Data show improvement in use of mental health system

Recent articles and editorials published in the Hono-lulu Star-Advertiser have expressed concerns regarding the current state of Hawaii’s mental health system.

The more recent data do not support an acute worsening of the mental health system, and in fact they show an improvement in the utilization trend.

For Medicaid beneficiaries, adjusted for enrollment, emergency room (ER) visits increased 7.4 percent between 2009 and 2012 and hospital admissions increased 11.1 percent. Between 2006 and 2009, the increases were 18.4 percent and 16.3 percent, respectively.

However, the data indicate a persistent challenge for mental health care. ER visits and hospitalizations for mental health conditions are potentially preventable, and any increase is too much.

Because the provision of specialized behavioral health services is carved out of the state Department of Human Services’ QUEST Expanded Access (QExA) program, any suggestion that this program caused worsened mental health from 2009 to 2012 is misleading.

In addition, the DHS did not reduce covered behavioral services during this period, and the few individuals who may have become uninsured as a result of the Medicaid eligibility reduction that aligned with the Affordable Care Act would have been eligible to receive services from the state Department of Health.

Both the DOH and the DHS provide mental health safety-net programs. The DOH currently provides specialized behavioral health services to individuals with serious mental illness who are uninsured or receiving court-ordered treatment, as well as some QExA members. The DHS also provides basic behavioral health services to all Medicaid beneficiaries and specialized behavioral health services to those with a serious mental illness through QUEST.

The DOH, DHS and community advocates recognize that parallel systems offered by the two departments cause unnecessary fragmentation of the mental health safety net. This fragmentation results in confusion for patients, administrative burden for providers and inefficiency.

To reduce the unnecessary fragmentation, the DOH and DHS plan to consolidate the provision of all specialized behavioral health services for Medicaid benefici- aries with a severe mental illness (i.e. QUEST and QExA enrollees) within one DHS-operated services program.

The DHS also is seeking federal approval to receive federal matching funds for expanded services for this population, including representative payee, peer specialists, supported employment, supported housing, funding for clubhouse services and expanded eligibility. This consolidation will provide better integration between medical and behavioral health care.

These changes, along with community engagement and increased investment in proactive care management and other initiatives, have been identified as important steps in transforming the state’s delivery of behavioral health services.

The combined forces of change will promote improved health outcomes, reduced cost and enhanced patient experiences.