The claim is often made that the adoption of single-payer health care in the United States would result in dramatic improvement of services for people with mental health and substance use disorders. Evidence from this sector in countries with such frameworks is mixed, however, presenting both positive and negative lessons for an American audience. Focusing on Canada as an example, this article sheds light on this topic by drawing on sources in the professional and academic literature, government reports, news stories and features, and research on-site by the author. A concluding section highlights key policy issues that American single-payer advocates will need to address for meaningful reform of the behavioral health care sector.
HeoY-CKahngSKKimS.Mental health system at the community level in Korea: development, recent reforms and challenges. Int J Ment Health Syst. 2019;
13:9.
22.
LinC-HHuangA-LMinasHCohenA.Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan. Int J Ment Health Syst. 2009;
3(1):1.
Health Disparities Task Group of the Federal/Provincial/Territorial Advisory Committee on Population Health and Health Security. Reducing Health Disparities: Roles of the Health Sector.
Ottawa, ON:
Health Disparities Task Group of the Federal/Provincial/Territorial Advisory Committee on Population Health and Health Security; 2005. http://www.phac-aspc.gc.ca/ph-sp/disparities/pdf06/disparities_recommended_policy.pdf. Accessed July 13, 2019.
32.
AllinS.Does equity in healthcare use vary across Canadian provinces?Health Policy. 2008;
3(4):83–99.
33.
RiceTQuentinWAnellA, et al.Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries. BMC Health Serv Res. 2018;
18:371.
34.
U.S. General Accounting Office. Canadian Health Insurance: Lessons for the United States. Washington, DC: U.S. General Accounting Office; June 4, 1991. https://www.gao.gov/assets/160/150584.pdf. Accessed July 13, 2019.
SicilianiLBorowitzMMoranV, eds. Waiting Time Policies in the Health Sector: What Works?
Paris, France:
OECD Health Policy Studies, OECD Publishing; 2013. http://www.quotidianosanita.it/allegati/allegato2476022.pdf. Accessed July 13, 2019.
37.
NadeauRBélangerÉPétryFSorokaSNMaioniA.Health Care Policy and Opinion in the United States and Canada.
New York, NY:
Routledge, 2015.
BadgleyRF.Social and economic disparities under Canadian health care. Int J Health Serv. 1991;
21(4):659–671.
40.
MhatrSLDeberR.From equal access to health care to equitable access to health: a review of Canadian provincial health commissions and reports. Int J Health Serv. 1992;
22(4):645–668.
RaphaelD, ed. Social Determinants of Health: Canadian Perspectives. 3rd ed.
Toronto, ON:
Canadian Scholars Press; 2016.
46.
BéginM.Foreword. In: MikkonenJRaphaelD, eds. Social Determinants of Health: The Canadian Facts.
Toronto, ON:
York University School of Health Policy and Management; 2010:5.
47.
RochefortDA.From Poorhouses to Homelessness: Policy Analysis and Mental Health Care. 2nd ed.
Westport, CT:
Auburn House; 1997.
48.
FierlbeckK.Nova Scotia: A Health System Profile.
Toronto, ON:
University of Toronto Press; 2018.
49.
BlackMFierlbeckK.Whatever happened to regionalization? The curious case of Nova Scotia. Can Public Admin. 2006;
49(4):506–526.
BartramMLurieS.Closing the mental health gap: the long and winding road. Can J Community Mental Health. 2017;
36(2):5–18.
53.
DickinsonHD.The Two Psychiatries: The Transformation of Psychiatric Work in Saskatchewan, 1905–1984.
Regina, Saskatchewan:
Canadian Plains Research Center; 1989.
Provincial Community Mental Health Committee. Building Community Support for People: A Plan for Mental Health in Ontario.
Toronto, ON:
Provincial Community Mental Health Committee; 1988. http://ontario.cmha.ca/wp-content/uploads/2016/08/grahamreport.pdf. Accessed July 13, 2019.
Province of New Brunswick. The Action Plan for Mental Health in New Brunswick, 2011-18.
Fredericton, NB:
Province of New Brunswick; 2010. https://www.gnb.ca/0055/pdf/2011/7379%20english.pdf. Accessed July 13, 2019.
Canadian Mental Health Association. More for the Mind.
Toronto, ON:
Canadian Mental Health Association; 1963.
63.
Canadian Alliance on Mental Illness and Mental Health. A Call for Action: Building Consensus for a National Action Plan on Mental Illness and Mental Health.
Ottawa, ON:
Canadian Alliance on Mental Illness and Mental Health; 2000. https://www.schizophrenia.ca/docs/CalltoActionCAMIMH2003English.pdf. Accessed July 13, 2019.
AustinSE.Extending mental health diagnostic privileges to social workers in Saskatchewan.Health Reform Observer – Observatoire des Réformes de Santé. 2017;
5(1): Article 4. https://mulpress.mcmaster.ca/hro-ors/article/view/2835. Accessed July 13, 2019.
66.
LurieSGoldbloomDS.More for the mind and its legacy. Can J Community Mental Health. 2015;
34(4):7–30.
BelzakLHalversonJ.Evidence synthesis – the opioid crisis in Canada: a national perspective. Health Promot Chronic Dis Prev Canada. 2018;
38(6):224–233.
RochefortDAGoeringP.“More a link than a division”: how Canada has learned from U.S. mental health policy. Health Aff. 1998;
17(5):110–127.
72.
JacobsPDewaCLesageA, et al. The Cost of Mental Health and Substance Abuse Services in Canada: A Report to the Mental Health Commission of Canada.
Edmonton, AB:
Institute of Health Economics; June 2010.
