Definitions of mental health are changing. It used to be that a person was considered to have good mental health simply if they showed no signs or symptoms of a mental illness. But in recent years, there has been a shift towards a more holistic approach to mental health.
Consider these key characteristics when assessing your own mental health:
Ability to enjoy life – Can you live in the moment and appreciate the “now”? Are you able to learn from the past and plan for the future without dwelling on things you can’t change or predict?
Resilience – Are you able to bounce back from hard times? Can you manage the stress of a serious life event without losing your optimism and a sense of perspective?
Balance – Are you able to juggle the many aspects of your life? Can you recognize when you might be devoting too much time to one aspect, at the expense of others? Are you able to make changes to restore balance when necessary?
Self-actualization – Do you recognize and develop your strengths so that you can reach your full potential?
Flexibility – Do you feel, and express, a range of emotions? When problems arise, can you change your expectations – of life, others, yourself – to solve the problem and feel better?
You can gauge your mental health by thinking about how you coped with a recent difficulty. Did you feel there was no way out of the problem and that life would never be normal again? Were you unable to carry on with work or school? With time, were you able to enjoy your life, family and friendships? Were you able to regain your balance and look forward to the future?
Taking the pulse of mental health brings different results for everyone; it’s unique to the individual. By reflecting on these characteristics, you can recognize your strengths, and identify areas where your level of mental fitness could be improved.
One topic I discuss on this blog is the tactics used by various advocacy groups to make misleading arguments in their efforts to advance their interests.
There is, of course, a large anti-psychiatry contingent that argues that severe and chronic mental illnesses like schizophrenia and (real) bipolar disorder are not real brain diseases. They also argue that, since their brains are normal, the abilities of affected individuals to think rationally enough to properly take care of themselves are not highly impaired, so that involuntary commitment and treatment are never indicated under any circumstances. Of course, they seem to make a big exception for people who suffer from the brain disease of Alzheimer’s disease, but that’s another issue.
It recently occurred to me that the argument I have been hearing from those who deny that climate change exists, or that people are contributing to it, is very similar to one that is used by the mental illness deniers. They knowingly set a bar for “proving” the nature of these phenomena that is totally unachievable by science, and then use this ridiculously high bar to assert that, since the science is not "proven," then it is invalid.
In complex phenomena like weather or brain structure and function, the number of involved factors contributing to the final result is enormous, and their interactions unpredictable to a significant degree. Schizophrenia, for instance, is clearly not a disease of the gross pathology of the brain, which is what the deniers insist is necessary for “proof,” but is probably a disease of the interconnections between literally billions of nerve cell synapses that connect one neuron to others. We have no way currently to map out these connections in precise detail, and they change constantly over very short periods of time, so we cannot prove that they are pathological. There is, however, an astronomical amount of indirect evidence that they are.
Similarly, climate change deniers use the fact that the various computer models which predict how the process will unfold differ from one another in their predictions about the exact timing and locations of various expected weather events as evidence that the science is completely flawed. What they completely omit to mention, of course, is that no one is arguing that we have or probably ever will have the ability to predict weather patterns with that degree of precision. They also conveniently forget to mention that all the models point in the same direction, and that the patterns are already happening in ways that are consistent with the more general predictions.
Well, there are a lot of things that science cannot predict with absolute certainty, so we have to go with the preponderance of the evidence. In cases in which the consequences of inaction are enormous, we still have to act without this ridiculously high level of “proof.”
I would argue that allowing the mentally ill to languish in jails or in cardboard boxes on the streets of cities like San Francisco is such an instance. So is climate change that can lead to mass population dislocations with resultant wars, severe pollution, starvation, and the spread of tropical diseases that might kill us all.
I do not know if there is a name for this logical fallacy so glibly employed by science deniers. But there should be!
Kafkaesque: of, relating to, or suggestive of Franz Kafka or his writings; especially: having a nightmarishly complex, bizarre, or illogical quality.
Rube Goldberg machine: a contraption, invention, device or apparatus that is deliberately over-engineered or overdone to perform a very simple task in a very complicated fashion, usually including a chain reaction. The expression is named after American cartoonistand inventor Rube Goldberg (1883–1970). Over the years, the expression has expanded to mean any confusing or complicated system.
Much to my own relief, I retired recently from my part-time job at the Veteran's Affairs (VA) hospital seeing patients in the mental health outpatient clinic. While I found the patients interesting and challenging, the VA bureaucracy was at times as infuriating as one might guess.
