Susan A. Pickett, Ph.D.

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Connecting people with serious mental illness to
Healthcare early lessons learned

• Susan A. Pickett, Ph.D.
• Advocates for Human Potential, Inc.

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Presentation overview

• Why health care matters
• Promises of the ACA for people with SMI
• Connecting people with SMI to health coverage and
  care
• What we know so far

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Health conditions of people with SMI

• The physical health of people with SMI is among
  the worst in the nation
• Mortality rate is 2-3 times that of the general
  population
• On average, people with SMI die 25 years earlier
  than non-disabled peers
• High rates of diabetes, cardiovascular disease,
  metabolic syndrome, respiratory diseases, obesity
  
• Psychiatric symptoms and medications may worsen
  some health conditions
• People with SMIs high rates of co-occurring
  substance use, poverty, homelessness and criminal
  justice involvement contribute to poor health

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Mission impossible accessing health care

• Most chronic health conditions are
  preventable(!!) but few people with SMI get
  appropriate care
• Less access to ANY health care
• Poorer service quality
• Poor health literacy
• Less likely to receive specialty and/or follow-up
  care
• Even if they can access it, most people with SMI
  cant afford health care
• 24 of people with SMI are uninsured
• 2.7 million low income people with SMI dont
  qualify for Medicaid
• Pre-Affordable Care Act (ACA) implementation

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Mission Impossible part 2health insurance
benefits

• Even when they can afford it, health insurance
  doesnt cover it
• No or few benefits for mental health and
  substance use treatment
• Health plans consider SMI a pre-existing
  condition
• Stricter lifetime limits for mental health care
  than other types of care
• Medicaid is not an option
• Childless adults dont qualify
• Disability status difficult to prove
• Pre-ACA implementation

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Promise of the aca for people with smi

• Low income people with SMI now qualify for
  Medicaid
• In States with Medicaid expansion, single adults
  with incomes 138 below the Federal Poverty Level
  qualify for Medicaid regardless of disability
  status
• Marketplace plans offer affordable insurance
• ALL plans
• Must cover mental health and substance use
  treatment
• Must provide mental health and substance use
  treatment at parity
• Cant drop or reject people because they have SMI

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Got coverage now what?

• Whats in my health plan?
• Where do I go? Whos my doctor? How do I make an
  appointment?
• Whats wrong with just going to the emergency
  room when I get sick?
• Why do I need a check-up, Im as healthy as a
  horse!

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What do we know so far? Not much

• People with SMI are enrolling but data on exact
  numbers not yet available
• Anecdotal evidence suggests
• Enrolled but waiting for final processing and
  approval
• Enrolled but plans are changing
• Enrolled but not using services
• Enrolled and using services

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What psychologists can do

• Think outside the box Innovative interventions
• Peer health navigators
• Care coordination entities for vulnerable
  populations
• Jail and probation enrollment
• Health fairs/health screening for people with SMI
• Health care happens everywhere, including in your
  office

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