SAMHSA, CMHS discuss integration of early intervention, coordinated care into U.S. mental health care system

At a national advisory council meeting Wednesday, members of the Substance Abuse and Mental Health Services Administration discussed potential approaches to mental health services that would achieve better patient outcomes while efficiently using available resources and recently awarded federal funding.

To illustrate the benefits of early intervention and a coordinated specialty care model, Robert K. Heinssen, PhD, of the National Institute of Mental Health, presented results from trials within the Recovery After an Initial Schizophrenia Episode (RAISE) initiative, a research project of the National Institute of Mental Health.

The RAISE Early Treatment Program (ETP) compares two treatment approaches for patients experiencing the early stages of schizophrenia and related illnesses in 34 clinics across 21 U.S. states. Both approaches include comprehensive initial evaluation at the earliest point after symptoms appear. Treatments may include medication, psychosocial therapies and supportive services.

“Our [current] treatment systems tend to focus on disease management, rather than trying to get in front of this process and encourage more of a recovery focus,” Heinssen said during the meeting. “There is a cost to that strategy, about $63 billion, of which only about a third is associated with treatment costs. Other costs are associated with homelessness, criminal justice involvement, caretaker burden and so forth.”

In an effort to find an approach to mental health services encourage positive outcomes while using resources efficiently, the RAISE trials explore how to efficiently integrate early intervention into the current mental health care system.

“[Services] are delivered in a shared decision-making framework, where there is a collaborative approach to treatment where the individual receiving services and the people providing services are engaged in a dialogue around problems, needs, goals and approaches,” Heinssen said.

Using federal funding

In April 2014, President Obama signed legislation that may enable the evidence-based approaches explored in the RAISE trials and other studies to be applied to the U.S. health care system.

“Section 223 of the Protecting Access to Medicare Act is a demonstration program to improve community behavioral health services by increasing access and expanding services in community behavioral health clinics and improving Medicaid reimbursement for community behavioral health services,” Cynthia Kemp, MA, LPC, chief of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) community support programs branch, said during the meeting. “This is a big deal. This act is an infusion of dollars into our systems.”

Section 223 set a goal to create and evaluate a demonstration program that implements community behavioral health clinics that emphasize high quality and evidence-based practices that will make these clinics eligible for enhanced Medicaid funding through a prospective payment system. The program will be implemented in eight U.S. states.

Plan of action

SAMHSA has the overall lead of the demonstration project of section 223, according to Kemp, and is responsible for developing criteria states will use to certify clinics; and providing annual reports to Congress on planning grants. CMS is responsible for developing a prospective payment system and implementing Medicaid payments in selected states and the Assistant Secretary of Planning and Evaluation (ASPE) is responsible for evaluating the program and identifying quality measures.

A draft of criteria was released in February 2015 and SAMHSA is conducting working feedback sessions in April in an effort to release final criteria.

According to Kemp, applications for planning grants will be due in August and will be awarded by SAMHSA in October. Eight states will be selected in December 2016.

Upon hearing these presentations, members of SAMHSA gave their feedback. One member was concerned that the funds will not reach the provider level and clinics would be short-handed and thus unable to fully implement new treatment approaches.

Kemp recognized these concerns and said SAMHSA, CMS and ASPE have made efforts to address them.

“I have been in the field for 30 years; we would often hear about something exciting happening at the state level and then we would not feel it at the local level,” she said. “That is one of the things we have tried to address with the supported employment grant. There are two pieces to the grant. One is infrastructure, where at the state level they are looking at how to build infrastructure within the state to expand and sustain supported employment. The other piece ensures that services are provided and that they will be felt at the local level.” – by Amanda Oldt

Disclosures: Heinssen reports no relevant financial disclosures. Healio.com/Psychiatry could not confirm relevant financial disclosures at the time of publication.