The Kafkaesque nature of the system in which I worked can best be illustrated by an experience I had with my picture ID card. The VA does extensive background checks on employees - as well they should - and requires fingerprinting when their identification cards get renewed every few years. The card contains a computer chip which allows the bearer access to the VA computer system, most notably patient electronic medical records. A few months ago, the computer chip in my ID card malfunctioned - way before its renewal date. I thought it should be no big deal to get it replaced. Yeah right. Not only did I have to get fingerprinted again and wait several days for them to be processed, making it extremely difficult to actually treat patients in the interim, but they also required me to produce two forms of picture identification.
The VA did not accept its own picture identification card for this purpose, which had not expired,as one of the two!
Before I go further with more bizarre stories about the place, let me make a couple of things clear. The fact that the VA is a governmentbureaucracy does not mean that private companies cannot be just as nuts - or even crazier. They can certainly be far more hostile. I used to work for one. As a friend of mine who worked for both of my former employers said, at least the VA bureaucracy was predictable in its crazy decision making, while the private firm we worked for was crazy but whimsical. Sort of like the Dilbert comic strip.
Let us turn to the issue that made the news: problemswith scheduling patient appontments in a timely fashion. Much of the coverage in the news simply ignored the fact that an influx of new patients who are veterans of the wars in Iraq and Afghanistan has overwhelmed the VA healthcare system. There are just way more people reliant on VA than ever before. This happened without a commensurate increase in funding or staff until just recently, and there is still a lot of catching up to do.
In 2003, The VA expected to see 4.7 million veterans in its hospitals and clinics, up more than 54 percent just from 1996. The influx of newly-injured and/or mentally traumatized vets has continued every year since then as the wars dragged on, and funding of the system for the treatment of these wounded warriors did not keep up. Not even close. Frankly, the politicians who yell "support our troops" the loudest do NOT believe in supporting our troops after they leave the service.
In mental health in particular, visits to mental health clinics have skyrocketed as the military has attempted to change the "macho" culture that discouraged such visits in the past.
So what to make of the bureaucrats who kept phony schedules to hide the fact that veterans often had inordinate waits before they received an appointment? Well, when you give employees a mandate to do something as a condition of continued employment, and you don't give them the tools and resources needed to accomplish the mandate, they will naturally become passive-aggressive and do crap like that. They have no choice. And we know how bureaucracies treat whistleblowers, so everybody shuts up and goes about their business doing their best to get around the double bind they are all in. To get patients seen in a timely fashion, you would think that the place would, at the very least, be very quick about putting in the appointment system the times when various doctors are available in their clinics to see and treat patients. Again you would be wrong. Whole clinic days of mine would disappear from my upcoming January schedule in the computer for an upcoming new year, and it would take two or three months of me complaining about it for the clinic times to reappear. I could not schedule anyone! I finally found out why it took so long. At least this is what I was told: There was just one person doing this job. Not one person for a few clinics. One person for the whole humongous medical center! 539 provider schedules, give or take.
Still, in the defense of the VA, at least part of the fault for patients not getting seen in time by a doctor may have in some cases lied with the patients. I can not speak for VA facilities in Phoenix or the rest of the country, but here is a photograph of an actual sign displayed prominently at the entrance to the VA hospital in Memphis:
In addition, at least in the mental health clinic I worked in, one of the doctors was always available to see every walk-in patient who came in without an appointment - even if they hadn't stopped near that sign to get checked in. Furthermore, the hospital had what they called a "patient advocate's" office, where vets could complain about problems they were having getting seen. The patient advocate was usually very effective at getting them in. If the patients described in the news media who died before they got in for an appointment were that sick, maybe they should have not just followed the instructions of the schedulers about how soon to come it. "I vas only following orderz" is not a good excuse.
Still, it is clear that the VA does tend to be a lot more concerned with looking good rather than actually doing good. For an illustrative example, a mandate came out that veterans who were diagnosed with mental trauma and post traumatic stress, either from war or military sexual assault, had to receive a certain number of psychotherapy sessions within a prescribed period of time after their initial evalutation.
The hospital administrators recently bragged in an e-mail to the department that they had met the target.
What they actually did was to put all of these patients into group therapy, which in my experience was, in a lot of cases, next to worthless - instead of giving them the much more effective individual treatments. The VA where I worked does not have nearly enough psychologists on staff to provide individual treatment to everyone who needs it, and the ones they do have are mostly busy doing other things because they are maldistributed as well.
For post traumatic stress disorder uncomplicated by major personality disorders, in my estimation the most effective psychotherapy treatment is something called prolonged exposure (PE), a type of desensitization treatment. Another treatment that is "empirically validated" - by which some people mean that there are some studies, no matter how pathetic, showing that it is minimally effective - is called cognitive reprocessing therapy (CPT). That in my experience is less effective for a lot of patients than PE.
