Guest Post: Donald M. Berwick, M.D., Centers for Medicare & Medicaid Services (CMS) Administrator
On May 3, I had the welcome opportunity to speak to the 3,000 people attending the annual meeting of the National Council for Community Behavioral Healthcare. They represent organizations that offer services in communities all over our nation for people with serious mental illnesses, behavioral health problems, and substance abuse. The visit reminded me both of how significant behavioral health problems are in our health care world and to our beneficiaries, and also how important CMS programs are to the professionals who try daily to help people afflicted by these problems.
Mental health problems are more common than cancer and heart disease combined. About one in every five Americans has a mental illness in any given year, and mental health problems account for 15% of the total economic burden of all disease in the United States. Mental health problems interact destructively with physical illnesses. For example, a diabetic person with depression costs 60% more on average to take care of than a diabetic without depression (approximately $20,000 per year vs. approximately $12,000 per year). And – get this – the life expectancy for an American with a major mental illness is 56 years, compared with 77.7 years on average for all Americans.
Together, Medicaid and Medicare provide about a third of all behavioral health services funding in our nation, representing more than half of all public spending for these services. Medicaid alone is the largest source of funding for mental health services, and the second largest source of funding for substance abuse treatment services. Behavioral health service users in Medicaid make up a little more than ten percent of the beneficiary population but account for almost a third of total program expenditures due to their high associated use of non-psychiatric services.
As you can imagine, community behavioral health centers are highly dependent on Medicaid for their funding, and many of their patients are “dual eligibles.” CMS is extremely relevant to the vitality of this provider community and to the well-being of the people they serve. I couldn’t help thinking as I addressed this fascinating and generous audience of committed behavioral health professionals, “How can CMS help even more to address mental illness and substance abuse in our nation.”
CMS is currently working closely with SAMHSA on a broad range of activities that impact the availability of high quality behavioral health services for beneficiaries including the development of quality health homes, standards for behavioral health in home and community based settings, guidance on the Mental Health Parity and Addiction Treatment Equity Act of 2008, Olmstead compliance, and behavioral health coverage for children and adults. It’s a time of unprecedented collaboration at the federal level in the area of behavioral health, but we know there is always more work to be done together.
At the conference, I spoke about a patient I had many years ago. He was a 15-year-old inner city teenager, in whom I diagnosed Acute Lymphoblastic Leukemia (ALL). We fought hard to save his life, and he eventually underwent a heroic bone marrow transplantation, with major complications. We pulled him through, and, nearly miraculously, he survived. His ALL was cured by modern medicine, against all odds.
But that wasn’t good enough to really help my patient. He had other, in many ways worse, problems. From age 12, he ran afoul of the law. He was intermittently addicted to drugs. His own brother was murdered. My patient became chronically depressed, unable to hold a job or to stay off drugs. He developed diabetes as a complication of his bone marrow transplant, couldn’t keep up with his medical care, had a major seizure with anoxic brain damage, and spent two years in a coma. His leukemia was cured. But his other afflictions – behavioral and social burdens – put him eventually beyond reach, and he died. This reminds me that the mind and the body are connected and we need always to help both.