Tuesday, February 25, 2003 at 2:01 PM
A special commission appointed by President Bush is taking a hard look at the plight of people with mental illness. The commission, led by the head of Ohio's Mental Health department, will deliver a final report at the end of April. The group's preliminary findings indicate serious systemic problems - chief among them - funding. Even though eighty billion dollars is spent each year on treatment and services, about half of all people with mental illness are not getting the treatment they need. ideastream's April Baer reports.
In some ways, funding for mental health is much healthier than it used to be. These days, when people develop mental illness, they’re much more likely to have at least some insurance coverage. Secondly, The federal government has made a financial commitment to meet the basic needs of people with severe mental illness. And finally, the old system which funneled dollars and patients straight to state mental hospitals has been dismantled, leaving room for programs that are locally-based, and locally responsive.
But in spite of these positive changes, Dr. Michael Hogan’s presidential committee recently noted in its interim report a disturbing lack of coordination among these options. In essence, Dr. Hogan says, there is no mental health system, per se. Since the demise of the big state institutions, no one entity is taking responsibility for consumers.
Michael Hogan: Paradoxically there are more options and opportunities now, but they are also more fragmented and harder to access. The well-intentioned reform has both improved them and made them worse at the same time.
Hogan estimates about half the money that’s spent on mental health services comes from federal programs like Medicaid, Medicare, and other entitlements. Nearly half flows from the private sector, with additional cash coming from foundations and other sources. Many reformers believe the first step to fixing the system is to encourage insurers to treat mental illness like other health problems. Striking a balance between what consumers need, and what employers will pay for is no small trick. At issue for insurers is the fear that forced parity will drive health costs even higher. However, there are some companies that have made the equation work. Lubrizol Corporation, based in Wickliffe, has been nationally recognized for the mental health benefits it offers full-time employees. Benefits Manager Thomas Tercek says while health care costs are rising, mental health benefits are not in danger.
Thomas Tercek: The cost of everything these days comes under the microscope for organizations. Those of us who deal in health care programs tend to slice and dice to see what costs are rising and what needs to be managed. Mental Health and substance abuse as a percent of our costs doesn’t seem to be increasing like it was ten or fifteen years ago.
Employers’ ability to provide mental health care depends on insurers’ ability to control costs. Bill Shuman is Vice President of Business Development for Flora Midwest, one of the largest preferred provider groups in Ohio. He says from an insurer’s perspective, mental illness is less controllable than other, physical complaints. When a consumer goes into the hospital, Shuman says, the insurer paying the bill wants to know if the treatment is going to work.
Bill Shuman: People go in and don’t come out cured. It doesn’t take too much math to realize that that’s going to put a plan in a precarious renewal position. It’s a lot like chiropractic medicine. It’s so difficult to diagnose and cure. The element of judgment plays such a huge role in the course of treatment. If the implication of the course of the treatment is not controlled, it is likely to spiral out of control and people will repeatedly use the benefit but make no effort to solve the issue. Some plans only cover inpatient stay if the patient completes the entire program. That’s what encouraged a lot more outpatient care, but one visit doesn’t cure anybody.
Many within the mental health system take issue with Shuman’s characterization.
Michael Hogan: The notion that treatment for mental illness is more subjective and wishy-washy is essentially malarkey.
Again, Dr. Michael Hogan of the state health department.
Michael Hogan: The diagnosis is perhaps more complicated, but the diagnoses are just as reliable and the treatments are just as effective. We have had times in the past when if we didn’t fund mental health care right, there were distortions in patterns of care.
As decision-makers in Congress and in boardrooms continue to work out the parity issue, they’re under increasing pressure from the community mental health groups that have become the backbone of the system. Ohio’s funding for mental health services has remained stagnant for about the past ten years. No increases in spending have been approved by the legislature, even though Medicaid enrollment has exploded. So locally raised money is gaining importance. The local mental health levies that were initially designed to supplement state and federal funding have become like structural pillars.
Recently, one of Cuyahoga County’s provider agencies, Spectrum of Support Services, courted County Commissioner Tim McCormack at a west side location. The agency wants to convince the county to increase the local funding commitment, so that programs like this vocational training woodshop will survive.
Later, Commissioner McCormack says he’s all too aware of the need, given the stagnance of mental health funding at the state and federal levels.
Tim McCormack: I’m personally convinced that greater resources could be well utilized to move people into a greater degree of independence than they have now. If we are not the ultimate backstop, no one will be.
With so much riding on the local funding commitment, agencies have two goals in mind: one-making sure this spring’s health and human services levy passes. Second, convincing McCormack and his colleagues that mental health deserves a larger slice of the funding pie. In Cleveland, I’m April Baer, 90.3.
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