Highlight on New Hampshire: Behavioral health services streamlined

New Hampshire plans to streamline its mental health and substance abuse programs for children, including unifying the delivery of mental health and substance disorder services to help during the transition from childhood to adulthood through the newly established Bureau of Children’s Behavioral Health. The Bureau’s establishment followed state lawmakers’ passage last week of a bill (SB 534-FN) directing the state’s Department of Health and Human Services (DHHS), along with other state agencies, to coordinate and integrate children’s mental health services in a system of care. The goal is to transform a straining mental health and substance use delivery system and provide a greater focus on the services and supports of children. The Bureau is part of the DHHS Division of Behavioral Health which itself was created in March. The proposal uses those two departments to create the framework but does not add new services, so no state money is attached to the bill for the first year. An additional $180,000 is included annually for the next three years to pay for more staffing.

Prior to the passage of the bill, proponents had argued that changes over the past 15 years within the DHHS organization structure had an adverse impact in the area of mental health in general, and children’s services in particular. The National Alliance on Mental Illness, in testimony before state lawmakers, had noted that the New Hampshire’s Children’s Mental health Director position had been vacant for seven of the past eight years. State action plans on rebuilding the mental health system were silent about children’s mental health issues. Combined with other factors, New Hampshire had a vacuum regarding strategic planning for children’s mental health.

The state had been studying the approach for the past several years through the New Hampshire Children’s Behavioral Health Collaborative.

Bipartisan group asks CMS for data on seniors’ mental health conditions

Although CMS’ performance releasing Medicare data in many areas has been “commendable,” very little information is available about the mental and behavioral health conditions of seniors. House Ways and Means Committee Chairman Kevin Brady (R-Texas), Ranking Member Sander Levin (D-Mich), Health Subcommittee Chairman Pat Tiberi (R-Ohio), and Health Subcommittee Ranking Member Jim McDermott (D-Wash) sent a letter to CMS Acting Administrator Andy Slavitt, asking the agency to collect, analyze, and publish additional data on Medicare beneficiaries’ mental and behavioral health.

The bipartisan letter seeks more robust data about the extent and nature of mental and behavioral health conditions among Medicare beneficiaries. In current data releases, information about depression and psychosis/schizophrenia is included; however, data about mood or personality disorders is not, leaving the public and policymakers without access to valuable information. The letter also refers to the ongoing opioid epidemic, which the legislators note affects seniors just like Americans of other ages, and urges ensuring seniors’ privacy when such data is released.

Mental and behavioral health conditions are often not given as much attention as other health conditions; this omission is particularly egregious when taking into consideration that depression accompanies senior health conditions like diabetes and coronary artery disease, leading to significantly higher health costs. The legislators asked CMS for more detailed data, specifically about anxiety disorders, bipolar disorder, personality disorders, and traumatic brain injury, to allow Medicare to meet the needs of seniors. Substance abuse data should also be made more widely available, with privacy measures such as de-identifying the data.