SUSAN A. PICKETT, PH.D.ADVOCATES FOR HUMAN POTENTIAL, INC.

CONNECTING PEOPLE WITH SERIOUS MENTAL ILLNESS TO

HEALTHCARE: EARLY LESSONS LEARNED

PRESENTATION OVERVIEW

• Why health care matters

• Promises of the ACA for people with SMI

• Connecting people with SMI to health coverage and care

• What we know so far

HEALTH CONDITIONS OF PEOPLE WITH SMI

• The physical health of people with SMI is among the worst in the nation• Mortality rate is 2-3 times that of the general population

• On average, people with SMI die 25 years earlier than non-disabled peers

• High rates of diabetes, cardiovascular disease, metabolic syndrome, respiratory diseases, obesity

• Psychiatric symptoms and medications may worsen some health conditions

• People with SMI’s high rates of co-occurring substance use, poverty, homelessness and criminal justice involvement contribute to poor health

MISSION IMPOSSIBLE: ACCESSING HEALTH CARE

• Most chronic health conditions are preventable(!!) but few people with SMI get appropriate care• Less access to ANY health care• Poorer service quality• Poor health literacy• Less likely to receive specialty and/or follow-up care

• Even if they can access it, most people with SMI can’t afford health care• 24% of people with SMI are uninsured• 2.7 million low income people with SMI don’t qualify* for Medicaid*Pre-Affordable Care Act (ACA) implementation

MISSION IMPOSSIBLE PART 2:HEALTH INSURANCE BENEFITS

• Even when they can afford it, health insurance* doesn’t cover it• No or few benefits for mental health and substance use treatment• Health plans consider SMI a pre-existing condition• Stricter lifetime limits for mental health care than other types of

care

• Medicaid is not an option*• Childless adults don’t qualify• Disability status difficult to prove

*Pre-ACA implementation

PROMISE OF THE ACA FOR PEOPLE WITH SMI

• Low income people with SMI now qualify for Medicaid• In States with Medicaid expansion, single adults with incomes

138% below the Federal Poverty Level qualify for Medicaid regardless of disability status

• Marketplace plans offer affordable insurance• ALL plans:

• Must cover mental health and substance use treatment• Must provide mental health and substance use treatment at parity• Can’t drop or reject people because they have SMI

GOT COVERAGE: NOW WHAT?

• “What’s in my health plan?”• “Where do I go? Who’s my doctor? How do I

make an appointment?”• “What’s wrong with just going to the emergency

room when I get sick?”• “Why do I need a check-up, I’m as healthy as a

horse!”

WHAT DO WE KNOW SO FAR? NOT MUCH

• People with SMI are enrolling but data on exact numbers not yet available

• Anecdotal evidence suggests:• Enrolled but waiting for final processing and approval• Enrolled but plans are changing• Enrolled but not using services• Enrolled and using services

WHAT PSYCHOLOGISTS CAN DO

• Think outside the box: Innovative interventions• Peer health navigators• Care coordination entities for vulnerable populations• Jail and probation enrollment• Health fairs/health screening for people with SMI

• Health care happens everywhere, including in your office