Journal of Psychiatry Depression & Anxiety Category: Clinical Type: Review Article
Mental Health First Aid Act: A Policy Analysis
*Corresponding Author:Sarmila Bhatta
School Of Nursing, University Of Texas At Austin, Texas, United States
Received Date: Jan 02, 2018 Accepted Date: Feb 12, 2018 Published Date: Feb 26, 2018
Several efforts have been made in the past to improve mental health care in the United States. The Affordable Care Act (ACA) provided opportunities for expanded access to behavioral health care and established mental health and substance abuse care as essential coverage. The Mental Health First Aid Act (MHFAA) was a bill introduced in Congress in order to improve awareness, identification, and ability to appropriately respond to the needs of persons experiencing symptoms of mental disorders. The goal of this act is to provide mental health first aid training to first responders. Mental health stigma is a significant barrier to participation in mental health care. Mental health first aid training can play a significant role in building community awareness and reducing stigma. Primary care providers can also play significant roles in early identification and establishment of care coordination of mental illnesses. The positive parenting programs that motivate parents to come and discuss their family issues without any fear or shame are advantageous in improving positive outcomes. Also, policies in reducing the scarcity of the mental health providers in all states and counties should be considered.
According to the CDC, the percentage of adults with serious psychological distress in the past 30 days was 3.6%. The number of outpatient visits including physician’s offices, hospital outpatient, and emergency departments with mental disorders as primary diagnosis in 2009-2010 was 63.3 million. According to 2014 data, the number of deaths due to suicide was 42,773 and suicide deaths per 100,000 population was 13. According to Cohen & Zammitti , from the national health interview survey early release program 2012- September 2015, in the first 9 months of 2015, 24% of adults with serious psychological distress and 6.1% of those without serious psychological distress had not received needed medical care due to cost.
Mental illness in children and adolescents
Suicide was the second leading cause of death in 2013 among teenagers and young adults . In 2012-2013, young adult males aged 18-24 years were more likely to commit suicide than young adult females. MDD is common in childhood and adolescence and is associated with functional impairment and suicide. Approximately 8% of adolescents were depressed within the past year . According to Hudson & Nandy , in the U.S, nearly 26,000 youth age out from the child welfare system annually. These youth are at risk for substance abuse, poverty and severe mental illness.
Adolescents in foster care have considerably more psychiatric symptoms than adolescents without foster care including suicidal ideation, alcohol abuse, and substance abuse . Data has identified that there is a higher proportion of drug abuse in youth with history of foster care than those without foster care history. Once former foster care youth become homeless, they might not have access to comprehensive mental health services; as a result, they self-medicate with methamphetamine .
According to Jonas, Gu & Albertorio-Diaz , the data from national health and nutrition examination survey, approximately 6.0% of adolescents aged 12-19 years reported psychotropic drug use in the past month. The use of antidepressants (3.2%) and attention deficit hyperactive disorder drugs (3.2%) was highest. Children and adolescents with mental health disorders are often encountered in primary care for healthcare services . Primary care providers can facilitate early identification of mental health disorders, initiate early treatment, and refer patients to appropriate services as necessary.
Mental illness related gun violence
Gun violence is common in the United States. Most gun violence is committed by youth and young adults. According to whitehouse.gov (n.d.) , on January 8, 2011, six people were killed, and 13 people were injured in a Tucson grocery store parking lot, in Arizona. On July 20, 2012, an armed man killed 12 people in a movie theater in Aurora, Colorado and wounded 58 people. Similarly, on December 14, 2012, a man killed 20 first graders along with 6 other staff members at Sandy Hook Elementary School. Likewise, 49 people were killed in Orlando gay bar shooting incident. Similarly, 59 people died in the sad incident that recently happened in Las Vegas . The tragic incidents indicate that the efforts need to be made to control gun violence related consequences. (Table 1).
