Testimony of Annabel Lane
National Alliance on Mental Illness (NAMI) of Massachusetts
Joint Committee on Mental Health and Substance Abuse
Thursday, October 22nd, 2015
Chairwomen Flanagan, Malia, and members of the Committee:
My name is Annabel Lane. I am here representing the National Alliance on Mental Illness of Massachusetts in support of Senate Bill 1027, an Act to Require Health Care Coverage for the Emergency Psychiatric Services.
NAMI is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services and is steadfast in its commitment to raising awareness about mental illness. Since our inception in 1979, NAMI has been dedicated to improving the quality of life of individuals and families affected by mental illness.
I want to thank you for this opportunity to offer input on Senate Bill 1027. This legislation is necessary to address the disparity in access to care for behavioral health emergencies by requiring all insurance providers to cover services by Emergency Service Providers, or ESPs. ESPs are mobile teams of clinicians that provide behavioral health crisis assessment, intervention, and stabilization services. They go out into the community and meet with people where they feel most comfortable, and connect people to appropriate supports so that they can maintain stability in the community. ESPs are vital resources that provide robust services in the least costly, most effective setting.
Currently, ESP services are only available to individuals with MassHealth and limited third party commercial insurance providers. This creates a disparity that just doesn’t make any sense. And private insurers are still covering emergency psychiatric services – they’re just providing them in a more expensive, less effective setting.
Without access to ESP services, the only option available for people in behavioral health crisis is a trip to the emergency room. These trips can be extremely traumatizing. Individuals wait for hours and sometimes never get to see someone who specializes in behavioral health. In the worst case scenario, which is very common, people are held for a few hours then released back into the community without support. The destabilization of this process only escalates symptoms, leading to a continuing cycle of ER trips and contributing to ER overcrowding.
ESPs are also a crucial jail diversion resource. Over 30% of the people in MA correctional facilities and 50% of those in county jails have a mental health condition. ESPs work with police departments to help people with behavioral health needs get care in the most appropriate setting, and prevent unnecessary arrests and incarcerations. Needless to say, this can result in significant cost savings. But it’s difficult for police departments to collaborate with the ESPs when access to this service is so inconsistent.
There is recent a precedent for the Legislature to require that commercial insurers cover specific clinical services. Chapter 258 of the Acts of 2014 requires commercial insurers to cover up to 14 days of detox and step-down detox services without prior authorization. In our view, requiring coverage for critically needed and cost saving crisis mental health services is equally compelling.
ESPs are a vital preventative service. They not only improve the health and stability of people with behavioral health needs, helping people access needed supports to live in the community, but they reduce the need for more costly emergency services.
NAMI supports S 1027 because ESPs are proven to help people access treatment. These successful services have helped to improve the quality of life for thousands of people over the years. With 1 in 5 adults (and many, many more children) experiencing mental illness in a given year, NAMI hopes this legislation will become law so that these critical services are universally available to all who need them.
Thank you for the opportunity to testify.
Created by TopCounselingSchools.org
On Saturday, October 3, 2015, NAMI Mass hosted an affiliate leaders meeting in Framingham to discuss all of NAMI’s Education and Support Programs. It was a fabulous meeting with over 10 Affiliates represented. Here is a photo of the NAMI Mass staff who presented at this Affiliate Leaders Meeting, along with our Board President, Steve Rosenfeld.
Pictured are from Left to right: seated is Bernice Drumheller, standing behind her is NAMI Mass staff; Steve Shea, Laurie Martinelli, Florette WIllis, Steve Rosenfeld, Eliza Williamson, Nancy Parker, Megan Wiechnik, Ilya Cherkasov, and Judi Maguire.
Testimony of Laurie Martinelli, Executive Director
National Alliance on Mental Illness (NAMI) of Massachusetts
House Bill# 1475 – An Act to reduce recidivism,
curb unnecessary spending, and ensure appropriate use of segregation
Joint Committee on Judiciary
Wednesday, October 14, 2015
Chairmen Brownsberger, Fernandes and members of the Committee:
My name is Laurie Martinelli, and I am the Executive Director of the National Alliance on Mental Illness (NAMI) of Massachusetts. On behalf of NAMI Mass’ Board of Directors, members, affiliates and supporters across the Commonwealth.
