Our Health Policy Matters

One of the most controversial elements of bipartisan mental health reform bills in Congress is a surprising one. It’s an effort to amend a 45 year-old regulation that outlived its useful life twenty-five years ago when the Americans with Disabilities Act (ADA) was signed into law.  It is referred to in Washington as “42 CFR Part 2.”  You might know it as the rule that forces you to sign at least two authorizations, instead of one, just to get your own health records sent from one place to another. Today, if you sign an authorization stating “please share all of my health records and medical history with another provider,” you might think that second provider is going to get everything.  But 42 CFR says substance use disorder isn’t covered by that – for that, you need a second one. Keep in mind that in 1970, when 42 CFR was being considered, you could discriminate against someone with a substance use disorder.  You could even fire them from their job....

One of the most controversial elements of bipartisan mental health reform bills in Congress is a surprising one. It’s an effort to amend a 45 year-old regulation that outlived its useful life twenty-five years ago when the Americans with Disabilities Act (ADA) was signed into law.  It is referred to in Washington as “42 CFR Part 2.”  You might know it as the rule that forces you to sign at least two authorizations, instead of one, just to get your own health records sent from one place to another. Today, if you sign an authorization stating “please share all of my health records and medical history with another provider,” you might think that second provider is going to get everything.  But 42 CFR says substance use disorder isn’t covered by that – for that, you need a second one. Keep in mind that in 1970, when 42 CFR was being considered, you could discriminate against someone with a substance use disorder.  You could even fire them from their job....

I was asked recently why I didn’t actively seek out a specialized school setting many years ago in which to educate my son. My son has a serious mental illness, one which first manifested when he was a child.  I’ve written about this before in Health Affairs and will write about it again in a book scheduled for publication later this year. The argument is this.  If you put children with a special condition – such as serious mental illness – into a classroom with other children with the same condition, then you can adjust your educational services to meet the needs of those children all at the same time – and you will get better outcomes. That’s essentially how our health care delivery system has often been built, too.  Through most of the twentieth century, people with mental illnesses were treated in one set of hospitals (usually state hospitals). And people with most physical conditions were treated in a different set of hospitals. I wrote “mos...

I was asked recently why I didn’t actively seek out a specialized school setting many years ago in which to educate my son. My son has a serious mental illness, one which first manifested when he was a child.  I’ve written about this before in Health Affairs and will write about it again in a book scheduled for publication later this year. The argument is this.  If you put children with a special condition – such as serious mental illness – into a classroom with other children with the same condition, then you can adjust your educational services to meet the needs of those children all at the same time – and you will get better outcomes. That’s essentially how our health care delivery system has often been built, too.  Through most of the twentieth century, people with mental illnesses were treated in one set of hospitals (usually state hospitals). And people with most physical conditions were treated in a different set of hospitals. I wrote “mos...

A Kaiser Health News sampling of the latest headlines about Obamacare reflects our continuing anxiety over the law just months before it is fully implemented. The most interesting to me was this one.  According to a new CNN poll, only 43 percent of the public favors Obamacare .  But of those who oppose it, only 35 percent do so because it is too liberal.  Sixteen percent say that it is not liberal enough! No matter how you feel about Obamacare, one of the most significant changes it facilitates will be the integration of health and behavioral health care – meaning that care for both physical and mental illnesses will soon be delivered together. This only makes sense.  People with cancer, for example, often develop depression or anxiety that complicates their care.  And people with mental illness often develop physical conditions – sometimes as a side effect from the medications they take – that can cut twenty-five years from their lives. Inte...

A Kaiser Health News sampling of the latest headlines about Obamacare reflects our continuing anxiety over the law just months before it is fully implemented. The most interesting to me was this one.  According to a new CNN poll, only 43 percent of the public favors Obamacare .  But of those who oppose it, only 35 percent do so because it is too liberal.  Sixteen percent say that it is not liberal enough! No matter how you feel about Obamacare, one of the most significant changes it facilitates will be the integration of health and behavioral health care – meaning that care for both physical and mental illnesses will soon be delivered together. This only makes sense.  People with cancer, for example, often develop depression or anxiety that complicates their care.  And people with mental illness often develop physical conditions – sometimes as a side effect from the medications they take – that can cut twenty-five years from their lives. Inte...