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Health Insurers Are Still Skimping On Mental Health Coverage

Because of low reimbursement rates, Harbin said, professionals in the mental health and substance abuse fields are not willing to contract with insurers

Health Insurers Are Still Skimping On Mental Health Coverage
November 30, 201710:38 AM ET

It has been nearly a decade since Congress passed the Mental Health Parity And Addiction Equity Act, with its promise to make mental health and substance abuse treatment just as easy to get as care for any other condition. Yet today, amid an opioid epidemic and a spike in the suicide rate, patients are still struggling to get access to treatment.

That is the conclusion of a national study published Thursday by Milliman, a risk management and health care consulting company. The report was released by a coalition of mental health and addiction advocacy organizations.

Among the findings:

In 2015, behavioral care was four to six times more likely to be provided out-of-network than medical or surgical care.

Insurers paid primary care providers 20 percent more for the same types of care than they paid addiction and mental health care specialists, including psychiatrists.

State statistics vary widely. In New Jersey, 45 percent of office visits for behavioral health care were out-of-network. In Washington, D.C., it was 63 percent.

The researchers at Milliman examined two large national databases containing medical claim records from major insurers for PPOs — preferred provider organizations — covering nearly 42 million Americans in all 50 states and D.C. from 2013 to 2015.

“I was surprised it was this bad. As someone who has worked on parity for 10-plus years, I thought we would have done better,” says Henry Harbin, former CEO of Magellan Health, a managed behavioral health care company.


Borderline Personality Disorder: Treatment Resistance Reconsidered

A major longitudinal study of BPD and other personality disorders with 16 years of follow-up showed that virtually all subjects with BPD achieve sustained remission for at least 2 years, and 78% sustain remission for 8 years.

Borderline Personality Disorder: Treatment Resistance Reconsidered

November 27, 2017 | Special Reports, Borderline Personality, Psychopharmacology
By Lois W. Choi-kain, MD, Ethan I. Glasserman, and Ellen F. Finch

The concept of treatment resistance deserves reconsideration. Originally formulated in psychoanalytic terms, resistance in treatment referred to the inevitable ways patients unconsciously express their psychology in terms of defense mechanisms and transference enactment. This form of resistance provides a window into the patient’s problems; therefore, it is a major focus of the inquiry and intervention. Modern psychiatry defines treatment resistance as a lack of response to adequate treatment. Both conceptualizations locate treatment resistance within the patient, rather than as a product of limited, underdeveloped, and ineffective treatments. As a result, the term “treatment resistant” can fuel views of patients as “oppositional” and recalcitrant, instead of expectably symptomatic.

Treatment resistance is highly prevalent across most psychiatric disorders—even in common diagnoses generally associated with positive outcomes, such as depression. There are many more obstacles to effective treatment (Figure 1) than the patient’s psychological resistance alone. Identification of specific factors that diminish treatment response may provide more useful points of intervention than the label of treatment resistance.

Comorbid disorders contribute to poor treatment response. Treatment guidelines are often based on a false assumption that patients present with single disorders that respond to specific evidence-based treatments. Regardless of increasing attention to problems of comorbidity, guidelines for combining and prioritizing the treatment of different diagnoses remain largely underdeveloped.

Comorbid personality disorders complicate treatment. Over 50% of patients in specialized psychiatric settings have personality disorders.1 These patients are more likely to face social adversity, suffer from complex comorbidities, and drop out of treatment or not adhere to medication regimens—all of which contribute to an increased risk of a lack of response to treatment. The presence of a personality disorder, particularly borderline, predicts persistence of anxiety and substance use disorders as well as poorer outcomes in depressive disorders. Moreover, 13% of those who complete suicide have personality disorders.2


Borderline Personality Disorder: Not Just an Adult Condition

Many start engaging in high-risk behaviors, such as substance abuse or self-harm, to help deal with the emptiness. The picture of BPD begins to emerge.

Borderline Personality Disorder: Not Just an Adult Condition

Batya Swift Yasgur, MA, LSW
November 20, 2017

To shed light on this ongoing controversy and its therapeutic implications, Psychiatry Advisor interviewed Carla Sharp, PhD, professor and director of clinical training in the Department of Psychology at the University of Houston, Texas. Dr Sharp is the co-editor of the Handbook of Borderline Personality Disorder in Children and Adolescents2 and the co-founder of the Global Alliance for Early Prevention and Intervention for Borderline Personality Disorder (GAP) Initiative.

Psychiatry Advisor: What is the controversy surrounding the diagnosis of BPD in adolescents?

Dr Sharp: Ever since the first descriptions of BPD and specification of its diagnostic criteria in the DSM [Diagnostic and Statistical Manual of Mental Disorders], there was no restriction placed on diagnosing it in adolescents. Nevertheless, in our training programs, we were taught that one does not make a personality disorder diagnosis before age 18 years, even though the DSM allows for it.

One of the major arguments raised against diagnosis prior to age 18 is that, since the personality is still forming and identity is still being consolidated, a personality disorder cannot be accurately diagnosed.

