In answer to a question in Portsmouth, New Hampshire, President Obama publicly unequivocally asserted his desire to include treatment for mental illness as part of healthcare reform. And he has mobilized public opinion against the discriminatory practices of private insurers. But when it comes to discrimination against the mentally ill, the federal government’s own program puts private insurers to shame. And Obama has yet to support the one bill, H.R. 619, that could fix it.
Hello, Mr. President,…(M)y question is if every American who needed it has access to good mental health care, what do you think the impact would be on our society?
A: THE PRESIDENT: Well, (applause), mental health has always been undervalued in the health insurance market. And what we now know is, is that somebody who has severe depression has a more debilitating and dangerous illness than somebody who's got a broken leg. But a broken leg, nobody argues that's covered. Severe depression, unfortunately, oftentimes isn't even under existing insurance policies.
So I think -- I've been a strong believer in mental health parity, recognizing that those are serious illnesses. (Applause.) And I would like to see a mental health component as part of a package that people are covered under, under our plan. Okay? (Applause.)
I wish it were “Okay”. Private insurers have largely ended discrimination against the mentally ill due to the passage of the Mental Health Parity Act of 2007. It forbids large group health plans from imposing treatment or financial limitations on mental health benefits that are different from those applied to medical or surgical services. That’s parity.
But for individuals with serious and persistent mental illnesses like schizophrenia, employer based insurance is largely irrelevant because employment is often impossible due to the severity of their illness.
For the severely mentally ill, unable to get employment--and the insurance that comes with it; or afford private insurance that would discriminate against them anyway, Medicaid remains their only safety net. And it’s a shameful failure.
Medicaid, with some technical exceptions, refuses to cover long-term treatment for the mentally ill ages 18 to 64. If you have a disease or illness in any organ other than the brain, and need long-term care, Medicaid pays. But if the illness is in your brain, Medicaid does not. It’s an obscure provision called the “Institutes for Mental Disease (IMD) Exclusion.”
This is government-sanctioned discrimination against the mentally ill. The effects of refusing to reimburse for long term care have been horrendous and Obama should eliminate the IMD Exclusion now.
According to “The Shortage of Hospital Beds for Mentally Ill Persons,” in 1955 (ten years before Medicaid) there were 340 public psychiatric beds available per 100,000 U.S. citizens. By 2005, the number plummeted to a staggering 17 beds per 100,000 persons. Some of that is due to improved treatments, but much of it is due to states kicking patients out of long-term care—where they were Medicaid ineligible—and forcing them into communities, where states could get federal reimbursement for half the cost of their care. (Disclosure: I am on the board of Directors of the Treatment Advocacy Center, which underwrote the report, and I assisted Dr. E. Fuller Torrey, the report’s author and the world's leading voice on mental illness research and reform.)
Where did the mentally ill who were kicked out of hospitals go? Today, over 150,000 live on the streets, 231,000 individuals with severe psychiatric disorders live in jail or prison. 5,000 take their own lives every year. Think of the money that could be saved if they were given treatment rather than the boot.
To write this wrong, and force the federal government to do what they forced private insurers to do--cover the mentally ill--Congresswoman Eddie Johnson and Representative Raj Grijalva introduced H.R. 619, which would eliminate the IMD exclusion and thereby let the government provide long-term care for those with mental illness the same way they provide long-term care for those with other illnesses. Elimination is supported by the National Association of State Mental Health Program Directors, the National Alliance for the Mentally Ill, and almost all who know the issue.
The largest and neediest group of uninsured Americans could very well be those with mental illness. If President Obama really believes in equal health care for all, he should eliminate the IMD exclusion in Medicaid law now by incorporating HR 619 in health care reform. That’s reform I can believe in.
Follow DJ Jaffe on Twitter: www.twitter.com/MentalIllPolicy
Per Ron Honburg and Andrew Sperling who have been working hard on this issue at NAMI, Senator Snowe introduced an amendment to the Finance Committee Chairman’s Mark that would create a demonstration project of $75 million for 8 states to allow non-governmental psychiatric hospitals to receive federal Medicaid matching payments for acute psychiatric treatment.
This Amendment stems from a similar bill that was introduced earlier this year by Senator Snowe, S. 1130. http://www.thomas.gov/cgi-bin/bdquery/z?d111:SN01130:|/bss/111search.html|
In my own personal opinon the bill is not nearly what is needed because the serously mentally ill who need long-term care are cared for by state hospitals, not private ones. The bill should include state hospitals.
A better bill was the one introduced the last few years by Congresswoman Eddie Bernice Johnson of La, HR 619, which would have repealed the IMD exclusion in its entirety. But congress wouldn't budge That’s the bill that should be included in heatlh care reform.
It was Amendment #D1
Thank you to Ron Honburg and Andrew Sperling at NAMI for giving this their best shot!
That's not to say that things like schizophrenia are not genuinely disabling, but "anxiety disorder" in an otherwise totally functional adult is, I'm sorry, not a disability. I've even met "profoundly depressed" people who were nothing of the sort. How do I know? Because they were complaining to me about not having access to their medications for months, yet they had no activity, appetite, sleep, behavioral or other markers for the "disease" beyond a certain laziness and a willingness to take advantage of the kindness of others. They may have been "depressed" at some point in the past, but SSI was paying them to cling to a continuing diagnosis.
