Having worked in mental health for 30-plus years, led systems in three states and chaired President George W. Bush's New Freedom Commission on Mental Health, I greatly appreciate the cover story on mental health reform in last week's issue of Modern Healthcare (“Mental health rises to top of agenda, but has a tough course ahead”). It will help galvanize attention on one of the most costly sets of illnesses—which still receive inadequate attention in most healthcare settings. My perspective over the very long term is that care for the brain a generation ago was like care for kidneys. Not much was done until the level of illness was catastrophic, and then patients were sent to separate providers paid from separate funding streams, where care neglected the rest of the body. An optimistic view today is that care for the brain will become like care for the heart—interventional treatments will be available, but prevention will be emphasized and most services delivered in primary care. The transition to better, integrated care is slow and proceeds in fits and starts. The reforms that Congress is considering, though helpful, are piecemeal. Modern Healthcare's article illustrates the operational challenges in re-engineering care so that it works for patients. Another litmus test of our commitment to taking mental health seriously is the challenge of taking suicide prevention seriously. The issue is currently relegated to overwhelmed mental health settings and emergency departments, where care is generally inadequate compared with what we know is effective. The Joint Commission's March 2016 Sentinel Event Alert is a sign that suicide care must become a core responsibility in all healthcare settings.
Michael F. Hogan, Ph.D.
Hogan Health Solutions
Albany, N.Y.
