The least you need to know about Clinton’s mental health policy

Hillary Clinton released a mental health policy proposal this week. It contains 27 bullet points outlining initiatives for everything from prevention to treatment to research. All the key behavioral health industry stakeholders seem to applaud the ideas. According to The Hill, Rep. Tim Murphy (R-Pa.), who is still out there trying to drive his mental health legislation, sees potential for bipartisan cooperation around the Clinton plan.

Here’s what jumped out at me:

1. Clinton vows to convene a White House conference on mental health during her first year in office. There’s a lot of opportunity there for behavioral health leaders to participate in a process that ideally would lead to increased funding for programs and services but in reality would likely lead to incremental tweaks. It would be tough for Clinton to drive sweeping changes in mental health policy at the federal level, especially with a Republican Congress, but the conference has potential to change the national dialog at the very least.

2. Clinton also vows to invest $5 billion over 10 years to scale up the Certified Community Behavioral Health Clinic (CCBHC) demonstration project that is currently underway but is limited to just eight states. While 24 states have planning grants now, only eight of the applicants ultimately will be selected to test their programs beginning in January 2017. Since the infrastructure is already in place, it seems as if that $5 billion could go a long way.

“The whole movement toward CCBHCs is important for a number of reasons,” Charles Ingoglia, senior vice president of public policy for The National Council for Behavioral Health, told me on the phone today. “We need to make sure there is adequate capacity to serve people, so that means we also need standards and quality measurements and sufficient reimbursement.”

He also told me that the only reason why the initial pilot was limited to eight states was because a larger program might not have been as palatable politically. The council has long been advocating for nationwide expansion.

3. Programs for kids that are showing good progress would see funding increases. Specifically, the Clinton proposal aims to increase the set-aside in the Mental Health Block Grant from 5% to 10% of the annual budget, while also moving the funds to a separate line item. Mental health first aid is included in the list. The National Council for Behavioral Health has set a goal to get 1 million people trained in mental health first aid by the end of this year.

4. Funds would be directed to colleges. Noting that programs on college campuses have had a positive effect on reducing suicides, the Clinton proposal pledges an increase of up to $50 million per year to provide support to 5,000 public and private colleges for such initiatives.

5. The Center for Medicare and Medicaid Innovation—a test kitchen that essentially generates cost-saving ideas—would be tasked with creating a reimbursement structure for collaborative care models. The models would address behavioral health disorders for the Medicare and Medicaid populations, but payment models like these have a way of bleeding over into the private market as well. You might be able to get involved in the center’s pilot studies.

6. Clinton’s proposal also cites the need for key federal agencies to “bring appropriate enforcement actions against insurers” who do not follow parity laws. And that’s the trouble with parity, isn’t it? There are no real penalties for insurers. While many will point to the current efforts of the new federal parity task force with its nationwide listening sessions, others will question whether any of the rhetoric will translate to practical changes. Health insurers are already highly regulated—more than providers, believe it or not—and more penalties or reporting requirements might lead to unintended consequences, such as insurers pulling out of markets where people really need behavioral health services. It’s something to think about.

Ingoglia told me that he sees some movement on parity these days with the federal task force as well as with other legislative proposals outside of Clinton's plan.

7. Community-based housing for individuals with mental health disorders or disabilities would gain $100 million per year for 10 years. There’s no indication about where this money would come from, but it could possibly be money that’s already in the system for institutional care. That’s just a hunch.

In all, the proposal is aligned with Clinton’s $10 billion addiction policy that was released last year, which also gained support from industry stakeholders. Ingoglia told me that while there are “a lot of cool things in the plan,” there are also a lot variables that could pose barriers to implementation down the road.

Updated at 3:25 p.m. ET to add Ingoglia comments.