Importance There have been recent calls for increased access to mental health services, but access may be limited owing to psychiatrist refusal to accept insurance. Objective To describe recent trends in acceptance of insurance by psychiatrists compared with physicians in other specialties. Design, Setting, and Participants We used data from a national survey of office-based physicians in the United States to calculate rates of acceptance of private noncapitated insurance, Medicare, and Medicaid by psychiatrists vs physicians in other specialties and to compare characteristics of psychiatrists who accepted insurance and those who did not. Main Outcomes and Measures Our main outcome variables were physician acceptance of new patients with private noncapitated insurance, Medicare, or Medicaid. Our main independent variables were physician specialty and year groupings (2005-2006, 2007-2008, and 2009-2010). Results The percentage of psychiatrists who accepted private noncapitated insurance in 2009-2010 was significantly lower than the percentage of physicians in other specialties (55.3% [95% CI, 46.7%-63.8%] vs 88.7% [86.4%-90.7%]; P P P P  = .02). Conclusions and Relevance Acceptance rates for all types of insurance were significantly lower for psychiatrists than for physicians in other specialties. These low rates of acceptance may pose a barrier to access to mental health services.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/1785174/yoi130079.pdf

Acceptance of insurance by psychiatrists and the implications for access to mental health care.

Current research has determined that a larger percent of social workers and other counselors are affected by PTSD types of symptoms when working with traumatized clients than the general population. While much of this research addresses workers in specific trauma areas like sexual assault centers or child welfare agencies, little specific thought has been given towards the special stress that working with Substance Abuse Disorders (SA) and trauma may present. This paper takes a brief look at the issues of vicarious trauma and compassion fatigue with SA practice and describes future investigation pathways toward this goal.

/pdf/the-unbearable-fatigue-of-compassion-notes-from-a-substance-4uxr3yq3yc.pdf

The Unbearable Fatigue of Compassion: Notes from a Substance Abuse Counselor Who Dreams of Working at Starbuck’s

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 requires commercial insurers providing group coverage for substance use disorder services to offer benefits for those services at a level equal to those for medical or surgical benefits. Unlike previous parity policies instituted for federal employees and in individual states, the law extends parity to out-of-network services. We conducted an interrupted time-series analysis using insurance claims from large self-insured employers to evaluate whether federal parity was associated with changes in out-of-network treatment for 525,620 users of substance use disorder services. Federal parity was associated with an increased probability of using out-of-network services, an increased average number of out-of-network outpatient visits, and increased average total spending on out-of-network services among users of those services. Our findings were broadly consistent with the contention of federal parity proponents that exte...

/pdf/federal-parity-law-associated-with-increased-probability-of-29hawalrou.pdf

Federal parity law associated with increased probability of using out-of-network substance use disorder treatment services.

Social workers are needed to implement science-based treatments for alcohol and other drug (AOD) problems. Changes in insurance coverage through the Affordable Care Act will increase the demand for licensed Master of Social Work (MSW) clinicians. This national study of MSW programs (N = 210) examines prevalence of addiction courses and specializations. Web-based analyses showed that only 14.3% of accredited schools offered specialization; only 4.7% of accredited schools had one or more required courses. Social work education has not met addiction workforce development needs; there is no evidence this pattern will change.

Addiction Training in Social Work Schools: A Nationwide Analysis

Practice-based research networks (PBRNs)—collaborations of practice settings that work together to generate research knowledge—are underused in mental health services research. This article proposes an agenda for mental health services research that uses a variety of PBRN structures and that focuses on what really happens in practice, the effectiveness of practice innovations in real world care, the challenges of implementing evidence supported interventions, modification of clinician behavior, and assessment of the effect of mental health policy changes on practice. The challenges of conducting research within PBRNs are substantial, including difficulties in maintaining positive member relations, securing ongoing funding, sustaining productivity, overcoming IRB entanglements and achieving both scientific excellence in recruitment and measurement validity and utility for practitioner members. However, the awareness of these challenges allows researchers and practitioners to build networks that creatively overcome them and that infuse mental health services research with heavy doses of the realities of everyday clinical practice.

/pdf/revisiting-practice-based-research-networks-as-a-platform-4ptrnx0wzd.pdf

Revisiting practice-based research networks as a platform for mental health services research.

