Expanding Medicare to Support Mental Health

October 31, 2023

By Courtney Wise

Plus, breaking the cycle of intrusive thoughts, and more. Read on!

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Medicare soon to expand access to mental health care for older and disabled Americans

Correction: Initial versions of the headlines for this story and the introductory note to the newsletter incorrectly referred to Medicaid. This story is exclusively focused on Medicare.

For decades, getting older has meant losing access to mental health services following the switch from private insurance to the federal Medicare system for many Americans. It happened to 68-year-old Lynn Cooper; she had to stop seeing the marriage and family therapist who helped her manage the depression and anxiety she developed after losing a job in 2019 and dealing with the unpredictability of the pandemic. “I was stunned,” Copper told the Washington Post. “I’ve always had the best health insurance a person could have. Then I turned 65 and went on Medicare, and suddenly I had trouble getting mental health services.” 

Trouble is an understatement. Even though Cooper works as a behavior health policy specialist for the Pennsylvania Association of Area Agencies on Aging, she struggled to find a provider who accepted both Medicare and new patients. Once she found one, she had to wait another six months before her first appointment. 

It’s not that Medicare doesn’t cover mental health services; it always has. But that coverage has been limited to services provided by psychiatrists, psychologists, licensed clinical social workers and psychiatric nurses, many of whom opt out of accepting Medicare due to low reimbursements and a convoluted bureaucracy. According to the Post, more than 124,000 mental health practitioners currently opt out of accepting Medicare—more than any other medical speciality. Fortunately, partial relief seems around the corner. 

Beginning in January 2024, Medicare will allow marriage and family therapists, like Copper’s beloved provider, and other licensed mental health professionals, to join its pool of approved providers. The change will open access to another 400,000 professionals, or 40 percent of the current mental health workforce. In addition, Medicare will allow a maximum of 19 hours per week of intensive outpatient mental health care, increasing peer support for people with severe mental illness and making mobile crisis services more available to people in their homes or on the streets, if they’re unhoused. “I think we are, hopefully, at a turning point where we’ll start seeing more access to mental health and substance use disorder care for older adults,” said Deborah Steinberg, senior health policy attorney at the Legal Action Center in Washington DC.

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The healing power of music therapy

At first glance, Isobell and Caitlin Bell look like artist and performance coach, rehearsing for an upcoming show. The room where they sit is filled with sheet music, music books, and a variety of instruments—including the guitar and piano they play. But they’re actually in a medical clinic— Manhattan’s Louis Armstrong Center for Music and Medicine to be exact—engaging in a music therapy session. And though Isobell is a talented singer and guitarist, gifted with what New York Times reporter Christina Caron calls a “breathy soprano that seems to float across the room,” musical talent is not a prerequisite to receive music therapy from one of the licensed professionals 

Such therapy is said to help reduce symptoms of anxiety and stress and improve the day-to-day function of people with depression. Moreover, a 2017 study found that music therapy can enhance the effectiveness of standard treatments like traditional therapy and medication. Scientists are looking into why it works so well, but they already know that music activates multiple areas of the brain. It can also help people manage stress, chronic pain, and high blood pressure, while lifting their mood. For Isobell, who asked to be referenced only by her first name to protect her privacy, music therapy made it possible for her to stop taking medication for anxiety. It “opens up so much in my mind,” she said. 

“We might wail on a drum together or we might give them something that really vibrates and provides a grounding sensation to help them connect with their body and their breath,” said Kerry Devlin, a senior music therapist at Johns Hopkins. “There isn’t such a thing as a wrong note.” It can even be used during end-of-life care for patients and their families. Devlin said she uses a special stethoscope to record a patient’s heartbeat and then works with the person or their family to add lyrics and harmonies.  “We use that person’s heartbeat as the rhythmic pulse,” she said. “This is a piece of their life, recorded forever and ever, which is such a gift.” (To find a music therapist near you, try searching the American Music Therapy Association’s online directory or give them a call).

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Breaking the cycle of intrusive thoughts

Intrusive thoughts are repetitive, unwanted, uncomfortable, and disturbing thoughts that seem to pop up out of nowhere. They can happen to any of us at any time.  They can also be about anything, but are typically violent, sexually inappropriate, or in such misalignment with a person’s values or character, they cause the person to experience deep disgust and anxiety. People with certain mental disorders, including OCD, PTSD, eating disorders, anxiety, and depression tend to see more intrusive thoughts than others, reports CNN. But, there’s good news: Researchers have learned that one particular form of cognitive behavioral therapy –  exposure and response prevention therapy – is most helpful in teaching people that intrusive thoughts aren’t dangerous and can be reduced by confronting the fear they reveal.

Overcoming the frequency and compulsions associated with intrusive thoughts happens with guided, professional support—which can also make one uncomfortable. In exposure therapy, one must face the thing that scares them the most. Cognitive behavioral therapies “require a lot of effort, and sometimes it’s unpleasant to face your fears,” said UNC psychology professor Jon Abramowitz. “But when we can help folks to do that successfully, they often get a lot of benefit. They learn how to see their thoughts differently. You’re looking at it rather than looking from it, if you will.” In addition to therapy, medication and lifestyle changes, like limiting processed foods, alcohol and other mood-altering substances in one’s diet, exercising regularly, and consistently getting enough sleep can reduce or eliminate intrusive thoughts—while providing lots of other welcome changes.

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In other news…

A plea for expanded mental health infrastructure: In a highly personal guest column for USA Today, Lauren Feldman Hay, the chief information officer of Fountain House, a nonprofit built by and for people living with serious mental illness, writes that her mother’s struggles with bipolar disorder, coupled with living on the streets, led to her eventual suicide. For years, the missing mental health infrastructure truly let her down, Feldman Hay said. “The lasting impacts of homelessness and housing instability are devastating and cruel,” Feldman Hay writes. “Not only does homelessness impact people’s health and wellness – drastically increasing their stress, exposure to communicable diseases and violence, and further exacerbating chronic health conditions – but suicide rates among people experiencing homelessness have been estimated to be at least nine times higher.”

Mental illness once again scapegoated as the cause of yet another preventable mass shooting: Republican presidential hopeful Vivek Ramaswamy blamed last Wednesday’s mass shooting in Maine that claimed 18 lives on mental illness and waxed nostalgic over the less violent 90s.In a scathing rebuke of his comments, Ana Marie Cox writes in a guest column for MSNBC that, she too, is nostalgic for the “downward trend of violent crime throughout the 1990s,” but for much different reasons than he. “The main reason that the nation saw fewer mass shootings from 1994 to 2004 is that there was a ban on assault weapons,” she writes. “So, sure, let’s bring back the ’90s!…I would like more Liz Phair albums and the assault weapons ban, please.” 

Grief is proof of love and an invitation to transformation:  I’ve been overwhelmed with grief this year. I thought I’d caught a break with only a few close deaths in 2022, following the onslaught of loss in 2020 and 2021. But, life. The fact is, everything that lives will one day die; that’s just one thing we trade for the gift of this human journey. And though excruciatingly painful, grief is a gift, says Jonathan McCrory in Yes! Magazine, because it is a reminder that “we are vessels able to love.” He continues that “if grief is the acknowledgment of losing something we once loved…then I invite it. I invite it because I need to be reminded I have the capacity to love. I invite it because the patterns that hold me now are the rhythms of subjugation, not liberation. I want to be liberated.” I welcome the new way to think about the pain I’ve been holding, though I’m not quite where McCrory is yet. 

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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