The Bailout and Mental Health

While the $700 billion bailout may be getting some economists down, it's also providing parity in health care for mental health. The New York Times gives greater detail, but in essence insurers have for decades set higher co-payments and deductibles and stricter limits on treatment for addiction and mental illnesses.

By wiping away such restrictions, the new law will make it easier for people to obtain treatment for a wide range of conditions, including depression, autism, schizophrenia, eating disorders and alcohol and drug abuse.

The goal of mental health parity once seemed politically unrealistic but gained widespread support for several reasons:

• Researchers have found biological causes and effective treatments for numerous mental illnesses.
• A number of companies now specialize in managing mental health benefits, making the costs to insurers and employers more affordable. The law allows these companies to continue managing benefits.
• Employers have found that productivity tends to increase after workers are treated for mental illnesses and drug or alcohol dependence. Such treatments can reduce the number of lost work days.
• The stigma of mental illness may have faded as people see members of the armed forces returning from Iraq and Afghanistan with serious mental problems.
• Parity has proved workable when tried at the state level and in the health insurance program for federal employees, including members of Congress.

Dr. Steven E. Hyman, a former director of the National Institute of Mental Health, said it was impossible to justify insurance discrimination when an overwhelming body of scientific evidence showed that “mental illnesses represent real diseases of the brain.”

This is good news for advocates for those in need of mental health services and we're very much in support of any measures that allow for better management of health conditions.

Medication as Mental Health?

What was once the defining characteristic of mental health care - psychotherapy - is increasingly being replaced by medication. In fact, the use of psychotherapy has dropped by 15% in the last eight years:

Researchers attributed the shift to insurance reimbursement policies that favor short medication visits compared with longer psychotherapy sessions, and to the introduction of a new generation of psychotropic medications with fewer side effects.

Although not a surprise to many psychiatrists, the findings were expected to intensify a debate over the increased medicalization of psychiatric care, which in part reflects an emphasis on the biology of mental illness, as opposed to the processes of the mind.

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Financial incentives were weighted against psychotherapy, the report said. Reimbursement for a 45- to 50-minute outpatient psychotherapy session was 40.9% lower than reimbursement for three 15-minute medication management visits, the report said, citing a 2003 study. Anticipated changes in Medicare reimbursement are expected to bring payments into closer balance, experts said.

It is true that not everyone can afford psychotherapy and oftentimes taking a pill (which your insurance policy may cover) seems easier than the process of working with a therapist. But we can't come to a place where we're making treatment decisions for people who are suffering based on reimbursements.

Source

Compassion in Mental Health

A powerful and scathing opinion-editorial was published in a recent issue of the Fort Lauderdale Sun-Sentinel. Written by Bob Sharpe, president of the Florida Council for Community Mental Health, the editorial calls the question about compassion for those suffering from mental illness:

Esmin Green sat alone in the emergency room. Suffering from psychosis and severe anxiety, she waited nearly 24 hours for help. After sitting alone in a waiting room chair for almost a day, Esmin fell from her seat, collapsing face-down on the floor at 5:32 a.m. One hour later, she was dead...Though this tragedy took place on June 19, it was largely ignored until a surveillance video surfaced weeks later showing the incident in its entirety.

When people witness such abuse, they are naturally shocked and outraged. Few people realize, however, that just one year ago something very similar happened to Edith Rodriguez at Martin Luther King Hospital in Los Angeles. Edith bled to death on the emergency room floor — a death that also was caught on video.

It is time to wake up and learn from these tragic events:

Thousands who desperately need care are not getting it.

Most of those in need of care do not have insurance to pay for it.

Our country would rather pay for criminal justice costs than mental health treatment.

Our health system far too often responds to poor, mentally ill people with a lack of compassion.

The real question here is not whether we CAN do better by people like Esmine Green and Edith Rodriguez, but whether we have the WILL to do better. We're spending the money in either event, and the real tragedy is that these women, and so many more people like them, are trapped between two broken systems -- the broken health care system and a broken criminal justice system. We are always looking for partners in our advocacy and community health efforts. If you have ideas, or think you might like to work with us to advocate on behalf of the mentally ill, send us an email.

Are We Letting Down our Nation's Veterans?

Yesterday, a federal judge in San Francisco dismissed a lawsuit filed by veterans’ groups that alleges the Department of Veteran’s Affairs is not providing adequate mental health services to veterans. In a nutshell, the judge found that, although many of the claims made by the veterans’ advocates are, in fact, a reality, it is outside the court’s jurisdiction to change the system or compel the federal government to act.

According to the San Francisco Chronicle, U.S. District Judge Samuel Conti confirmed that:

The VA is understaffed and takes an average of nearly 4 1/2 years to hear veterans' appeals of benefit denials, and a long-range improvement plan the agency adopted four years ago is still mostly in the pilot stages, the judge said.

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But Conti said, "The remedies sought by plaintiffs are beyond the power of this court and would call for a complete overhaul of the VA system.