The impact of substance abuse on society is wide ranging and costly. According to a Robert Wood Johnson Foundation (RWJF, 2001) report, substance abuse, including tobacco use, is the cause of more deaths, illnesses, and disabilities than any other preventable health condition. This same report indicates that approximately 25 percent of the more than 2 million deaths each year in the United States are attributable to alcohol, illicit drugs, or tobacco. The Department of Health and Human Services (HHS) estimates that drug and alcohol abuse contribute to more than 120,000 deaths in the United States each year (HHS, 2002). According to Healthy People 2010 (HHS, 2000), alcohol and illicit drug use are associated with a wide range of health and social welfare problems, including child and spousal abuse, sexually transmitted diseases, teenage pregnancy, school failure, motor vehicle crashes, low worker productivity, increasing health care costs, and homelessness. Furthermore, long-term heavy alcohol use can lead to heart disease, cancer, liver disease, pancreatitis, and fetal alcohol syndrome (HHS, 2000). In 1995 the cost of alcohol and drug abuse to society was conservatively estimated at more than $275 billion per year (RWJE 2001). These figures reflect costs associated with illness, deaths, medical care, crime, other related costs (for example, motor vehicle crashes), and special conditions related to substance abuse (for example, HIV/AIDS attributable to substance abuse). According to a Substance Abuse and Mental Health Services Administration (SAMHSA) report, it is estimated that 18 to 26 million Americans were in need of substance abuse treatment in 2002 (SAMHSA, 2003). The 2002 National Survey on Drug Use and Health estimated that 22 million people age 12 or older were classified with substance abuse or dependence, supporting the need for substance abuse treatment in the United States. Estimates from SAMHSA indicate that the need for substance abuse services for individuals with an illicit drug problem are increasing (SAMHSA, 2002a). Furthermore, abuse of alcohol and drugs (both legal and illicit) affects nearly 17 percent of adults age 60 or older (SAMHSA, 2002b). Although the need for treatment is documented, it is estimated that only 3 million people actually received substance abuse treatment in 2002 (SAMHSA, 2003). Literature Review: The Role of Social Workers A Bureau of Labor Statistics (BLS) report indicates that there were 477,000 social work positions in 2002 (BLS, 2004). Of these positions, 95,000 were in mental health and substance abuse. A 1993 HHS report suggested that only 6 percent of all staff in substance abuse treatment programs in the United States were social workers at the master's level or higher. According to the BLS report, employment of social workers is expected to increase faster than the average for all occupations through 2012, and employment of social workers in substance abuse settings will grow rapidly between 2002 and 2012 (BLS).This projected increase is due to a variety of factors, including placement of substance abusers, particularly abusers of illicit drugs, into substance abuse treatment programs instead of into the criminal justice system; recognition of the need to provide substance abuse treatment in the United States; and increased comorbidity of substance abuse disorders with other problems (for example, mental health disorders, HIV/AIDS and other sexually transmitted diseases, child welfare cases). For instance, Hall and colleagues (2000) found that at least half of all hospitalized patients in urban areas have substance abuse--related problems. Often, social workers are the first service providers to come in contact with substance abusers in the various service delivery systems, including child welfare, employee assistance programs, hospitals, schools, programs for elderly people, and community-based services. Social workers often provide key assessment and referral services in an array of health and mental health care settings (Hall et al. …

Social Workers in the Substance Abuse Treatment Field: A Snapshot of Service Activities

Two current congressional bills mandate parity for benefits for mental disorders with benefits for medical/surgical conditions in private insurance when mental health benefits are provided; the bills differ in regard to benefit levels and access to out-of-network coverage. This study assessed clinicians’ and beneficiaries’ participation in managed care networks in the national capital area under the Federal Employees Health Benefits (FEHB) parity program. Approximately one-third of the clinicians studied participated in FEHB networks, and only 44 percent of FEHB patients received care from network clinicians. Out-of-network mental health benefits are an important policy consideration to ensure access to mental health treatment under parity proposals.

Toby Weismiller

Papers

Social Workers in the Substance Abuse Treatment Field: A Snapshot of Service Activities

Parity And The Use Of Out-Of-Network Mental Health Benefits In The FEHB Program

Social Work Profession: Workforce