Alignment for Progress: 
A National Strategy for Mental Health and Substance Use Disorders

MHPAEA requires equity in coverage between mental health and substance use disorder (MH/SUDs) and medical/surgical benefits.[2][3] When passed in 2008, the MHPAEA applied only to group health plans and group health insurance.[2][3] However, in 2010, the Affordable Care Act amended the law to include the individual health insurance market.[2][3] While the MHPAEA has significantly improved access to MH/SUD coverage for millions of Americans, the Department of Labor, in coordination with state regulators, has uncovered numerous health plans in violation of MHPAEA.[4] Everyone deserves equal coverage of mental health and addiction treatment services, and the Department of Treasury’s failure to use its existing authority has weakened the ability to enforce the law.[5] It should utilize its existing authority to levy taxes on plans in violation of the MHPAEA.[1][3]

Medications for Opioid Use Disorder (MOUD), particularly when coupled with therapy and support services (collectively often referred to Medication-Assisted Treatment, or MAT) has been effective in treating opioid use disorder (OUD), but cost can be a barrier to accessing treatment.[2][3] Siloed healthcare can also be a barrier for people to obtain the treatment they need. Patients with OUD who are not treated effectively with MAT can add billions of collars in costs to the healthcare system (e.g. increased frequency of emergency department visits and preventable hospital admissions.[4] Medicare is currently the only insurance that offers a bundled payment option for opioid treatment programs (OTP) that helps coordinate and connect care for patients with OUD.[5] The Patient-centered Opioid Addiction Treatment (P-COAT) payment model is designed to improve treatment outcomes with coordinated care, control costs, and ensure appropriate reimbursement rates through bundled payments.[4] There are three bundles, including Patient Assessment and Treatment Planning, Initiation of MAT, and Maintenance of MAT. Each is a payment focused on the different components of OUD treatment covering evaluation and diagnosis, initial outpatient MAT and support services, and ongoing treatment.[6] P-COAT should be used as alternative payment model for OUD treatment to enhance care coordination, improve health outcomes, and lower costs. [1]

The Residential Substance Abuse Treatment (RSAT) program includes grants to state, local and tribal prisons and jails to provide mental health and substance use disorder (MH/SUD) treatment and resources to incarcerated adults and youth.[2] To receive funding, grant recipients must provide aftercare services to individuals who participate in MH/SUD treatment and services while incarcerated.[3] These services include education, job training, and peer, self-help, and half-way house programs.[4] The “Residential Substance Use Disorder Treatment Act,” as introduced in the 118th Congress, expands residential SUD treatment programs under RSAT to include the use of medication-assisted treatment (MAT).[5] In addition to aftercare services, eligibility for grants made through the RSAT program should be contingent upon the use of MAT.[1][6]

Pregnant women who are incarcerated are more likely to have mental health and substance use disorders (MH/SUD) than the general population.[3] Unfortunately, these individuals do not consistently receive the care they need, including medication to treat SUDs.[4] In addition to SUD treatment, pregnant women who are incarcerated often need care for mental health conditions, such as postpartum depression or depression related to pregnancy.[2] Many incarcerated individuals are primary caretakers,[5] and incarcerated parents experience higher rates of depression, anxiety, and increased stress due to the lack of contact and forced separation from their children.[6] Informed care for pregnant women and primary caregivers who are incarcerated, including adequate screenings and treatment for MH/SUD issues, should be a mandatory federal requirement.[1][2]

Instrumental Activities of Daily Living (IADLs) are the activities we do every day to maintain an independent lifestyle and are a crucial tool for assessing and ensuring quality of life.[2] They include cooking, cleaning, transportation, laundry, and financial management.[3] IADLs are traditionally closely associated with Activities of Daily Living (ADLs) which are concerned with basic self-care skills such as eating, bathing, and mobility; and both are used by occupational therapists to determine the balance of independence and support a person needs when recovering from a physical or cognitive injury, or older adults facing physical or cognitive decline.[3] While IADLs are assessed for all hospitalized patients, individuals with a mental health or substance use disorder (MH/SUD) may experience challenges beyond IADLs. MH/SUDs can impair a person’s ability to make and hold appointments, shop for basic necessities, and other activities that impact quality of life. Additionally, their IADLs may never be assessed if they are never hospitalized. Those experiencing MH/SUD could benefit from the support IADL assessments and support services offer.

The number of incarcerated individuals with a mental health or substance use disorder (MH/SUD) continues to increase and conditions in correctional facilities can exacerbate these issues.[4] Many criminal legal system employees lack the necessary training to support an incarcerated individual with MH/SUD.[5] Similar to the recruitment incentives currently available through the Bureau of Prisons, there should be a federal incentive for criminal legal system employees to obtain training on MH/SUD issues and screening techniques.[1][2][3][6] With the knowledge, skills, and understanding to successfully identify and screen for MH/SUD,[5] employees can identify individuals in crisis and provide more appropriate interventions.[7]