A Cry for Mental Health Change
Reform legislation could be huge step forward, advocates say
By Meredith Cohn | meredith.cohn@baltsun.com
October 4, 2009
Deneice Valentine was a wife, mother and college-educated professional with a family income in six figures. But for a year and a half in the late 1990s, she slept in a small park across the street from Morgan State University.
Valentine was diagnosed with major depression and a stress disorder but lost her mental health insurance after her divorce. She eventually lost her Baltimore home, custody of her children and the ability to care for herself.
Stories like hers are the reason that mental health advocates have joined the immense lobbying effort in Washington on health care reform. If they are successful, advocates say, reform legislation could be a huge step forward for the mentally ill. Of uninsured Americans who might gain coverage, an estimated one in four has a mental health condition.
But while key lawmakers have included some provisions for the mentally ill in the bills winding through Congress, high costs and competing needs mean the amount of care and the number of people who would get it remain uncertain.
Valentine was saved by a police officer who plucked her from a park bench and dropped her at a state psychiatric hospital where she stayed for a year and a half on the public's tab. Once an auditor at the Department of Defense, she now works at a mental health organization coordinating support groups and helping others navigate through the public system.
"I'm lucky," said Valentine, now 55 and living in Baltimore. "I could go work somewhere else and make two to three times my salary, but this is too important to me."On Capitol Hill, the debate has centered on issues such as government-run health care and sideshows about "death panels." But the main goal of the overhaul is to provide general health coverage to 30 million Americans with no insurance. Even more lack mental health coverage or are underinsured, leaving an estimated 25 million with an untreated behavioral disorder. Many also are substance abusers.
Providing more mental health care will be costly. The bill for health care reform is expected to be in the hundreds of billions of dollars. Premiums could rise 1 percent to 3 percent for everyone if basic mental health benefits were mandated, and more for fuller coverage, according to the Council for Affordable Health Insurance, which represents small insurance companies.
"You'll probably run into people like the guy at Joe's Auto Body who makes $9 an hour and can't afford that," said J.P. Wieske, the council's director of state affairs. "That's the rub. You increase the comprehensiveness, and you probably make it unaffordable."
But there are costs now, advocates say. Mental health disorders and addiction cost U.S. businesses $171 billion a year in lost productivity, according to estimates from the Campaign for Mental Health Reform, an umbrella group for mental health advocates. That doesn't count costs to the criminal justice system, nonprofit groups and other public providers - or costs to society, advocates say.
When problems are left to linger, they only get worse, according to Mental Health America, a mental health and education association. People with mental health problems typically die 25 years earlier than the general population because they often have other untreated conditions such as diabetes, heart disease or cancer. Half the people with a mental health diagnosis have problems by age 14 but do not get treatment for a decade, leaving them less able to study and work, the group says.
The goal for mental health advocates is to go beyond basic coverage for the uninsured and attain parity with medical coverage. Those with mental health insurance now typically pay higher deductibles, pay more for drugs and are allowed fewer services, such as days spent in the hospital, said Kirsten Beronio, Mental Health America's vice president of public policy and advocacy. That will change in the coming months for some, however, because a law passed last year requires insurers that offer mental health coverage now to provide benefits on par with their medical coverage.
"We've battled discrimination for so long," she said. "We want to build on our progress and not go backward."
The major House version of the health care overhaul bill would require behavioral and addiction coverage on par with medical coverage for just about everyone. On the Senate side, the two major bills exempt smaller employers from providing coverage and one exempts some larger employers, too.
Beronio said those left out likely will be poorer and sicker, "and it's troubling that this population would have less coverage."
In Maryland, there are about 750,000 people without health insurance. But the situation is better than in most states for mental health because Maryland covers some people who don't qualify for Medicaid and even some people whom the state doesn't provide with medical care, said Dr. Brian Hepburn, executive director of the state Mental Hygiene Administration.
Still, the people who get state aid are typically those in crisis, which probably costs the state more than if it offered early care, Hepburn said. They are people coming out of psychiatric hospitals, the homeless, those in jail or prison and those on disability because of mental illness.
The state picks up the tab for about 15 percent of approximately 100,000 people in treatment at any time, with Medicaid paying the rest. With its annual budget of $950 million, Maryland runs six state hospitals, which largely treat people sent from the jails, and two institutions for children. The funds also go to treat people in private facilities near their homes.
It is not known how many more people need services. And adding a lot more people to the system could be a challenge, Hepburn acknowledged. But more insurance would help pay for it. There could be savings to those with insurance now because private hospitals typically charge them more to compensate for treating those without.
"If everyone had insurance, that would be very helpful," he said. "We spend much of our time trying to budget and preserve services for persons who are uninsured."
One of those institutions that receives public money is the Sheppard Pratt Health System, the largest provider of mental health and addiction services in Maryland. But the system treats more people than it is compensated for, said Steven Sharfstein, its president and chief executive.
Some of those whom Sheppard Pratt treats are not fully covered by public or private sources, costing the facility and patients more. The parity bill passed by Congress should at least help those who already have insurance, Sharfstein said.
"When you don't have coverage or enough coverage, you can't afford medication and the likelihood of relapse is much greater," Sharfstein said. "It's penny-wise and pound-foolish."
That's Deneice Valentine's story. She relapsed after losing her insurance and ended up costing the state for an extensive stay in the hospital. Now she is functioning well, but she still needs medications that her insurance doesn't fully cover. She sometimes cuts corners. She also has a daughter who has insufficient insurance from her college to cover drugs for her bipolar disorder and must come up with extra money for that.
Valentine works at the National Alliance for the Mentally Ill-Metropolitan Baltimore Inc., a nonprofit support provider and advocacy group. Kathryn Farinholt, the executive director, said she hired Valentine for her skills and not her experience with mental illness, though she said that helps.
Farinholt said she hopes health care reform will mean that fewer people will have to have Valentine's experience. It's better for her, her family and the country if she's a functioning member of society, she said.
Farinholt said her group did an unscientific study of people who come for support groups on Saturdays and found that 90 percent had been homeless in the past two years.
"That's stunning," she said. "Some people have good insurance. Some people are getting good care in the public system in Maryland. There are some people in the middle not getting anything, and some aren't getting enough. There is a cost to society. To everyone."
By the numbers
- More than 25 million Americans suffer from untreated mental illness or substance abuse disorders.
- Health care reform seeks coverage for 30 million Americans who have no medical or mental health coverage. More lack mental health care or are underinsured.
- An estimated one in four people without insurance has a mental disorder.
- Untreated mental illness and addiction cost the country a combined $171 billion in lost productivity each year.
- Those with mental health problems typically die 25 years earlier than the general population because they often have other untreated conditions such as diabetes, heart disease or cancer.
- Half the people with a mental health diagnosis have problems by age 14 but get no treatment for a decade.
Sources: Coalition for Whole Health, Mental Health America
http://www.baltimoresun.com/health/bal-md.hs.mental04oct04,0,6711282,full.story