The task force established after the Newtown shootings to examine mental health issues among young adults released 47 recommendations Tuesday in what a key legislative leader described as a “blueprint” for future legislative action on behavioral health.
The task force concluded that the state’s overall system of providing mental health and substance abuse treatment for young people does not function well in meeting the needs of individuals and their families, although it cited some pockets of excellence.
The group’s recommendations ranged widely, but many focused on the need to expand the capacity of professionals to provide behavioral health services to young people, access to services, and issues related to the rights of people with mental health or substance abuse problems.
It remains to be seen whether the task force’s recommendations will become law or change state policy; or whether they will, like many other task force reports, remain largely unfulfilled. Legislators from both parties attended the press conference where the report was released, and some spoke of the recognition by state leaders of the need to do more to address mental health, particularly among young people.
“This is something we all need to learn more about,” said Rep. Terrie Wood, R-Darien, one of two leaders of a bipartisan panel on mental health set up in response to the Sandy Hook Elementary School shooting. She noted that one in 10 adolescents experience mental health issues, and one in five people will at some point in their lives.
The focus on young adults aged 16 to 25 grew out of concerns raised after the Newtown shootings, when many people spoke during public hearings and in private conversations with lawmakers of challenges young adults face getting mental health services. They cited barriers including too few outpatient services and psychiatric placements, challenges getting the right services for young adults, and difficulty getting insurance to cover needed treatments.
Addressing mental health issues in young adults can be particularly complex. Young adulthood is the time when serious mental illnesses first manifest for many people. People in that age range might be legally independent but still largely reliant on their parents, creating challenges related to health care decisions and privacy. And it’s a period when people transition from a health care system designed for children and teens to a system for adults that’s in many ways very different.
Mandatory outpatient treatment?
One of task force's more controversial recommendations was to establish a separate task force to study involuntary outpatient commitment, the practice of compelling people with mental illness to receive treatment. Most other states allow involuntary outpatient commitment, but mental health advocates in Connecticut have long opposed it as unfair and ineffective. Although the task force’s recommendation is to continue to study the issue, several members of the task force wanted to instead end discussion of it.
Other recommendations call for the state to:
- Mandate that primary care providers of children and young adults under 25 screen patients for behavioral health problems. Evidence suggests that screenings for problems like depression can be effective, but many providers don’t do it, in some cases because they don’t have time or because it’s difficult to find appropriate services for children who screen positive.
- Create and enforce uniform standards for both public and commercial insurers on the range of behavioral health services to be provided, the criteria for receiving them, and definitions of medical necessity.
- Invite private insurers and employer-based health plans to participate in the Connecticut Behavioral Health Partnership, a highly regarded program that oversees mental health and substance abuse care for people in Medicaid and the child welfare system. Some child psychiatrists have recommended having the program be used for all private insurance clients, with insurance companies contributing money to fund it, but the task force did not make that recommendation.
- Consider creating an independent office in the state Office of the Healthcare Advocate that would monitor data from private and public insurers on behavioral health services provided and outcomes. The office would be known as the Office of Behavioral Health Relations and Accountability.
- Improve reimbursement rates to clinicians so more will accept Medicaid patients. Strategies recommended include loan forgiveness programs for mental health professionals who treat children, adolescents and young adults; tax credits for accepting insurance or working with young people in underserved areas; and malpractice coverage incentives.
- Increase the age of majority to 18 for decisions regarding mental health and substance abuse treatment.
Several recommendations were aimed at improving access to mental health care in schools, including:
- Expand the number of school social workers and psychologists.
- Expand the presence of school nurses and expand comprehensive school-based health centers, particularly those that provide mental health services.
- Develop regional hubs of behavioral health and developmental specialists who are available to each school district, as well as private schools and colleges and universities.
- Require teacher preparation programs to include coursework on mental health, early identification and safety and classroom management issues.
It’s not clear how much money the recommendations would cost, or how much money the state could devote to any changes. House Speaker J. Brendan Sharkey, D-Hamden, said he couldn’t say how much funding would be available, but that state leaders have all worked to dedicate more funds to mental health issues. They needed a blueprint for how to spend additional resources, he said, adding that the task force’s recommendations would do that.