Change Direction discussion highlights connection between mental health issues and addiction

Monitor staff – Wednesday, November 16, 2016

Twenty years ago, when someone seeking mental health treatment in New Hampshire went to get help, the person doing intake often asked whether they were self-medicating with drugs or alcohol.

If the answer was yes, “the intake person would say, ‘get yourself sober, then come back for treatment,’ ” Riverbank Community Mental Health CEO Peter Evers remembered.

The approach of treating addiction and mental health as different issues is fundamentally flawed, Evers told dozens of mental health clinicians and students on Wednesday night during a panel discussion co-sponsored by New England College and mental health awareness campaign Change Direction.

Sixty percent of people with substance use disorder also have co-occurring mental health challenges, according to the National Institute on Drug Abuse.

“If I feel psychological pain and I can get out of that for a minute, I’m going to do that,” Evers said, adding many use drugs and alcohol to escape disorders like schizophrenia, bipolar disorder and depression.

Evers was one of four panelists who addressed the link between mental health issues and substance use disorder – a pressing topic, given the state’s exploding drug crisis. All spoke about the need to boost prevention and awareness about mental health issues in addition to more treatment.

“Treating these things together is part of that, Evers said.

The room at New England College’s Concord office was packed – an encouraging sign, panelists said.

However, the talk also came at an uncertain time for mental health and substance use services, given the recent election of Donald Trump as president.

Trump has repeatedly pledged to “repeal and replace” the Affordable Care Act and has proposed giving states federal block grants to fund expanded Medicaid – a move that could ultimately reduce the amount of federal money each state receives. Trump has also said he wants to give states more authority in how they administer their programs.

New Future policy director Michele Merritt said the New Hampshire Medicaid Expansion program has been essential to connect people to treatment.

“These are individuals that are extremely, extremely low-income,” Merritt said. “This program is the only thing that’s able to connect them to treatment.”

Merritt also said the provision of the Affordable Care Act allowing children to stay on their parents’ insurance until age 26 is an important tool to make sure they get treatment for mental health and substance use disorder.

Trump has signaled he would be open to keeping that popular part of the law.

Merritt also talked about ongoing issues with insurance parity – insurance companies covering mental health and substance use disorder services the same way they would cover physical health issues.

Parity is federally mandated, but a recent study from the National Alliance on Mental Illness showed there are still a lot of gaps. In addition to a nationwide shortage of mental health providers, many are not in insurance networks due to low reimbursement rates.

Lack of insurance means many patients must pay out of pocket, or forgo mental health services, the report found.

On Wednesday, Merritt reminded clinicians to help patients figure out insurance in addition to treating them.

“You have a responsibility to your clients to help them navigate insurance,” she said.

Panelists also encouraged audience members to start talking openly about mental health and addiction, and share stories with New Hampshire policy makers.

“People like me, we can only say so much,” Merritt said. “But if you have someone that comes out and shares their stories, that’s what changes people’s minds.”

(Ella Nilsen can be reached at 369-3322, or on Twitter @ella_nilsen.)