Big changes for mental health, substance abuse

Do you enjoy change? Good. It's on the way.

Maybe you like Obamacare. Or, maybe you view the Patient Protection and Affordable Care Act as yet another nail in the coffin of individual liberty. In either case, the law promises to make sweeping changes in the Arizona's healthcare system, and nowhere more so than in the treatment of mental illness and substance abuse.

These changes were the topic last week of the "Town Hall" portion of the 13^th annual Summer Institute, four days of presentations and workshops concerning Arizona's behavioral healthcare system put on by Arizona State University's Center for Applied Behavioral Health Policy.

The Town Hall segment featured a panel of six physicians, providers and assorted experts speaking before an audience of some 300 clinicians, therapists and others from across Arizona.

This is, of course, a confoundingly complex topic. But during the next 18 months — and assuming the Affordable Care Act is not somehow derailed — Arizona should see a substantial growth in the numbers of residents eligible for services, a greater push towards integration of primary and behavioral care, a heightened demand for a well-trained workforce and knotty problems concerning data-sharing and reimbursement.

Some of these trends were spurred several years ago by the Mental Health Parity and Addiction Equity Act of 2008; together with the Affordable Care Act, it will require us to treat mental disorders and substance abuse atresource levels comparable to other chronic conditions, and to eliminate barriers to enrollment and coverage of patients with pre-existing conditions.

Complicated enough? There's more: Arizona will also be launching its own new primary care "medical home" model for individuals designated as seriously mentally ill.

So … what's going to happen? Nobody exactly knows, in part because many remain concerning details of the new laws. If they work more or less according to plan, we should see many more Arizonans become eligible for publicly funded behavioral healthcare, further strides towards a "holistic" approach to dealing with patients' mental as well as physical ailments, and an end to some of the more restrictive practices of insurance companies.

Is Arizona up to the challenge? That may well be the bigger question. Our system remains woefully underfunded. And so far, Gov. Jan Brewer has not said whether Arizona will agree to expand Medicaid coverage to include individuals making up to 133 percent of the federal poverty level — a crucial element of the ACA.

In any case, hold on.