National Association of Counties
Washington, D.C.

 NACo recommends robust mental health care in fight to curb violence

NACo First Vice President Linda Langston joined President Obama during the Jan. 16 White House unveiling of comprehensive proposals to reduce violence in American communities.

As part of his package of legislative proposals and executive actions, the president included a recommendation from NACo and the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD) calling for full parity and integration of behavioral health and medical care.

During the nationally televised event, the president announced that the administration would expedite defining essential health benefit categories, including mental health and substance abuse services that health plans must offer as required under the Affordable Care Act.  NACo supports that effort, as well as the president’s intention to make clear to state health officials that expanded Medicaid coverage plans must comply with mental health parity requirements.

NACo has long supported these and other steps that Congress and the administration should take to help prevent future violence in communities. Those steps including enhancements to behavioral health services, youth development, inmate re-entry and the criminal justice system were all shared earlier with Vice President Joe Biden who led a fast-track high-profile review of comprehensive proposals to curb violence in communities in the wake of the Sandy Hook Elementary School killings.

In addition to Langston, NACo President Chris Rodgers also represented NACo during the Jan. 9 conference call with Biden.

Rodgers and Langston said county governments play a critical role in behavioral health, juvenile justice and the criminal justice system.  During the call with the vice president, they detailed several ways the current systems and processes can be improved, and offered specific executive and legislative actions that can be taken to avert future violence in communities.

One of the key actions outlined by Rodgers would be to harmonize federal regulations so that eligible individuals who are in custody, but not yet convicted, can maintain federal health insurance coverage and benefits.

 “Disjointed federal and state policies that cut off benefits for some who enter county jails can cause dangerous gaps in coverage — particularly prescription drug coverage and behavioral health and substance use treatment — for those who need it,” Rodgers said.  “These shortsighted regulations make encounters with the justice system far more likely to send troubled individuals through the revolving door of the system, rather than a gateway to recovery and health.”

 Rodgers and Langston also discussed how amending the Health Information Technology for Economic and Clinical Health (HITECH) Act to cover behavioral health providers would improve the ability of county behavioral health and substance use treatment providers to coordinate care for their clients.

The HITECH Act, enacted in 2009 as part of the American Recovery and Reinvestment Act, gives incentive payments to health care providers to implement electronic health records, in order to improve care coordination among providers and thereby improve quality and drive down costs due to unnecessary tests and treatments.

Unfortunately, Rodgers and Langston said, behavioral health providers were not included in the law, which means that medical care providers will not be able to share their patients’ records with their mental health providers with the same efficiency.

“County behavioral health providers play a crucial role in the public health system, and excluding them from the HITECH Act incentives undermines the goal of greater integration of behavioral health into the health care system,” Langston said.  “As this discussion moves forward, NACo will continue to be engaged in the dialogue and offer ideas to build a more integrated public health and mental health system, a smarter justice and corrections system, and safer more resilient families and communities.”

Across the country, counties own and operate 750 behavioral health authorities and 2,920 jails with more than 13 million admissions and releases each year.

“As this discussion moves forward,” Rodgers said, “and with Congress expected to debate many of the president’s legislative recommendations over the next year, NACo will continue to be engaged in the dialogue and offer ideas to build more integrated and efficient public health, criminal justice, juvenile justice and mental health systems.”