Briefing on Mental Health and Substance Abuse

The COVID-19 pandemic is exacerbating the mental health crisis the US was already facing. Experts are warning mental health issues and substance use disorders are becoming more challenging for people who already have these conditions and may lead to new cases in the general population. Before the pandemic unfolded in early 2020, 40% of US adults said they were struggling with mental health or substance use, and 15% reported symptoms of “serious psychological distress.” These symptoms are at the highest among young adults, people with low incomes, and people of color.

Mental illness is often devastating for the patients, their families and loved ones. Schizophrenia and bipolar disorder are cruel by nature. Left untreated or undertreated, they can result in tragedy. When patients do seek treatment, they are often faced with seemingly insurmountable hurdles.

What can policy makers do to improve our handling of these issues and make treatment more easily accessible to those who need it? Utilization Management tools such as prior authorization/step therapy are hurdles that need to be addressed. Also known as pre-approval or fail first requirements, these utilization procedures are designed to cut costs for public and private insurers by limiting access to medications—a strategy that has backfired.

Health outcomes data shows that prior authorization policies for psychotropic medications in Medicaid patient populations have led to poorer outcomes for patients, including medication discontinuation, lapses in care, homelessness, emergency room visits, incarceration and an increased use of crisis services. Additionally, this approach stretches an already stretched provider group by adding to the administrative burden of providing care in our current healthcare system.

Our experts will discuss how these methods to restrict access to medications hurts patients and state pocketbooks, and provide concrete examples of efforts to eliminate the burden of prior authorization on individuals, providers and communities.

Mental health treatments are not one size fits all. Treatment plans should be designed between a patient and his or her doctor, and not burdened by restrictive policies.

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In Depth: Health

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