No. of Gun Violence Related Death
Tucson grocery store incident
Movie theater incident, aurora colorado
Sandy hook elementary school incident
Orlando gay bar shooting
Las vegas incident
PREVIOUS EFFORTS TO IMPROVE MENTAL HEALTH CARE
Former president obama’s plan against gun violence
Proposed bills related to mental health care
Medicaid expansion under Affordable Care Act (ACA): The patient protection and ACA of 2010 gives states the option of extending Medicaid coverage to uninsured adults younger than 65 years whose family income is below 138% of the federal poverty level defined by the US Department of Health and Human Services. Twenty Seven states are currently expanding Medicaid under ACA. Adults with untreated serious mental illness are often poor, uninsured, or enrolled in Medicaid . The provision of ACA provides opportunities for expanded access to behavioral health care and establishes mental health and substance abuse care as essential coverage.
Mental Health Parity and Addiction Equity Act of 2008: It provides access to mental health and substance abuse services without limitations than those of medical and surgical insured services. Prior to mental health parity legislation, there were major flaws on public health insurance coverage of mental health services. It was extremely difficult to get enrolled in the insurance due to its strict requirements. The division of Medicaid funding between the federal government and states also contributed to difficulties in getting access to mental health services coverage. The mental health coverage under Medicaid was not consistent and uniform across the country .
According to the national counil.org (n.d.) , in 2008, the National Council, the Maryland Department of Health and Mental Hygiene, and the Missouri Department of Mental Health brought mental health first aid to the United States. The goal of the program was to make mental health first aid as common as Cardiopulmonary Resuscitation (CPR) in 10 years. In the 2013-2014 legislative session, 21 states passed legislation or introduced executed programs related to mental health first aid.
According to the national counil.org (n.d) , the target mental health first aid trainees are law enforcement officers, juvenile detention officers, teachers, school counselors, education administrators, social workers, child welfare personnel, and foster caregivers. One of the goals this training is to reduce gun violence by educating people and law enforcement personnel, especially those who interact with children and youth. According to Clay , initial evaluation of the mental health first aid training have shown that the program effectively reduces stigma, increases knowledge of mental illness, and boosts confidence in responding appropriately to emergency mental health crisis.
Originally, the mental health first aid training was developed in Australia in 2001, which is now adopted in the United States and other countries around the world. President Obama has included mental health first aid in his plan to reduce gun violence by training school teachers and other adults who interact with youth . Initial evaluation has shown that the program successfully reduces stigma and improves knowledge about mental illness and also prepares trainees appropriately respond to crisis . According to Jorm , four randomized controlled trials have been carried out comparing the course with wait-list controls. These trials have found that mental health first aid training has brought improvement in knowledge, confidence in providing help, helping behavior, and stigmatizing attitude.
ANALYSIS OF LEGISLATION
Analysis of the bill
Economic burden of mental illness
Limitations for access to mental care
Role of primary care in improving mental health outcome
Primary prevention of mental health problems should be included in any mental health related legislative plans. Several meta-analytic reviews have shown that prevention programs for children and adolescents produce significant benefits by reducing the rate of future behavioral problems . Parenting can play a significant role in the prevention of certain mental illnesses such as depression, anxiety, drug abuse, etc. Creating a positive parenting program that motivates parents to come and discuss their family issues without any fear or shame may be valuable. There are programs that have been found beneficial in preventing specific mental illnesses in youth. These programs are: Child abuse prevention programs, programs designed to prevent negative consequences of divorce on parents and children, and drug abuse prevention programs .
Finally, mental health first aid training is still in the initial phase and more data is available to evaluate its effectiveness in long-term. The program should be improved by expanding the scope of training and using the high fidelity training methods. Primary prevention of mental disorders should be included in future legislative action. More comprehensive mental health programs should be offered in each county. All states and counties should have an adequate number of mental health providers.
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Citation:Bhatta S (2018) Mental Health First Aid Act: A Policy Analysis. J Psychiatry Depress Anxiety 4: 013.
Copyright: © 2018 Sarmila Bhatta, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.