NAMI is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, and is steadfast in its commitment to raising awareness about mental illness. Since our inception in 1979, NAMI has been dedicated to improving the quality of life of individuals and families affected by mental illness.
I want to thank you for this opportunity to offer input on behavioral health services in general and more specifically, why H1475 is so important. This legislation, filed by Representative Elizabeth Malia and 20 of her colleagues in both branches builds on 2012 reforms on the use of segregation in Department of Correction facilities as well as county jails and houses of corrections and is critically important to ensure segregated housing is the exception in Massachusetts, not the rule.
• People with mental illness are disproportionately represented in the Commonwealth’s County Houses of Correction and state prisons.
• Nearly 30% of inmates in the custody of the Department of Correction receive mental health services and approximately 16% are diagnosed with a serious and persistent mental illness. In County Houses of Correction between 25% and 50% of detainees and inmates are seen as having mental health needs. Among female inmates at MCI Framingham upwards of 70% of the inmate population receive mental health services.
• In Segregation Units, inmates whose behavior is viewed as problematic are segregated from the rest of the prison population in conditions of solitary confinement.
• In an environment in which being able to follow rules and compliant behavior are necessary to successful adjustment, inmates with mental illness are more apt to accumulate segregation time, accrue additional time on their sentences, and be “over-classified” to higher security settings.
• There is mounting evidence that conditions of solitary confinement produce many harmful psychological and physical outcomes.
• Not surprisingly, inmates with mental illness are overrepresented in segregation units throughout the country, and under conditions of isolation, are likely to decompensate even further.
• Inmates with mental illness often get stuck in a cycle whereby their behaviors result in disciplinary sanctions, including segregation time, which in turn results in a worsening of their symptoms and behavior which leads to additional segregation time.
• For inmates at risk for suicide and self-injurious behaviors, prolonged time in segregation units can exacerbate their illnesses and put them at even greater risk.
Massachusetts, like many other states, has been engaged in litigation on the issue of segregation housing for inmates with mental illness. In 2012, that lawsuit was settled leading to major reforms including the opening of special housing units to be used as alternatives to segregation units for inmates with mental illness. House 1475 seeks to build on these reforms on the use of segregation in Department of Correction facilities as well as county jails and houses of corrections.
NAMI Massachusetts views these reforms as being pivotal to use segregated housing only as a last resort and to mitigate the ill effects of conditions of isolation through limits in the amount of time spent in solitary confinement, procedural protections to assure that no less restrictive housing alternative is appropriate, and to provide special protections for vulnerable populations such as people with mental illness and others.
Thank you for the opportunity to provide this testimony.
October 13, 2015
The Honorable James T. Welch
Senate Chair, Joint Committee on Health Care Financing
State House, Room 309
Boston, MA 02133
The Honorable Jeffrey Sánchez
House Chair, Joint Committee on Health Care Financing
State House, Room 236
Boston, MA 02133
Re: H. 984/S.606, An Act to Keep People Healthy by Removing Barriers to Cost-Effective Care
Dear Senator Welch and Representative Sánchez:
Thank you for the opportunity to submit testimony on the critical issue of removing barriers to costeffective care and increasing medication and treatment adherence. As a group of organizations committed to access to affordable, quality health care, we strongly support H. 984, S. 606, An Act to Keep People Healthy by Removing Barriers to Cost-Effective Care.