Sorry, "mental illness" is whatever the persons making money off it say it is. Hence, the definition keeps growing and growing, as does the "diagnosed" population.
"Depressed" people recover at a greater rate with sunshine, activity, conversation and a sound diet, (and relapse less) than they do on medication. There's evidence this may even be true of schizophrenia. http://www.moshersoteria.com/ How many "diseases" can you say that about?
Since when is suicide a symptom of anything? It's a deliberate act - often a vindictive one. Factually, there is no medical or scientific basis to pathologize it.. The very existence of the vast majority of mental "disorders" is pure opinion and conjecture, "validated" by a bunch of people with degrees who are making a living by saying so. There is plenty of evidence that drugging people to cure an imaginary "imbalance" increases suicide rates, and almost NONE that it reduces suicides. That's the science. Those are the statistics.
Every "mental" condition which finally gets a medical diagnosis and related medical treatment immediately gets reclassified as medical - not psychiatric. Hence, if medicine can diagnose it and cure it, it's covered. If it remains in the opinion-based field of theory and conjecture, payers cannot be blamed for being skeptical.
You are ignorant about mental illness. I'm not saying that some people do not take advantage of the system. Most people with mental illness serious enough to be considered a disability struggle with the ability to work. Often they can work for short periods of time then the stress causes a relapse. They have good days and bad days. Poor attendence makes it hard to hold a job. Not to mention the stigma trying to get a job. You cannot see confusion or fear in people that have learned to hide it well. Psyche medications are not consistant with their effectiveness and can have diffucult side effects.
People on disability can work and be paid. And they want to work because they can't live on what disability pays.
The limits put on coverage also limit the effectiveness of the treatment received.
He is constantly shuffled from one hospital, doctor and treatment plan to another. It is the same as no care at all. In fact it is more traumatizing than just It is a tragedy waiting to happen.
I know a woman on five, count 'em five, psychotropic meds. SSI, Medicare etc. pay for everything. Three of these are guaranteed to cause her eventual liver disease, tardive dyskenisa, and a very high risk (near certainty) of iatrogenic diabetes. Per the literature four of them, in two different combination sets, should not be taken together. She's a walking chemistry experiment. And everyone who knows her/knew her before the meds swears that the only difference between her then and now is that then she was productive, creative, capable, often cheerful, but jittery, (and sometimes abused by her husband, who's now in prison) and now she's wooden.
In my experience, disabled people who work (on the books) have genuine limitations - (hemiparisis, missing limbs, congitive deficits, crippling arthritis) and a desire to overcome them. The desire has been medicated out of our girl above. Her disability is her treatment.
Read more at: http://www.huffingtonpost.com/dj-jaffe/health-care-reform-keeps_b_293917.html?view=screen
Ya think? See it every week with all violence.
(Also, as I've said before, we don't have a gun problem, we have a mental health problem in this country).
Can anyone afford the Insurance policy premium increase?
Can any of us really afford NOT to hold the insurance companies accountable for this?
Insurance premiums going up is what is happening and that will continue to happen without check unless needed reforms are put in place. From my experience, in the last 15-20 years premiums have climbed higher (as well as deductibles) and coverage is less and less.
It takes at least a month for an antidepressant to start working, but you can only be in the hospital for 2 weeks.Outpatient care is also just as poor. Often the nedded drugs aren't covered. If reatment is discontinued because of insurance the patients (otherwise known as victims) are just set up to relapse because the medication wasn't that good after all.
The Rosalynn Carter Fellowships For Mental Health Journalism
"Informed journalists can have a significant impact on public understanding of mental health issues as they shape debate and trends with the words and pictures they convey. They influence their peers and stimulate discussion among the general public, and an informed public can reduce stigma and discrimination."
- Former First Lady Rosalynn Carter
This could be a organization worth looking into, to help get the word out there.
On a personal note, I have a friend who developed schizophrenia many years ago. Her parents were well off, and she spent time in private hospitals. She has used up all the insurance is willing to pay. She receives $160.00 a month from SSI, and food stamps. She lives at home with her 80 year old mother, and I often wonder what will happen to her, when her mother is no longer there to take care of her.
and psychologists are gonna get off their high horse and really
start studying such illnesses instead of following in lock-step
the pat textbook label scenarios.
So many psychiatrists and psychologist in the SSI, Medicare and
Midicaid merry-go-round look like offices with a revolving door
that churns out patients with prescriptions in their hands. No
attempts are made at treatment, just issue a prescription. It's
almost a "Don't let 'em leave without one!" atmosphere. That
prescription proves the doctor saw the patient and can be turned
in to SSI, Medicare or Medicaid for reimbursement of their time.
Psychiatrists are an entirely different breed.
Psychologists, typically, spend about 9 years studying psychology, and put in two to three years of internship before they can be licensed. Psychiatrists, typically, spend three years studying psychology and two years in internship.
Psychology, and psychologists, are not part of the reason why healthcare, and health, in America stinks.
Please get your facts straight.