Senator Hagan steps up on veterans' mental health

I received this earlier today via e-mail from a Governor's Focus member:

U.S. Senator Kay R. Hagan (D-NC) yesterday cosponsored a bipartisan bill to help service members access mental health care services...

“Our service men and women put their lives on the line for our country, and they now face an unnecessary, administrative hurdle to accessing mental health care,” Hagan said. “As a U.S. Senator from North Carolina and member of the Senate Armed Services Committee, I am focused on ensuring our veterans, active duty military and their families can access the services they need. Mental health care for our returning troops is so critical, and I will work with my colleagues to ensure this important bill is signed into law.”

Here's the core of the problem Kay is trying to fix:

Currently, TRICARE, the health care system for service members, requires them to obtain a physician referral in order to see a licensed mental health counselor. However, this same obstacle is not applied to licensed social workers or certified marriage and family therapists.

I'm going to attempt to give you some background on this issue, but if any MH professionals notice any fallacies or points that need clarification, please let us know. Getting it right is critical.

TRICARE is not a facility or a group of practicing clinicians, it's a funding vehicle. And for those who have left active duty service, it soon becomes a health care insurance plan that requires a monthly premium payment, if they want to remain enrolled. It doesn't provide care, it pays for care, and the dollars are appropriated for and administered by the Department of Defense. And it's not some sort of entitlement program dreamed up by soft-hearted politicians, it's an integral part of our nation's defense framework.

I wanted to make that clear upfront, because the bill in question, if passed, will facilitate the needed treatment of thousands of current and former service members. And that's going to cost money. A lot of money. As such, there will be opposition to this increase in spending, both from Congress and the DoD itself. Opposition which should (and probably will) be ashamed to show its face in public.

Now to the "why" this is needed. Within the mental health field in general, and the substance abuse field in particular, the vast majority of counselors and clinicians are not (medical) doctors. This is not to disparage the value of doctors in the system, but to provide demographics. The number of MD's is so limited, the few in the system are often responsible for serving several clinics, making an appearance at each maybe once a week. Meaning, if an individual must see a physician before he/she can even begin the evaluation/treatment process, that appointment could be weeks in coming. And for some, those few weeks could be a lifetime.

Speaking of, now is as good a time as any to talk about suicide rates in the ranks:

June was not only the worst month ever for American combat deaths in Afghanistan. It was the worst month ever for suicides in the Army, CBS National Security Correspondent David Martin reports.

A total of 32 soldiers, both active duty and reserve, took their own lives in those 30 days. So far this year, 145 soldiers have committed suicide compared with 130 during the first six months of last year, which at the time was the worst on record.

We've lost more troops to suicide in the last nine years than have died in combat in Afghanistan. To say we have a mental health crisis is such an understatement that I can find no analogy with which to make a suitable comparison. And the scary part is, even if we withdrew all forces from the theater today, the legacy of that mental health damage will continue to take lives for years.

Back to the people who can ease that suffering and save those precious lives and families. Those non-MD's; the PA's, nurses, psychologists, licensed counselors, etc., are the eyes, ears, mouths (and yes) hearts of our mental health system. They have the brains and ability to both assess problems and open doors where solutions can be found. Whether it's in- or out-patient treatment relying on government, private, or faith-based resources, these folks are armed with answers. Our troops are in desperate need of those answers, and the extra funding that would require.

Comments

Thanks

It's helpful to keep track of the good things Kay's doing.

I decided to wait a while

before injecting partisan politics into the diary, because I wanted the focus to be on the troops.

That said, it comes as no surprise that Richard Burr has yet to sign on as a co-sponsor. He's all gung-ho about veterans until they need money, especially those who don't wind up and march so good anymore.

But this is one case where I hope he makes a liar out of me.

We can't afford this...

I wanted to make that clear upfront, because the bill in question, if passed, will facilitate the needed treatment of thousands of current and former service members. And that's going to cost money. A lot of money. As such, there will be opposition to this increase in spending, both from Congress and the DoD itself.

...we have the Bush tax cuts that must be renewed first.

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The measure of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little. - FDR

Seriously...

can someone quickly provide the bill #?
Thanks!

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The measure of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little. - FDR

Here you go:

It's S 3371:

SECTION 1. SHORT TITLE.

This Act may be cited as the `TRICARE Mental Health Care Access Act'.