Increasing co-pays and deductibles have become an obstacle to good health care. According the most recent Center for Health Information and Analysis (CHIA) Annual Report on the Performance of the Massachusetts Health Care System, Massachusetts continues to see increased enrollment in high deductible health plans – which are now 19% of the commercial market – and increased consumer costsharing, which rose by 4.9% in 2014 while benefit levels remained constant. The report notes that the continued growth in high-deductible products significantly shifts cost-sharing risk to consumers and may hinder access to cost-effective medical services. Research in this area documents that increased cost-sharing may actually reduce efficiency by increasing the underuse of needed treatments and medications, particularly for individuals with chronic conditions.2
984/S. 606, An Act To Keep People Healthy by Removing Barriers to Cost-Effective Care, would help address this problem by eliminating co-pays and deductibles for cost-effective prescription medications, services and treatments in order to increase adherence and help patients avoid further complications and hospitalizations. Specifically, the bill would establish a state panel of experts to recommend high-value and cost-effective services, treatments, and prescription drugs that would not be subject to cost-sharing under all fully-insured health plans, including MassHealth and all fully insured commercial insurance. The experts would include individuals with expertise in health economics, actuarial sciences, primary care, health care cost-effectiveness, mental health care, pediatric health, pharmacology, chronic illness and consumer concerns. Relying on panel recommendations, the Executive Office of Health and Human Services (EOHHS) would annually determine a list of the designated high-value cost-effective services and treatments that all fully insured health plans are required to cover without cost-sharing. The Center for Health Information and Analysis would evaluate the impact on treatment adherence, incidence of related acute events, premiums and cost-sharing, overall health and long-term health costs.
This proposed “No Co-Pay” bill, was developed to align patients’ out-of-pocket costs with the value of health services. Cost-effective treatments help avoid the need for expensive acute care. Research shows that certain medications and services for chronic conditions such as hypertension, high cholesterol, diabetes, asthma, depression, and HIV/AIDS are considered “high value,” because they provide large health benefits with comparatively low costs. The health system should therefore encourage patients to use these treatments, instead of imposing high co-pays and deductibles that discourage adherence to prescribed treatments and lead to further complications and expensive emergency services and hospitalizations. Removing barriers to essential, high-value health services is often cost-neutral to implement and even potentially cost-saving in the long term.
Thank you for your time and consideration on the critical issue of eliminating barriers to care and improving health outcomes. We strongly urge you to favorably report H. 984/S. 606, An Act to Keep People Healthy by Removing Barriers to Cost-Effective. Please contact Alyssa Vangeli at Health Care For All with any questions at (617) 275-2922 or firstname.lastname@example.org. We look forward to working with you and the entire committee on the shared goals of improving access to health care for consumers and curbing overall health care costs in the Commonwealth.
AIDS Action Committee
American Heart Association/American Stroke Association
Boston Children’s Hospital
Crittenton Women’s Union
Health Care For All
Health Law Advocates
Joslin Diabetes Center
National Alliance on Mental Illness of Massachusetts (NAMI Mass)
1199SEIU – United Healthcare Workers East
cc: Members, Joint Committee on Health Care Financing
 Center for Health Information and Analysis, Annual Report on the Performance of the Massachusetts Health Care System: 2015. 2 Swartz, Kathy, Cost-sharing: Effects on Spending, Robert Wood Johnson Foundation, December 2010.
 For more information: Center for Value-Based Insurance Design, University of Michigan, available at: http://www.sph.umich.edu/vbidcenter/
 Lee, Joy L., et al. “Value-Based Insurance Design: Quality Improvement But No Cost Savings.” Health Affairs 32, no. 7 (July 2013): 1251-1257.Academic Search Premier, EBSCOhost (accessed June 29, 2015).
Sometimes an injury caused by an unkind remark will hurt even more if you continue to use the harsh words. Put a soulful Band-Aid on it instead. Make it up from gentle and caring words. The results will be more positive and long lasting.
“I think you’re strange” can be helpful if you change it to “I’d like to get to know you.”
“What’s wrong with you?” can be less stigmatizing if you look your peer in the eye and say “I feel your pain and would like to help.”
“You’re on your own” hurts more than “I am on your side.”
“I am going through the same things you are” means more than “I have no idea what you’re talking about.”
“We’ll try to get you help” can ease the burden unlike “don’t bother me.”
“If I can’t assist you, we’ll find somebody who can” can help a person with worse experiences than yours feel better than if you say “you have to deal with the problem on your own.”
“I am a peer and you are a person who is also a peer” should be an insight strong enough to ensure words that can bring healing instead of those that bring harm, especially if you are peers who share a history of mental illness.
Dare yourself to take somebody by both a literal and poetic hand to reach for a greater comfort zone. You’ll be helping each other embrace the experience of hope and a healthier lifestyle.