WangJJacobsPOhinmaaALesageA.Public expenditures for mental health services in Canadian Provinces. Can J Psychiatry. 2018;
63(4):250–256.
76.
CohenRATerlizziEMartinezME.Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey.
Hyattsville, MD:
National Center for Health Statistics; May 2019. https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201905.pdf. Accessed October 6, 2019.
AndradeLHAlonsoJMneimnehZ, et al.
Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med. 2014;
44(6): 1303–1317.
BoseJHeddenSJLipariRNPark-LeeE.Key Substance Use and Mental Health Indicators in the United States: Results From the 2017 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Washington, DC: U.S. Department of Health and Human Services; September 2018. https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report. Accessed July 13, 2019.
84.
President’s Commission on Mental Health. Report to the President From the President’s Commission on Mental Health.
Washington, DC:
President’s Commission on Mental Health; 1978. https://babel.hathitrust.org/cgi/pt?id=uc1.b4087615&view=1up&seq=18. Accessed July 13, 2019.
85.
Office of the Surgeon General. Mental Health: A Report of the Surgeon General.
Rockville, MD:
Office of the Surgeon General; 1999.
Bazelon Center for Mental Health Law. Following the Rules: A Report on Federal Rules and State Actions to Cover Community Mental Health Services Under Medicaid. Washington, DC: Bazelon Center for Mental Health Law; 2008. http://www.bazelon.org/wp-content/uploads/2017/01/Following-the-Rules.pdf. Accessed September 26, 2019.
96.
ShernDSNeylonKNKazandjianMLuttermanT.Use of Medicaid to Finance Coordinated Specialty Care Services for First Episode Psychosis. Information Brief.
Alexandria, VA:
National Association of State Mental Health Program Directors; 2017. https://www.nasmhpd.org/sites/default/files/Medicaid_brief_1.pdf. Accessed September 26, 2019.
97.
Bazelon Center for Mental Health Law. When Opportunity Knocks: How the Affordable Care Act Can Help States Develop Supported Housing for People With Mental Illnesses. Washington, DC: Bazelon Center for Mental Health Law; April, 2014. http://www.bazelon.org/wp-content/uploads/2017/01/When-Opportunity-Knocks.pdf. Accessed September 26, 2019.
98.
RochefortDA.The Affordable Care Act and the faltering revolution in behavioral health care. Int J Health Serv. 2018;
48(2):223–246.
EmbuldeniyaKMWalkerKWodchisWP.The generation of integration: the early experience of implementing bundled are in Ontario, Canada. Milbank Q. 2018;
96(4):782–813.
LewisVALarsonBKMcClurgABBoswellRGFisherES.The promise and peril of Accountable Care for vulnerable populations: a framework for overcoming obstacles. Health Aff. 2012;
31(8):1777–1785.
104.
RubinR.How value-based Medicare payments exacerbate health care disparities. JAMA. 2018;
319(10): 968–970.
105.
BaoYCasalinoLPPincusHA.Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organizations. J Behav Health Serv Res. 2013;
40(1):121–132.
106.
PressMJHoweRSchoenbaumM, et al.Medicare payment for behavioral health integration. N Engl J Med. 2017;
376:405–407.
LerchS.The Role State Mental Health Authorities Can Play in Delivery of Integrated Primary and Behavioral Health Care for People With Serious Mental Illness, Including Those With Co-Occurring Substance Use Disorders.
Alexandria, VA:
National Association of State Mental Health Program Directors. https://www.nasmhpd.org/sites/default/files/TAC.Paper_.6.IntegratedCare_Final.pdf. Published August 2017. Accessed September 26, 2019.
KeithK.Texas arguments lead heavy ACA action. Health Aff. 2019;
38(10):1614–1615.
111.
GrobGN.Government and mental health policy: a structural analysis. Milbank Q. 1994;
72(3):471–500.
112.
RochefortDA.Origins of the “Third Psychiatric Revolution”: the Community Mental Health Centers Act of 1963. J Health Polit Policy Law. 1984;
9(1):1–30.
RobertsonDB.Federalism and the Making of America. 2nd ed.
New York, NY:
Routledge; 2018.
115.
Substance Abuse and Mental Health Services Administration. Projections of National Expenditures for Treatment of Mental and Substance Use Disorders, 2010–2020. U.S. Department of Health and Human Services.
Rockville, MD:
Substance Abuse and Mental Health Services Administration; 2014. https://store.samhsa.gov/system/files/sma14-4883.pdf. Accessed July 13, 2019.
116.
FrankRGGoldmanHHHoganM.Medicaid and mental health: be careful what you ask for. Health Aff. 2003;
22(1):101–113.
Congressional Budget Office. Key design components and considerations for establishing a single-payer health care system. Congress of the United States. May 2019. www.cbo.gov/publication/55150. Accessed July 13, 2019.
125.
MillerJE.Too Significant To Fail: The Importance of State Behavioral Health Agencies in the Daily Lives of Americans with Mental Illness, for their Families, and for their Communities.
Alexandria, VA:
National Association of State and Mental Health Program Directors; 2012.
126.
Advocates for Human Potential, Inc. Best Practices for State Behavioral Health Planning Councils: The Road to Planning Council Integration.
Rockville, MD:
Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. https://www.samhsa.gov/sites/default/files/manual-planning-council-best-practices-2014.pdf. Published February 12, 2014. Accessed October 2, 2019.
127.
WerlinSHWalcottAWJoroffM.Implementing formative health planning under PL 93-641. N Engl J Med. 1976;
295:698–703.
128.
MelhadoEM.Health planning in the United States and the decline of public-interest policymaking. The Milbank Quarterly. 2006;
84(2):359–440.
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