Table Of ContentMoniz and Gorin’s Behavioral and Mental Health Care Policy and Practice could not be more timely. In their usual
comprehensive and insightful fashion, the authors analyze the core issues in this complex and increasingly important
arena of policy and practice. This book is a valuable resource for faculty teaching in this area and for current and future
practitioners in the field.
—Michael Reisch, Ph.D., MSW, Daniel Thursz Distinguished Professor of Social Justice, School of Social Work,
University of Maryland
Moniz and Gorin’s new companion piece to their successful health policy book adds a timely policy analysis of the
behavioral and mental health fields. The authors present a critical view of policy development from the Kennedy-Johnson
days to the chaotic Trump era, followed by practice recommendations to improve access to underserved populations.
Faculty and students alike will appreciate this judicious offering.
—Cathleen Jordan, Ph.D., LCSW, Professor, School of Social Work, University of Texas at Arlington
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Behavioral and Mental Health Care Policy and
Practice
Cynthia Moniz and Stephen Gorin’s Behavioral and Mental Health Care Policy and Practice: A
Biopsychosocial Perspective is a new mental health policy textbook that offers students a
model for understanding policy in a framework that addresses policy practice. Edited to read
like a textbook, each chapter is written by experts on an aspect of mental health policy. The
book contains two parts: Part I chronicles and analyzes the evolution of mental health policy;
Part II analyzes current policy and teaches students to engage in policy practice issues in
different settings and with diverse populations.
Cynthia D. Moniz is Professor Emeritus of Social Work and former Department Chair at
Plymouth State University in New Hampshire.
Stephen H. Gorin is Professor Emeritus of Social Work at Plymouth State University in New
Hampshire.
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Behavioral and Mental Health Care Policy
and Practice
A Biopsychosocial Perspective
Edited by
Cynthia Moniz and Stephen Gorin
4
First published 2018
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2018 Taylor & Francis
The right of Cynthia Moniz and Stephen Gorin to be identified as the authors of the editorial
material, and of the authors for their individual chapters, has been asserted in accordance with
sections 77 and 78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilized in any
form or by any electronic, mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information storage or retrieval system,
without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identification and explanation without intent to infringe.
Library of Congress Cataloging-in-Publication Data
Names: Moniz, Cynthia, editor. | Gorin, Stephen H., editor.
Title: Behavioral and mental health care policy and practice : a biopsychosocial perspective /
edited by Cynthia Moniz and Stephen Gorin.
Description: New York, NY : Routledge, 2018. | Includes bibliographical references and index.
Identifiers: LCCN 2017041165 (print) | LCCN 2017042234 (ebook) | ISBN 9781315641379 (ebook)
| ISBN 9781138189881 (hardback : alk. paper) | ISBN 9781138189898 (pbk. : alk. paper) | ISBN
9781315641379 (ebk)
Subjects: | MESH: Mental Health Services | Mental Disorders | Health Policy | Insurance,
Health | Medical Assistance | United States
Classification: LCC RA418 (ebook) | LCC RA418 (print) | NLM WM 30 AA1 | DDC 362.1—dc23
LC record available at https://lccn.loc.gov/2017041165
ISBN: 978-1-138-18988-1 (hbk)
ISBN: 978-1-138-18989-8 (pbk)
ISBN: 978-1-315-64137-9 (ebk)
Typeset in Stone Serif
by Apex CoVantage, LLC
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Contents
Preface
Part I Where We Are and How We Got Here
Chapter 1 Behavioral Health and the Affordable Care Act
John Orwat and Whitney Key
Chapter 2 The Origins of Federal Mental Health Policy: Kennedy-Johnson Great
Society
Eileen Klein
Chapter 3 The Decline of Community Mental Health Under Reagan and Bush
Alexander Sawatsky
Chapter 4 Clinton’s Efforts to Respond to Escalating Costs and the Emergence of
Mental Health Parity
Alexander Sawatsky
Chapter 5 Financing and Delivery of Behavioral Health in the United States
John Orwat, Shveta Kumaria, and Michael P. Dentato
Part II Policy Practice: Advancing Access to Behavioral and Mental Health
Care
Chapter 6 Social Workers and Policy Practice: Affecting Policy and Achieving Policy
Action
Cynthia Moniz
Chapter 7 Analyzing the Problem: Access to Care
Christine M. Rine
Chapter 8 Analyzing the Problem: Disparities in Behavioral Health Services for People
of Color and Latinxs
Tenesha Littleton, Megan Lee, and Llewellyn Cornelius
Chapter 9 Analyzing the Problem: Gender Disparities in Behavioral and Mental Health
Care
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Whitney C. Sewell, Whitney Key, and Sarah Gehlert
Chapter 10 Analyzing the Problem: Disparities in Behavioral and Mental Health Care
for Children and Youth
John Orwat and Whitney Key
Chapter 11 Analyzing the Problem: Disparities in Behavioral Health Care for Older
Adults
Kyeongmo Kim, Amanda J. Lehning, and Paul Sacco
Chapter 12 Analyzing the Problem: Disparities in Behavioral and Mental Health Care
for Lesbian, Gay, Bisexual, and Transgender (LGBTQ) Individuals
Eileen Klein
Chapter 13 Conclusion: Advocating for Policies That Address Inequities and Disparities
in the Behavioral and Mental Health Care System in the U.S.
