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Health reform could help close gaps in mental health care

By Anna Gorman

11:05 AM EDT, July 17, 2013

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A disjointed financing system for mental health services in California has led to gaps in care, but the national healthcare law is expected to help close some of those holes, according to new research by the California HealthCare Foundation.

Half of the state’s adults and two-thirds of the adolescents with mental health issues aren’t receiving treatment, according to the study.

Private insurance has historically lacked mental health services, so patients often seek care through the public system. Nearly $7.8 billion in public money was spent in fiscal year 2012-13 on mental health care, with the largest share — $3.3 billion—paying for Medi-Cal beneficiaries.

Counties must stretch the resources they have to care for residents with mental health issues, often serving only those with the most serious problems, said Sandra Shewry, director of state health policy at the foundation. Over the last two decades, the state has seen a reduction of inpatient and residential care and an increase in outpatient treatment.

There are also wide disparities across the state, with the poorest regions of the state having the highest rates of mental illness and the lowest number of licensed mental health professions.

The Affordable Care Act, however, is expected to improve access for many. The law expands who is eligible for Medi-Cal, the coverage program for poor and disabled residents, enabling them to get comprehensive mental health services, and California residents purchasing insurance through the healthcare marketplace will also have access to mental health care.

"We should be seeing the opportunity for that whole infrastructure to bulk up to meet the demand," she said.

In addition, the law promotes more integration between mental health care and physical health care. There is an increasing awareness about how important it is for doctors to address mental health and substance abuse needs among their medical patients, said Neal Adams, deputy director of the California Institute for Mental Health.

"When we talk about pursuing health for people, it really needs to include emotional well-being as well as physical well-being," said Adams, a psychiatrist and the project manager for one of the reports.

Even with the changes in the national healthcare law, policymakers will still face challenges, including connecting patients to care and ensuring there are enough providers, researchers said. An estimated 125,000 uninsured people who will become eligible for Medi-Cal next year will need mental health services.

"As we bring more uninsured and poor people into the healthcare delivery system … there is a really serious question about how and where those needs are going to be met," Adams said. "People are very worried about workforce shortages."

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anna.gorman@latimes.com