Care and Counseling Blog

February 28, 2011

State Budget Cuts: A National Crisis for the Mentally Ill

World events have dominated the news in the past few weeks. We have watched our televisions in awe as people have taken to the streets in Egypt, Tunisia, Bahrain, and Libya. Whether through the international media, Facebook, or Twitter, everyday people have spoken and made their voices heard. While the accompanying violence has been regrettable, people have been willing to risk their lives to bring about changes in their governments.

Closer to home, tens of thousands of people have gathered in Milwaukee to protest the legislation supported by Wisconsin's governor to eliminate the collective bargaining rights of public workers. Although the bill has passed the Wisconsin Assembly, it remains to be seen whether it can be passed in the Senate.

With so many dramatic events grabbing the news headlines, you may not have heard about NAMI's briefing of Congress about the potential effects of state budget cuts. NAMI is the National Alliance on Mental Illness. On February 16, a NAMI representative, Lt. Col. (ret.) James Walsh, President of NAMI Alabama, spoke to Congress about massive state budget cuts in mental health care, and he called this a national crisis. In his state alone, funding for mental health care has decreased by 32 percent from 2008 to 2011. It is projected that 20,000 people in Alabama who have severe mental illness will lose access to mental health services.

Walsh reported that across the nation, budget cuts are reducing the numbers of front-line clinical staff, restricting eligibility for services, and closing public facilities. He stated that the programs and services being eliminated are often the last resort for under-insured and uninsured children and adults who have schizophrenia, bipolar disorder, or major depression. He said that many with severe mental illness have nowhere else to turn. He noted that the situation is compounded by high levels of unemployment and the corresponding loss of health care benefits. It is also affected by veterans returning to our communities who have a high incidence of serious depression, PTSD, and family problems.

Walsh and NAMI are not alone in predicting a mental health care crisis. Financial analysts are saying that decreases in mental health services will ultimately result in increased costs to cities and states. When the mentally ill lose services, they decompensate. This results in an increase in emergency room visits and psychiatric hospitalizations. It also results in an increase in incarcerations. Numerous corrections officials are expressing concerns about the increases they expect to see in their prison populations as mental health services decline. Yet the greatest costs are to the mentally ill and their families who suffer because they cannot get the treatment and support they need.

What would happen if tens of thousands of people protested on behalf of the mentally ill? Could we change the opinions and priorities of our elected officials? Could we persuade them that services must be provided for the mentally ill? Could we persuade them that it is more costly, as well as inhumane, not to provide services?

Please consider what you can do to make a difference. Write your senators and representatives. Share ideas with your mental health colleagues. Start a revolution for mental health on Twitter. Make your voice heard. Someone might just listen and join you.

Nancy Higgins, Ph.D., M.Div.

Care and Counseling, Inc., Staff Psychotherapist

President, St. Louis Psychological Association

The text of the NAMI Congressional staff briefing may be found at http://www.nami.org/Template.cfm?Section= February20&Template=/ContentManagement/ContentDisplay.cfm&ContentID=115834.

October 13, 2010

The Affordable Health Care Act, Part One: The Provisions

On March 23, 2010, President Obama signed into law The Patient Protection and Affordable Care Act (PPACA). On March 30, 2010, he signed the Health Care and Education Reconciliation Act of 2010, legislation that amends the PPACA. Together, these acts form our country’s health care reform law, and they are referred to as The Affordable Health Care Act. This legislation will affect every citizen of the United States. Many of us will be affected by it both as providers and as consumers of health care services.

The Affordable Health Care Act is nearly a thousand pages long. Due to its length alone, it is difficult for anyone to grasp all that it covers. According to various Web pages published by the federal government, the purpose of the Act is to put citizens back in control of their health care and to curb the worst abuses of insurance companies. This legislation has been very controversial, and many myths have been circulated about what it says and what its effects will be.

The Act has numerous provisions. They are being phased in over a number of years. Here are a few of the provisions that will be of interest to many of us.

Effective March 23, 2010

• Restrictions are imposed on the annual dollar limit amounts insurance companies can set for covered health benefits. Annual dollar limits are gradually phased out. They are not allowed on most covered benefits for policies beginning on or after January 1, 2014. 
• Medicare enrollees who are affected by the gap in Part D prescription coverage, known as the "donut hole," are eligible to receive a $250 rebate. The first checks were mailed in June 2010. In 2011, the gap will be reduced by 50 percent, and by 2020, it will be completely eliminated.

 Effective July 1, 2010:

• Uninsured adults with pre-existing conditions can join a temporary high-risk insurance pool. This provision will be phased out in 2014 because health care exchanges will be established by that time. The premiums for the high-risk insurance pool are set for a standard population and not for a higher health risk population.

Effective September 23, 2010:

• Insurance companies cannot exclude coverage for pre-existing conditions for children who are under 19.
• Dependents can remain on their parents’ insurance plans until age 26. This includes dependents who are no longer living with their parents, are not listed as dependents on a parent's tax return, are not students, or are married.
  • New policies must give policyholders access to preventive services and medical screenings without having to pay a co-payment or deductible.
  • For new policies, women have the right to see an ob-gyn without getting a referral from another doctor.
  • Health plans are prohibited from putting a lifetime dollar limit on most benefits for policies issued or renewed on or after September 23, 2010.
  • Insurance companies are prohibited from rescinding insurance coverage or retroactively canceling policies except in cases involving fraud.

 Effective January 1, 2011

• Insurance companies must spend 80 to 85 percent of the premium dollars they collect on health services and health care quality improvement. If they fail to do this, they must give rebates to policyholders.

This is just a small sampling of the health reform measures. They will clearly benefit millions of people. However, the potential costs and savings of the changes they will bring and the implications for providers are difficult to identify and assess. These issues will be explored in next month’s President’s Column.

Submitted by:  Nancy Higgins, Ph.D., MDiv