Cynthia Moniz
About the Authors
Glossary
Index
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Preface
The first part of this text provides an historical overview of the behavioral and mental health
system in the U.S., from the early days of mistreatment of people with emotional and mental
health problems to the current effort by the Trump administration to “repeal and replace” the
Affordable Care Act (ACA). The U.S. Congress first made progress in expanding access to
mental and behavioral health coverage in 2008 by passing the Wellstone-Domenici Mental
Health Parity and Addiction Equity Act. The legislation required that large-group plans cover
mental health and substance use treatment on a par with other medical and surgical care
coverage. In 2010, the ACA extended the equity act to include individual and small-group
plans and Medicaid. Since January 2016, all individual and small-group plans have been
required to cover behavioral health services with no annual or lifetime dollar limits and no
annual or lifetime cap on spending for benefits. The Medicaid expansion program under the
ACA increased access, provided marketplace exchange subsidies to individuals with incomes
between 100 and 400 percent of the poverty level, and significantly increased access for low-
income individuals and people of color. Throughout the first part of the text, where
historically appropriate, the authors incorporate the positive impact of the parity legislation
and the ACA and discuss the potential harm if efforts to repeal rather than improve the ACA
occur.
The second part of the text addresses the inequities and disparities in behavioral and mental
health that exist for populations-at-risk in the U.S., including people of color and Latinx,
women, children and youth, the LGBT community, and people living in poverty. These
chapters examine the behavioral and mental health of these populations, identify and analyze
problems in the delivery of behavioral and mental health services to these groups, and offer
policy recommendations for reform. The final chapter briefly considers advocating for policies
that address inequities and disparities and building a better system of behavioral and mental
health care.
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Purpose of the Book
In 2002, we published the first edition of our textbook, Health Care Policy and Practice, to
address the lack of textbooks available for social work educators to teach health care policy.
Social policy, in general, can be a challenging subject to teach to social work students who
want to focus on becoming effective practitioners, and health care policy may seem even more
narrow a focus. However, with increasing attention being paid to the social determinants of
health and mental health, there is increasing awareness of the importance of the role of social
policies in the health and well-being of individuals, communities, and populations. With this
text in its fourth edition (soon to be fifth edition), we wanted to create a companion text that
focused on behavioral and mental health policy. Here too there are few social work textbooks.
We thought it might be useful to instructors and students to frame this text in a fashion
similar to the health policy text. For social work schools and programs that have a combined
health and mental health concentration or courses, this would serve as complementary
resource.
The book attempts to provide a comprehensive overview of behavioral and mental health
policy, policymaking, and related behavioral and mental health practice. It includes an
historical examination of the evolution of mental health policy in the U.S., the role of major
substantive policies (public health, community mental health centers, Medicare, Medicaid,
parity legislation, and the Affordable Care Act), the policymaking process, and health
disparities and inequities for populations-at-risk. Each of the chapters on populations-at-risk is
structured to address basic questions of policy analysis:
What is the social problem?
Who is affected? What is the extent of the problem?
What are the dimensions and boundaries of the problem?
What evidence is there that a problem exists?
How serious is the problem?
What is the perceived cause of the problem?
What explanations exist for the problem?
The chapter authors are social work scholars and educators who have applied their knowledge
and experience to provide an historical analysis of mental health policy in the U.S. and the
current state of behavioral and mental health for people of color and Latinx, women, children
and youth, the LGBT community, and people living in poverty. The development of this book
would not have been possible without the contributions of these colleagues who graciously
agreed to contribute to the project. We appreciate their hard work, knowledge, and
commitment and thank them for their willingness to share their expertise.
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