When
the Action Alliance selected the integration of suicide prevention into health
care reform as one of its four national priorities stemming from the National Strategy for Suicide Prevention, it was still unclear as to what the
Supreme Court’s response would be to legal challenges involving the Affordable
Care Act. Either way, the Action Alliance felt that major changes to the health
care system were going to occur. Should we not strive to use the momentum of
reform to better focus health care on people at risk for suicide?
Most
mental health professionals and advocates agree that the health and behavioral
health care system in the US does not currently meet the needs of patients
struggling with suicidal behavior – in sum, “suicide care” is inadequate. Health
care reform presents the most significant opportunity in a generation to make the
health care system more responsive to individuals who are at risk for suicide
or who are engaging in suicidal behavior. It’s an opportunity to save lives,
contributing to the realization of the Action Alliance’s goal of saving 20,000
lives in five years.
The
US Centers for Medicare and Medicaid Services (CMS) has the lead responsibility of interpreting and implementing the Affordable Care Act of 2010, and the
Substance Abuse and Mental Health Services Administration (SAMHSA) has the lead
on behavioral health issues. For this reason, the Action Alliance has been working
with SAMHSA Administrator Pam Hyde to engage senior CMS leadership in a
conversation about the integration of suicide prevention into health care
reform over the last year and a half.
Health
care reform aims to deliver what former CMS Administrator Don Berwick called
the Triple Aim: better health for populations, better care for individuals, and
reduced costs to society. Transforming health systems to prevent suicide and
improve suicide care addresses all of these goals.
By
identifying patients at risk for suicide early, risks can be reduced and effective
treatment can be delivered. By providing early and effective treatment in a
behavioral health setting or in a collaborative care setting where primary care
and behavioral health care are integrated, we can save lives and prevent some suicide
attempts that result in costly emergency medical expenses.
We
know that people admitted to hospital or emergency department care with suicidal
behavior remain at high risk when they leave. And we know that if we ensure a
patient receives continuity of care through the discharge and out-patient care
engagement process, we can reduce expensive re-hospitalizations and suicides.
We have also learned that when health systems focus on safety and suicide care, the results are far better than those achieved through piecemeal approaches. One of the keys must be leadership among health plans and systems. They can encourage better screening for depression and suicidality, delivery of effective, evidence-based treatment and continuous care to patients who are at risk. Health plans and payers must transition from paying for the quantity of episodic services to paying for better integrated care that will change the health outcomes of populations.
I have been privileged to meet with the
Action Alliance Co-Chairs, SAMHSA Administrator Hyde, CMS Administrators (Acting
Administrator Don Berwick in 2011, and current Acting Administrator Marilyn
Tavenner in 2012), my fellow Action Alliance Executive Committee member Paul
Schyve, and the Action Alliance Secretariat on several occasions to discuss
areas of health care reform implementation that are relevant and critical to
suicide prevention. The Action Alliance has also submitted public comments in
response to CMS’s efforts to implement electronic health record technology. In
all of our interactions, we have focused on three domains: promoting early identification of those at
risk for suicide, the delivery of effective treatment for suicidal behavior,
and the provision of the follow-up care for those at risk as they transition
from one setting of care to another. Later this year, the Suicide
Prevention Resource Center will partner with The National Council for Community
Behavioral Healthcare to “go live” with a website providing tools for providers
to take these steps. These improvements within an evolving health system are
the key targets for getting us to that goal of saving 20,000 lives in five
years.
What do you think? How would you like to see suicide
prevention integrated into health care reform? Please comment and share your
ideas below.
