Psychiatry’s Role in Fighting Barriers to Access and Coverage


Under Medicare, beneficiaries are limited to just 190 days of inpatient psychiatric care in their lifetimes. Because many beneficiaries who use psychiatric services are eligible for Medicare due to a disability, they are often younger beneficiaries who can easily reach the 190-day limit over their lifetimes.

Eliminating the 190-day lifetime limit would equalize Medicare mental health coverage with private health insurance coverage. It would also expand beneficiary choice, increase access for the most seriously ill, improve continuity of care, and create a more cost-effective Medicare program.

Congress is hearing from constituents about access challenges, and a number of measures are now under consideration.  Your voice — calling on Congress to pass comprehensive mental health reform — can truly make a difference.

In the House of Representatives, Rep. Tim Murphy (R-Penn.) is about to reintroduce comprehensive mental health reform legislation, the Helping Families in Mental Health Crisis Act. This broad-ranging bill fights discrimination by modifying the IMD exclusion; aims to improve quality by giving psychiatric hospitals and other behavioral health providers incentives for health information technology; supports integration with provisions to better coordinate behavioral health with overall health care; and elevates behavioral health within the federal government by creating an Assistant Secretary for Mental Health and Substance Use within the Department of Health and Human Services. 

In the Senate, Sens. Ben Cardin (D-Md.), Patrick Toomey (R-Penn.), and Susan Collins (R-Maine) have introduced S.599, the Improving Access to Emergency Psychiatric Care Act. This bill would extend and expand a federal Medicaid Emergency Psychiatric Demonstration Project.  The demonstration — which is set to end this year if Congress does not act — addresses the IMD exclusion by giving adults with mental illness access to the same hospital treatment that their Medicaid insurance card covers for all other conditions.

Recent polls4 have shown that the American public believes it’s time for comprehensive mental health reform. As psychiatrists, it’s our time to support national efforts to make that change a reality. 

Lisa Shea, MD, is medical director at Butler Hospital in Providence, R.I., and 2015 Board Chair for the National Association of Psychiatric Health Systems (NAPHS). She will be speaking at the NAPHS Annual Meeting in Washington, D.C., which runs from March 16-18.


  1. Substance Abuse and Mental Health Services Administration (SAMHSA). January 2012. See

  2. SAMHSA. 2013 National Survey on Drug Use and Health. See news release at  November 20, 2014.

  3. Health Care Cost Institute. “Selected Health Care Trends for Young Adults: 2007-2012” at  September 2014. 

  4. “Poll: 71% of Americans Call for ‘Significant’ or ‘Radical’ Changes in Way Mental Health and Addiction are Treated; Research Comes as Patrick J. Kennedy and Dr. David Satcher Join Forces, Announce New Center for Mental Health Policy and Research to Tackle Critical Needs.” PR Newswire. Accessed at