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Howard Meitiner Headshot

Government Reopens, But We're Not Out of the Woods

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For more than two weeks, the insurance marketplaces created by the Affordable Care Act have been open for business. This is good news for millions of previously uninsured Americans and it's especially positive for those in need of addiction treatment. The passage of healthcare reform and mental health parity marked an important step toward closing the gap between the 23 million who need substance abuse treatment and the few who receive it.

Still, as we recover from a 16-day government shutdown -- which began because of an attempt to defund the Affordable Care Act -- it's clear that we're by no means out of the woods. Both federal and state governments are trying to cut spending left and right -- and mental health services are often the first to go. The Substance Abuse and Mental Health Services Agency (SAMHSA) now plans to cut a whopping $168 million from its 2013 budget. And between 2009 and 2011, states have reduced mental health spending by a combined $4 billion, the greatest reduction since mental health services were deinstitutionalized in the 70s.

When critical services are cut, it's always the least fortunate among us who suffer most. 15 percent of people in this country are below the poverty line. There's a proven correlation between personal economic hardship and increased rates of depression and substance misuse. Thus, those with limited resources are often those most in need of mental heath services. By leaving these individuals without proper access to the care they need, we're failing to address a serious medical issue that affects one in 17 Americans.

Of course, it's not just individuals who suffer in this climate. It's families and entire communities. In the wake of Aurora, Newtown and other mass shootings, there has been significant criticism of our mental health system. Many of us have asked, "How could these shooters, who demonstrated significant psychiatric problems, have slipped through the cracks?" Yet tragic incidents continue to occur, as we saw with the recent casualties in Washington. How many more innocent victims must die before we as a society recognize the consequences of undiagnosed and untreated mental illness? Now is the time to invest more in behavioral health services, not less.

Investing in mental health care is not only the moral thing to do; it's the fiscally responsible thing to do as well. Our failure to provide consistent, informed care to psychiatric patients until they are in the midst of a crisis has taken a tremendous financial toll. As The New York Times reported, a single hospital admission for an uninsured or underinsured person may cost more in taxpayer dollars than an entire year of private outpatient care would. Plus, ERs are simply not equipped to provide the type of care that would produce lasting results. Emergency medical personnel will handle the crisis at hand to the fullest extent possible, but this is merely a Band-Aid solution. In the absence of comprehensive, ongoing treatment, those who struggle with addiction and other psychiatric conditions become chronic recidivists, draining our medical as well as our criminal justice systems.

Now, I'm aware that when the government stops paying, everyone makes the case that their cause is the most important one. I'm advocating for greater investment in behavioral health services, but in the end, we all need the government to do its job. To avoid future gridlocks, we need our elected officials to do what's in the best interest of the nation. Those who vigorously oppose healthcare reform legislation seem to have forgotten this: The law is the law. And the best approach to the Affordable Care Act is to improve it, not to repeal it. In the absence of a better plan, let's make this one work.