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Funding Mental Health Care in America
Introduction
Several years ago, in society’s eyes, seeking the aid of a mental health professional meant you were labeled as crazy or insane. As a result many made the choice to live with their mental illness rather than have the stigma of being labeled insane. Today, such is no longer the case. People are more openly and actively reaching out for counseling or seeking the treatment of a psychiatrist. The issue today is finding the means with which to pay for the needed help that a mental health profession can provide and the work skills needed to become self-sufficient after their recovery. Some private insurance companies and the government allow for a limited amount of coverage but there remains a gap between what is needed and what is actually provided. There have been minor efforts made in closing the gap, but as of today, there are still people in need of mental health care with no means of getting that care.
Critical Evaluation
In the early days before the community fully understood what it meant to be mentally ill, people who suffered with it were treated very inhumane. They were placed in institutions, physically and mentally abused, restrained with straight jackets or arm and leg irons, and their very dignity was taken away (National Mental Health Association and the History of the Mental Health Movement). “These facilities essentially functioned as warehouses. Patients were admitted for unspecified periods of time and received little or no treatment” (Brown). One man, Clifford Beers, a Yale graduate who suffered a mental breakdown and had to be placed in a mental institution, sparked a revolution that was the beginning of change for the mental health reform movement everywhere. He later wrote a book telling of how he was abused and about the deplorable conditions of the institution. The book was called, “A Mind That Found Itself” (National Mental Health Association and the History of the Mental Health Movement).
In 1908 Beers founded a society which eventually became known as the National Committee for Mental Hygiene. This was a national committee that had three basic goals:
After World War II the Congress’ Joint Commission on Mental Illness and
Mental Health, an arm of the federal government, did the following: created the Great Society programs and community mental health centers, enacted amendments to the Social Security Act; and passed the Medicare and Medicaid bill (History of Public Mental Health in California and the U.S.). These actions were an attempt by the federal government to help emphasize more outpatient care as opposed to institutionalized care. Although the community centers did experience some success they did not replace the need for institutionalization for the chronically mentally ill.
In the 1980’s federal dollars for mental health care waned, budgets were tightened and community interest abated. The federal government continued to provide limited support but the mental health centers were eventually incorporated with the Alcohol, Drug Abuse, and Mental Health Administration (History of Public Mental Health in California and the U.S.).
Today, state hospitals for the mentally ill remain expensive, inefficient, and in need of improvement. Many with mental illness live on the street and only receive treatment when arrested by the police or they become physically ill and have to go to a hospital for medical treatment. “Researchers, policymakers, and advocates continue to struggle with the organization and financing of mental health services in order to improve health care for persons with mental illness” (History of Public Mental Health in California and the U.S.).
Medicare is one way the federal government utilizes to cover some of the cost incurred by persons receiving mental health care, but it is not enough. Medicare consists of two parts: Medicare part A which covers in-patient stays and Medicare part B which covers out-patient services. If a person is covered by Medicare part B he is entitled to visit a health care professional without having to be hospitalized. Medicare will cover some therapy such as:
At first glance, it may appear the government is doing its part to help the mental health patient get the needed treatment, but such is not the case. Here is a list of the services not covered by Medicare:
The co-payment for a person receiving mental health care on an outpatient basis is 50% as opposed to a 20% co-payment for medical treatment. Someone receiving treatment on an in-patient basis is responsible for paying 20% of their mental health services. There is also a $100 yearly deductible for Medicare part B recipients (Medicare and Mental Health Benefits).
If someone is covered by Medicare part A and is placed in a specialty mental health hospital they only have 190 lifetime maximum days they can use. They must then be placed in a regular hospital for their mental health treatment. Lastly, when someone goes into the hospital there is an $840 deductible for the first 60 days (Medicare and Mental Health Benefits). After that, the costs only continue to rise. This alone is a deterrent to many getting the help they need to cope with their mental illness. The average person receiving Medicare benefits can not afford to pay 50% of what a mental health professional charges for their services or any deductible that is charged by the mental health facilities. The end result is a great number of people going without mental health treatment.
Supporting Arguments
It has already been established that too many Americans go everyday without enough insurance to care for their mental health needs. In an attempt to help rectify this problem Congress introduced an act called the Mental Health Parity Act. In 1996, the act was passed. The Mental Health Parity Act was designed to eliminate the dollar and lifetime limits placed on the mental health care that a person can receive. To date, there are only thirty-three states that recognize some form of the parity law (National Mental Health Association). There remain eighteen states with very limited or no coverage at all for its citizens that suffer from some kind of mental health illness. And even with the thirty-three states that have enacted some form of the Parity Act, it discriminates against children and only covers a small amount of the many disorders that the jaunt of mental illness covers.
