans and be able to establish how they impact on the patients, health care providers and other stakeholders like insurers and the leaders (Jonas & Kovner, 2011). The next step is to establish the pros and cons of having such health plans (Jonas & Kovner, 2011). This would then influence a particular advocacy plan and the objectives of the policy. The objectives should take into account the prime position played by politicians in policy change (Alberta Heath Services, 2009). To effectively advocate for mental health, one needs to understand what is actually available.
The facts are as follows: The US Department of Health and Human Services estimates that 47 Million of Americans are uninsured and out of this number 25% of them suffer from mental health or substance abuse disorder or a combination of the two. 1/3 of insured individuals have no coverage of both including outpatient therapy visits and inpatient crisis intervention. Then there is MHPAEA that exempts small groups therefore individuals insured under small group market may not have mental health coverage (unless the employer chose to provide one). The HHS estimates that about 95 percent of those with small group market coverage have substance abuse and mental health benefits (HHS, 2012). Communication to Various Stakeholders
Communication in the public health sector can be done in several forms including through the mass media, seminars, schools, and churches and depending on the situation, place and target group, several methods can be used including posters, speeches, skits and literature among others. As a policy oriented approach, it divides the target audience into primary, secondary and tertiary. The primary target addresses the organizations, groups and people with the power to effect change. The secondary target is represented by those who can be mobilized to participate in the implementation. The tertiary target is the general public (Alberta Heath Services, 2009). In effect, therefore, mass media as means of advocacy help the organizations and the general public to make better health choices. The approach of communication NAMI took is to involve all three targets.
The tertiary target i.e. the general public has also been the focus of NAMI especially because of the link between mental illness and substance abuse. Efforts to raise awareness are underway especially in the DC metro area where frequent walks organized by NAMI are happening. The aim of NAMI walks is to raise awareness of mental health and well-being in communities and to improve the general understanding of the illness, and reduce the misunderstandings and stigma associated with it. NAMI educates and trains practitioners and patients of the different pathways to recovery. Health practitioners, especially nurses get a larger opportunity to educate about the disease in their area of practice and also be the voices for the patients who do not have a voice. Data and Evidence to Substantiate Proposed Need
The Patient Protection and Affordable Care Act (ACA), which is commonly referred to as the ObamaCare, has become regarded as a historical law ever since it was signed into the law in March 23rd, 2010 by President Obama (American Public Health Association, 2013). ACA built on the structures of MHPAEA to expand coverage of mental health and substance use disorder for more than 62 million Americans in the following three ways: 1.Essential Health Benefits
Mental health and substance use disorders will be part of all individual and small group market “non-grandfathered” insurance plans (essential health benefits) effective January 1st 2014. “non-grandfathered” means plans that were not in existence before ACA was signed into law. This statute ensures that at least 5.1 million individuals (3.9 million currently covered in the
individual market and 1.2 covered in small group plans) and will gain either mental health or substance use disorder coverage or both. 2.Parity in the Individual and Small Group Markets
Under the ACA and the MHPAEA 7.1 million Americans currently covered in the individual market who currently have some mental health and substance use disorder benefits will have access to coverage of Essential Health Benefits comparable to their general and surgical medical coverage. 3.Increasing Access to Quality Health Care
Finally, the ACA will expand essential health benefits insurance coverage to an estimated 27 million uninsured Americans through access to insurance market places and CMS. The essential Health Benefits packages includes mental health services In total, the Affordable Care Act will expand federal parity protection to at least 62 million Americans. Application of Attributes of Effective Advocacy Programs to Proposed Campaign
Among many other health-care policies that have proved to be workable, Obamacare turned out to have adequate advantages that can be borrowed and applied in this campaign. Obamacare health policy emphasizes on quality health-care and not quantity. For instance, doctors and other health-care professionals are paid according to the quality of health service they provide (Obama Care Facts, 2013). Obamacare also highlights the importance of non-discrimination in the provision of health services across the entire population, thus ensuring uniformity in its application.
One yet another vital attribute that is also of importance is the reduction of costs for preventive health-care options. This ensures that options explored by the general public are not exploitative and overburdening to them (Obama Care Facts, 2013). Obamacare has also been to a greater degree people-driven, as the citizenry have been effective in pushing their political leaders to support the health plan (Obama Care Facts, 2013). It does not take rocket science to know that mental health and substance abuse disorder patients would benefit tremendously from such a program. Impact of Existing Laws or Regulations
The Patient Protection and Affordable Care Act legislation contained several health reforms provisions that were already being rooted for by a number of health stakeholders including American Public Health Association (APHA) and other population health experts (APHA, 2013). Following the enactment of the Affordable Care Act, there has been a shift from the focus on treatment of the sick to the focus on promoting people’s health (APHA, 2013).
The ACA and HP2020 have a common goal which is to create social and physical environments that promote health and wellness in all populations. The ACA will be effective in January 2014, so far the program looks very promising and the statute have been found to have very little impact on the employer-based insurance with a projected slight increase (2.7% only), especially with regard to the high end employers. However, there appears to be a decrease for the low end employers (Blumberg et al., 2012) contrary to what the critics of ACA are speculating. Analysis of Methods Used to Influence Policy Makers
According to Milstead (2013), for nurses to succeed in advocating for the enactment of new and better policies, it is imperative that they strike a working relationship with the government agencies, officers as well as with the elected officials. This way the nurses have the chance to be recognized as having what it takes to effect policies concerning population health issues, and this will thus be included in making decisions concerning population health matters (Milstead, 2013).
Establishing such a cordial relationship would be instrumental in helping both parties, namely the nurses and the policy makers to be able to review existing health policies and enact better campaigns (Milstead, 2013). Other than striking a rapport with the political leaders, the nurses should also strive to enhance their understanding of the policy-making process through the nursing internships that were already put in place by the nursing organizations (Milstead, 2013). Anticipated Obstacles and Strategies
According to the online article by Alberta Health Services (2009), several challenges abound when it comes to advocating for population health. The leading and most obvious problem lies in the main aim of advocacy, which is to effect legislations that would then lead to changes in policies. This is the case since the policy change is highly a political issue whose process results in public tensions (Alberta Health Services, 2009). Almost all legislative changes and implementations are funded by the public resources, and, therefore, any suggested changes are often contested (Alberta Health Services, 2009).
Further still, these changes often have economic consequences as well. As a result, more often than not population health advocates together with the like-minded politicians and members of the public of good will find themselves at the receiving end on the part of various interest groups who wish to maintain the status quo (Alberta Health Services, 2009). Obamacare, which seeks to provide preventive services also covered in insurance plans and to ascertain that people with insurance covers are not dropped while sick, has for instance, faced several obstacles mainly from the stakeholders in the insurance industry (Obama Care Facts, 2013). Anybody who wishes to conduct a successful advocacy for mental health and substance abuse disorders must be prepared to deal with all these obstacles, especially given that most insurance companies would be less willing to cover against mental health.
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