A strong research base2 has been mounting, especially in the past 10 years, supporting the concept of a diagnosis of BPD in teens. It has been found that personality traits are as stable in children and adolescents as they are in adults. In other words, we have overestimated the stability of personality traits in adults. We used to see them as fixed and stable and postulated that they would be less stable in children and adolescents. But in reality, this is not the case. Traits wax and wane in both age groups.

Psychiatry Advisor: Adolescence is often a time of angst, stormy emotions, moodiness, and confusion. How do BPD traits differ from those of normal adolescence?

Dr Sharp: The first clue that a teenager may not be experiencing “normal” adolescent angst is that these traits likely began before adolescence and even in childhood. Children come into the world with a given temperament, and in the case of these children, they are unusually sensitive. I compare this type of child to a burn victim. When you touch the skin of a burn victim, he or she experiences pain that is far greater than the pain that might be experienced by an ordinary person from the same type of touch.



A recent CDC report shows that the percentage of adults with serious psychological distress who are uninsured has dropped from 28.1 percent in 2012 to 19.5 percent in the first nine months of 2015.



Look at a map of states president-elect Donald Trump won in November alongside a map of states with the highest rates of opioid prescriptions, and you’ll see they mostly overlap. Look more closely at the data, as one Penn State professor recently did, and you’ll find that Trump outperformed his Republican predecessor Mitt Romney the most in counties where opiate and suicide mortality rates are highest.

It’s little wonder, then, that mental health and substance abuse issues have become a key talking point for Trump, who has promised to crack down on drug cartels and called America’s mass shootings an issue of mental health—not guns.

He’s not the only Republican to adopt behavioral health as a priority. House Speaker Paul Ryan pushed for mental health legislation in the wake of the San Bernardino shooting. Senate Majority Leader Mitch McConnell, whose home state of Kentucky is a leader in opioid deaths, recently penned an op-ed titled “More Must Be Done on Heroin – soon.” And the Republican-authored 21st Century Cures Act, signed into law in December, will set aside $1 billion over two years to fight opioid abuse.

And yet, late last week, Senate and House Republicans set in motion the first steps of a plan that researchers warn could cut mental health and substance abuse treatment off at the knees: the repeal of Obamacare.

“I don’t think there’s anyone in the mental health community who thinks withdrawing the Affordable Care Act would be good for behavioral health,” says Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, who advised the George H.W. Bush, Clinton, and Obama administrations on health policy. “It’s hard to even conceive of how that would be true.”



Trumpcare Will Be Catastrophic For People With Mental Health Issues

Experts in behavioral health and lawmakers who have been fighting for mental health awareness vehemently oppose the legislation.

Trumpcare Will Be Catastrophic For People With Mental Health Issues

House Republicans on Thursday passed an updated version of the American Health Care Act, which could affect the millions of people who live with a mental health or substance-use disorder.

Analysis of the GOP bill by various organizations shows a grim outlook. Not only would people dealing with mental health conditions or drug dependency have to pay higher premiums, many may not even be covered.

This could have serious consequences, with the country in the throes of one of history’s worst opioid epidemics. Drug overdose is the leading cause of accidental death in America.

And, according to experts, if Trumpcare becomes law, it may undo years of progress on behavioral health.

How the bill can affect those with mental illness and addiction

The legislation threatens to gut protections for the majority of people with pre-existing conditions, which could include mental illnesses and addiction. This means the GOP legislation could allow insurers to make coverage more costly for people with existing health issues.

Premiums are likely to skyrocket. A person around the age of 40 with a drug dependency could see increases as high as 500 percent, according to the liberal think tank Center for American Progress. Those with bipolar disorder or major depressive disorder may see a 200-percent rise in surcharges.


Professor who developed therapy for uncurable mental illnesses wins 2017 Grawemeyer Award in Psychology

The institute’s mission is to transfer the principles of dialectical behavior therapy to more practitioners and to aid current practitioners with the burnout that can come with working with heard-to-treat patients.

Professor who developed therapy for ‘uncurable’ mental illnesses wins 2017 Grawemeyer Award in Psychology
By MELISSA CHIPMAN | December 3, 2016 6:00 am

Marsha Linehan, director of University of Washington’s Behavioral Research and Therapy Clinics, Center for Behavioral Technology, has been selected as the 2017 Grawemeyer Award winner in Psychology.

Disorders like borderline personality and suicidal ideation have long been considered nearly impossible to treat, but Linehan has developed dialectical behavior therapy, which has shown positive effects during studies. The treatment is a type of cognitive behavioral therapy that teaches four skills to clients: mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation.

“In addition to being considered the state-of-the-art treatment for chronically suicidal individuals, dialectical behavior therapy has been found to be effective for other behavioral disorders, including eating disorders, addiction, anxiety related disorders, post-traumatic stress disorder and depression,” said Professor Woody Petry, award director, in a news release.

Linehan is a Zen master and is credited for bringing Zen-informed practices, like “being fully present in the moment,” into mainstream psychotherapy.

“At a young age, I vowed to get myself out of hell and then to go back and get others out,” said Linehan, who acknowledged publicly in 2011 her own longtime struggle with suicidal ideation and behaviors similar to those found in borderline personality disorder.