Opponents of the Parity Act have said that to enact parity would be too much of an increase in the mental health cost for not only private companies but also for the government. There has been documentation that proves this to be incorrect. For example, “In Minnesota, Blue Cross/Blue Shield reduced its insurance premiums by five to six percent after one year’s experience under the state’s comprehensive parity law” and “In North Carolina, mental health expenses have decreased every year since comprehensive parity for state and local employees was passed in 1992” (National Mental Health Association). These are just two reported examples of how certain states saved because of the parity act. Many companies have begun Employee Assistance Programs (EAP) to assist its employees with situations that might affect their mental health and job performance. EAP has proven to be cost effective for companies such as, Chevron, Campbell Soup and Virginia Power (National Mental Health Association).
The Mental Health Parity Act requires that there be equivalence between mental and medical coverage provided by the insurance companies. For example, if you are provided a $1 million lifetime limit on your medical coverage then you must also have $1 million limit on your mental health care. The very word, “parity”, means equivalent. An important fact to realize is, “Parity does not require group health plans and their health insurance issuers to include mental health coverage in their benefits package. The law's requirements apply only to group health plans and their health insurance issuers that include mental health benefits in their benefits packages” (Centers for Medicare and Medicaid Services). And the company must also employee at least fifty-one workers.
Opponents of the Parity Act have brought about several myths of why they feel it is not economically smart to implement the act. Some of the myths include:
These are a few of the myths that try and prevent parity from becoming a national program. Thus far, all have been proven to be unfounded. Today, there are over 360 organizations around the country that support the Mental Health Parity Act (National Mental Health Association).
As mentioned earlier, not all states have some kind of parity law in effect. There are three states at this time that have no parity law. These states are Iowa, Idaho, and Wyoming. The states that have enacted some kind of parity law range from good to limited. There are fifteen states that do not have a parity law but have some form of a mental health mandate. At present, there are twenty-four states with limited parity laws. Limited parity law states, “Parity applies only to select groups such as those with severe mental illness or state & local employees, or only protects against certain types of discrimination” (What Have States Done to Ensure Health Insurance Parity?).
The following is considered good parity law: “Not quite comprehensive parity due to certain exemptions and/or limitations”. There are five states that fall into this category: Indiana, Kentucky, Maine, New Mexico, and Rhode Island. Lastly, are the states believed to have the best parity law in effect today. These states include Connecticut, Maryland, Minnesota, and Vermont. The criteria for having good parity law states, “Parity applies to all mental health and substance abuse disorders under private insurance plans. No exemptions” (What Have States Done to Ensure Health Insurance Parity?). Maybe the states with the best parity law can serve as examples to the other states that have yet to pass a parity law or to those who need to make improvements to their existing laws.
As we know, The Mental Health Parity Act came into effect in 1996. It was only supposed to be in effect for six years with a renewal due in 2001. In 2001, the Mental Health Equitable Treatment Act (MHETA) was introduced before Congress; it was an extension of the Mental Health Parity Act (Marshall). This act did not pass. Instead, Congress voted to keep the already enacted parity for another year. In 2003, MHETA was again brought before Congress. Today, the act still has not been passed. The new bill proposes to include all “non-discriminatory coverage for adult and childhood mental illnesses as determined by medical science in conjunction with the Diagnostic and Statistical Manual of Mental Disorders which includes: schizophrenia, bipolar disorder (or manic depression), major depression, obsessive compulsive disorder, and severe anxiety disorders” (Marshall). Proponents of this bill continue to push for its passage and apparently, will not stop until it does indeed pass.
According to government rules, in order to implement the parity act it is necessary that Congress amend other laws. These laws include: The Employee Retirement Income Security Act; Internal Revenue Service and Department of the Treasury; Pension and Welfare Benefits Administration and Department of Labor; Department of Health and Human Services; and Health Care Financing Administration (Centers for Medicare and Medicaid Services). This is another reason why opponents of the act feel the cost of parity is too high. Although the changes to these laws are slight, humans have proven to be creatures of habit and do not adapt well to change, so any change to some is too much change.
Main Web Page Conclusion and Works Cited
National Mental Health Association
The National Institute of Mental Health
Centers for Medicare and Medicaid Services
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Copyright © 2005 L. Woods-Roberson. All Rights Reserved