Is a complete overhaul of the system really necessary to provide adequate services to veterans?  The Chronicle goes on to report that Paul Sullivan, executive director of Veterans for Common Sense, one of the plaintiff organizations, chose to look on the bright side of the ruling.

Conti "confirmed many of our allegations" and issued "a huge alarm bell for Congress and the VA to take action now," said Sullivan, a Gulf War veteran.

Hopefully, this ruling will impel our nation’s leaders to work to ensure veterans receive mental health care services they need and deserve.

How Can Hospitals Better Serve the Mentally Ill?

An interesting issue that rarely gets discussed is the mentally challenged population’s experience in the healthcare system. These patients continue to get care that does not meet their needs, even in a government-run system like Canada's, where one in every 11 visits to ER is for a mental-health issue. So is one in every seven hospital admissions, and, because these patients stay much longer, they account for an astounding one-third of all hospital time.

Andre Picard captures this frustration in his article for Canada's Globe and Mail from all sides of the equation, including patients, caregivers and advocates.

[Patients with mental health problems] can wait years for a bed in a long-term care facility or a spot in supportive housing, so they end up as detested “bed blockers” or sometimes on the streets. In the community, family doctors do the bulk of treatment by default, but they are rarely equipped to deal with the complexity of care required by patients with severe depression, bipolar disorder or schizophrenia. Often, they just prescribe drugs.

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“The system is in chaos,” said Donald Milliken, former president of the Canadian Psychiatric Association and a practitioner with nearly 40 years of experience. "The fundamental trouble is not necessarily a lack of money or a shortage of beds but a lack of organization."

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What many patients need is stability – a place to live, a basic income, assistance with daily activities, monitoring of their medication. When these are not available, illness can flare up and hospital visits follow.

“Hospitals are just trying to ‘deal' with this – and I use that word in its most Spartan sense,” said Pamela Fralick, executive director of the Canadian Healthcare Association. She said health-care professionals are compassionate people, but “these are cuts that can't be sutured in hospitals.” Also, while most people recover from bouts of mental illness, a minority of cases are simply intractable.

Picard exemplifies one center that has taken on the task of meeting the challenging needs of this community, the The Archie Courtnall Centre. One notably success is the increased privacy that patients experience.

The centre is a big bright place with a dozen La-Z-Boy chairs and four short-stay beds where psychotic or suicidal patients can remain until a crisis passes. “This is a safe place, where patients get treated with respect,” said Rivian Weinerman, the site chief for psychiatry.

In particular, there is more privacy than in the general ER waiting room, where a person weeping uncontrollably, muttering loudly about conspiracies, going through withdrawal, or wearing leg irons and handcuffs is bound to draw a lot of unwanted attention.

Highlighting that something as easy as providing additional privacy in the waiting room could go a long way, the question begs to be asked “In what other ways can hospitals and other centers become friendlier for mentally challenged patients?”

Longer ER Waits for Mentally Ill

USA Today reports on a study of hospital ERs by the American College of Emergency Physicians. They found that psychiatric patients wait four hours or more to be admitted. Why:

Only half of the 328 hospitals surveyed had psychiatric units. The rest transferred patients, sometimes far from homes and families. Hospitals are closing their units because of inadequate payments from government and insurers, unpaid costs for the uninsured and too few psychiatrists willing to work in hospitals, says James Bentley of the American Hospital Association.

Talking About Mental Illness

Canada's Chatham Daily News calls the question:

Why does society not want to talk about mental illness? Why is mental illness such a source of so many flippant remarks or cruel jokes? There is a lack of understanding in our society to the degree that two thirds of those experiencing a mental illness do not seek help or will not talk about what they are going through because of their fears of being rejected or stigmatized.

And yet we all know someone who has experienced or are experiencing such difficulties. Remember: one in five people [will be diagnosed with mental illness at some point in their lives].

Mental illness is real - so what can you and I do about it? There are many different kinds of services available, although in some communities while limited, there have been improvements over the last number of years. However, as a society we can all help by reducing the stigma. Mental illness is like any other illness - it is not caused because someone is weak, it is not always something that people will never recover from, it does not make people commit crimes, and it is not a result of being lazy.

The month of May is Mental Health Awareness Month. We'll be blogging more about it then. Stay tuned.

Compassion in Mental Health

A reader suggests adding a new subject to our ongoing conversation - that of compassion in mental health:

"The nature of the affliction directly affects the sufferer's mind. If the mind is the universal ordering principle, these folks are vulnerable in a very unique way.

The essence of compassion is: we are the same, there is no meaningful difference, our joys and sufferings are shared.

Mental health patients and everyone else are therefore the same. There's a beauty in that perspective."

Indeed.  What has your experience been?  Is there equity in the way mental health and physical health are treated?  How would a compassionate society meet these needs?

You can also suggest a topic that's of interest to you, by clicking here.