Much of the effectiveness data focus in MHSA benefit management has been on psychotropic medications, given high costs of newer agents and controversies about their effectiveness relative to less expensive choices. In addition, there are consumer and provider concerns over extensive off-label use of psychotropic medications in children, and corresponding limitations in efficacy data. Data on effectiveness and comparative effectiveness of psychosocial treatments are mainly relevant to provider training and program planning, and certain state initiatives. 11
Otherwise, with limited regulation or monitoring of practice, there are few mechanisms to tie effectiveness data to reimbursement policy or practice management.7
To achieve reform goals, it will be important to support research to fill gaps in evidence for children and vulnerable groups and to explore how to promote provision of evidence-based psychosocial treatments, balancing data with patient and provider preferences, and availability of interventions.
Healthcare reform discussions have focused on additional issues. For example, the MHSA provider workforce is diverse, including psychiatrists, psychologists, nurses, social workers, counselors, and for prevention, teachers and community leaders. Increasing workforce capacity may require incentives to bring providers into insurance, workforce entry incentives especially for child providers and in underserved areas, development of communication infrastructure for distant services delivery.
Social stigma, privacy laws and limited information systems may challenge efforts to improve access and coordinate care for MHSA clients, suggesting important roles for policy, clinical, and community leaders in achieving goals of healthcare reform. Overall, delivery and financial reform is needed, with transparent management, to assure access and bring services together for clients across systems under coordinated care. Healthcare reform may coincide with implementation of new parity laws, offering a unique opportunity to improve financial access under more coordinated and comprehensive care in the private sector. Achieving a comparable scope in the public sector may require public-private partnerships supported by adequate funding and local accountability. Regional and national input by diverse stakeholders is needed to consider these and other options to meet reform goals for persons with MHSA conditions, followed by ongoing evaluation and revision of any substantial reform achieved.