SEC. 2. MENTAL HEALTH COUNSELORS UNDER THE TRICARE PROGRAM.

(a) Referral Under TRICARE-

(1) REFERRAL- Paragraph (8) of section 1079(a) of title 10, United States Code, is amended--

(A) by inserting `or licensed or certified mental health counselors' after `certified marriage and family therapists' both places it appears; and

(B) by inserting `or licensed or certified mental health counselors' after `that the therapists'.

(2) AUTHORITY TO ASSESS MEDICAL OR PSYCHOLOGICAL NECESSITY OF SERVICE OR SUPPLY- Paragraph (13) of such section is amended by inserting `licensed or certified mental health counselor,' after `certified marriage and family therapist,'.

(b) Services of Mental Health Counselors-

(1) AUTHORITY TO ENTER INTO PERSONAL SERVICES CONTRACTS- Section 704(c)(2) of the National Defense Authorization Act for Fiscal Year 1995 (10 U.S.C. 1091 note) is amended by inserting `mental health counselors,' after `psychologists,'.

(2) APPLICABILITY OF LICENSURE REQUIREMENTS FOR HEALTH CARE PROFESSIONALS- Section 1094(e)(2) of title 10, United States Code, is amended by inserting `mental health counselor,' after `psychologist,'.

(c) Requirements for Mental Health Counselors Practicing Under TRICARE- For purposes of practicing as a mental health counselor under the TRICARE program pursuant to the amendments made by subsections (a) and (b), an individual shall meet the following:

(1) The individual shall possess a masters degree or higher level degree in counseling from a program in mental health counseling or clinical mental health counseling that is accredited by the Council for Accreditation of Counseling and Related Educational Programs.

(2) The individual shall possess a State license in mental health counseling at the `clinical' or higher level or at the highest level available in States that have tiered licensing schemes.

(3) The individual shall have passed the National Clinical Mental Health Counseling Examination.

(4) The individual shall have a well-defined scope of practice (as determining utilizing a systematic assessment of the professional competencies necessary to address the mental and behavioral needs of the population of beneficiaries under the TRICARE program).

(d) Reports on Implementation-

(1) INITIAL REPORT- Not later than 180 days after the date of the enactment of this Act, the Secretary of Defense shall submit to Congress a report on the implementation of this section and the amendments made by this section.

(2) UPDATED REPORT- Not later than one year after the date of the enactment of this Act, the Secretary shall submit to Congress an update to the report submitted under paragraph (1).

(e) TRICARE Program Defined- In this section, the term `TRICARE program' has the meaning given that term in section 1072(7) of title 10, United States Code.

Sorry that took so long. Been trying to fix a roof leak, and succeeding in getting myself heat exhausted.

Thanks...

...and good luck with the leak...

Reminds me of the old "Arkansas Traveler" routine...

Hello, stranger..

Hello stranger.

That roof looks mighty leaky. When are you going to fix it?

Well, when it's raining, I can't fix it. And when it's not raining, it doesn't leak!

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The measure of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little. - FDR

Heh :)

I said something like "I wish it would rain" to my ex father-in-law (his house) while I was trying to locate the leaks. I spent 2 hours in their attic (barely a crawl space), and it must have been close to 120 degrees in there. :o

I seem to be confused

From what I know about Tricare they do now cover mental health issues. I am confused why this bill is being put forward.

http://www.tricare.mil/mybenefit/

Click on the mental health tab.

Maybe there needs to be a fix to the current inequities rather than just one more bill?

Reading the original post...

It seems that current law requires a referral by a physician to a mental health counselor (as defined in the bill cosponsored by Sen. Hagan). The bill simply removes the requirement for the physician referral, and defines the requirements for a qualified mental health counselor.

Often fixing the current inequities requires a bill to change an existing law.

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The measure of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little. - FDR

What a crock

So instead of just changing the current part of the existing law there has to be a completely new law with all that it entails.

Ah yes. The government at work. What a crock.

Read the bill above

They are changing the old law, not creating a whole new one. And the only way to change a law (thank God) is for Congress to pass a bill which the President must sign. This process (amending current statute) makes up the bulk of bills Congress deals with.

I have learned

something here then. It does seem like they could just change something in a current bill or law without everything it takes to come up with a new bill. But I am not really that versed on all of this so I will just consider this a little education for myself. Thanks.