Mental Health Research Could Shape MA Social Work Practice

December 20, 2017

John Orlando, a student in the Wheelock@Worcester Master of Social Work program, presented his research report "Mental Health Care: A National and Local Crisis" to a crowded room full of high-level decision makers as part of the Mayor's Task Force on Mental Health on 

John Orlando presents his research

November 29 in Worcester. Invited guests included Scott Taberner, Chief of Behavioral Health and Supportive Care for the Executive Office of Health and Human Services, Office of MassHealth.

Orlando worked with the Worcester Commissioner of Health and Human Services, Dr. Matilde Castiel, to identify gaps in services and make suggestions for policy changes that could benefit mental health care recipients. Castiel said during the presentation that access to care is a human right that is often denied to people most in need.

"I know the system of care is a challenge to navigate for both providers and recipients, and that the demand for qualified help far outweighs the supply of helpers, but I did not realize the extent of the issue, and the resulting implications until I heard John's report," said Amy Ebbeson, Coordinator of the Wheelock@Worcester Program.

Orlando's research, which could potentially have far-reaching implications for social workers in Massachusetts, looked at the ways that insurance reimbursement rates and policies affect the quality of and access to mental health care in the state. He found that serious mental illness costs the US $193.2 billion in lost earnings per year and that mental illness can double or triple the cost of care to Medicaid and Medicare for individuals who are dually eligible. In Massachusetts, suicide is the second leading cause of death for ages 15-34 and cost the state a total of $728.3 million in combined lifetime medical and work loss in 2010, his report said.

Another member of the Mayor's task force, Paul Richard of the Shine Initiative, has worked to get mental health viewed in the same light and with the same advocacy afforded to physical health. The stigma that mental health carries is often cited as one of the root causes of the current crisis.

Orlando's report found that the primary barriers to mental health care in Massachusetts are:

  • Insurance company policies and practices, including low reimbursement rates and burdensome administrative requirements
  • Long waiting lists for patients
  • Limited services for cultural and linguistic minorities
  • Workforce shortage among providers
  • Lack of compensation for overhead and no shows-; the "fee for service" model
  • Logistics, including confusion over insurance coverage, transportation issues, and the cost of co-pays/deductibles

To begin addressing the problem, Orlando's report recommended:

  • Alternative payment methods for providers, such as day rates or monthly rates
  • Social Work loan forgiveness, which would encourage recruitment and retention of qualified providers
  • Legislation outlawing clawbacks, a method where insurers retroactively deny claims without explanation or time restrictions
  • Legislation allowing clinicians, rather than insurers, to determine medical necessity

Participants in the forum affirmed these findings and shared their direct experiences facing these issues themselves. Taberner delivered a presentation in response that highlighted many of the issues Orlando's report surfaced. Ebbeson said it was rewarding for everyone in attendance to see the feedback loop from clinical direct service practitioners to the macro. She said many attendees expressed hopefulness that these barriers could be addressed as policy change.

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