Commensurate with my experience at the VA in Memphis, an article in the journal Psychiatric Services by Watts and others published in May of 2014 found out that, nationwide, the percentage of veterans who received any sessions of either PE or CPT was six percent. Six percent! But our VA bragged about fulfilling the mandate because the veterans were seen by a mental health professional the correct number of times. Well sort of seen, anyway.
More on looking good rather than doing good in upcoming posts in this series, coming soon to a blog near you.
As the world grows richer and older, mental illness is becoming more common. John Prideaux considers the consequences
IT ALL BEGAN when she lost her head. According to legend, Dimpna, a 7th-century Christian heroine, fled her native Ireland when her father, mad with grief at the death of his wife, developed an incestuous passion for his daughter. The father came after the girl and, rebuffed once more, beheaded her in the flatlands of what is now northern Belgium. Dimpna was canonised, and in medieval Europe developed a reputation for divine intercession that could heal madness. Her cult centred on Geel, a small Belgian town that forms one point of a triangle with Brussels and Antwerp. By the 19th century Geel had developed a system of foster care for the mentally ill in which patients, or guests as they are referred to, are adopted by families. It continues to this day. When at the turn of the 20th century the Belgian government threatened its existence with a decree that the insane should live in institutions, the whole town designated itself as an asylum.
Geel’s system can make heavy demands on the host families. Not everyone is deemed suitable for a foster placement—a high suicide risk and a penchant for pyromania are two counter-indications—“but the list of exclusions is not so long,” says Bert Lodewyckx, who runs a team at the local hospital that looks after elderly patients. In a town of just 35,000 souls, about 270 families have people living with them who would otherwise be kept in an institution. Foster families are told nothing about the psychiatric history of their new companions. “For a time, being a foster family was prestigious, a bit like owning a Mercedes-Benz,” Mr Lodewyckx explains. Host families are paid about €20 a day, but their main motives are tradition and altruism.
The way the mentally ill are treated in Geel is unusual. At most times and in most places, caring for such people has been the responsibility of the biological family, which is not always kinder than strangers. Medieval Europeans sometimes locked up family members in basements or shut them away in pig pens. In China, where care of mental patients continues to fall largely on their families, such treatment is sometimes still being reported. In one case a man fashioned a homemade restraint for his son by fitting chains to a chair; in another a woman suffocated her sister with a pillow to lift the burden on the family.
China’s psychiatric system, such as it was, was largely shut down after 1949; the new Communist government made no provision for mental illness in a rationally ordered society. Yet as the country has grown richer and more urbanised, demand for mental-health care has grown. In 2012 China passed its first national mental-health law.
This is a typical pattern. The rise of psychiatry in America coincided with the post-war economic boom. Surveys by the World Health Organisation (WHO) show that spending on mental-health services increases sharply once GDP per person reaches around $20,000—the same level at which people start buying insurance, yogurt and other middle-class indulgences.
Two things lie behind this. Richer societies put more resources into diagnosing and treating mental illness, and older societies have more people with dementia. China is on its way to becoming both rich and old. This shift is usually accompanied by an expectation that society ought to shoulder more of the cost of treating mental illness, which can become too heavy for a single family to bear.
The statistical relationship between mental illness and development is new evidence for an old theory. Since the 19th century, people have been arguing that mental illness is a price to be paid for progress. In “Civilisation and its Discontents”, Sigmund Freud popularised the notion that neurosis increased in tandem with profit. Before Freud, an American neurologist, George Beard, had noted that a nervous disorder he labelled neurasthenia (and others nicknamed “Americanitis”) was on the rise. He put it down to the speeding up of modern life, facilitated by the telegraph, the railway and the press.
Neurasthenia disappeared from the psychiatrist’s lexicon in 20th-century America but enjoyed a long afterlife in China; Chairman Mao himself was said to suffer from the condition. It faded from view only after Arthur Kleinman, a Harvard anthropologist, conducted fieldwork in China in the 1980s and concluded that the symptoms of neurasthenia were rather like those of depression. Drug companies spied an opportunity to sell pills that they were already making. Rates of diagnosis for depression, which was virtually unknown in China 20 years ago, are now catching up with those elsewhere.
This is not because economic progress, of which China has seen more than any other country over the past three decades, makes people sick. Rather, it is due to a combination of the profound effect that growing richer has on diagnosis and the less forgiving standards for normal behaviour set by modern service-sector jobs. Dealing directly with customers makes different demands on the brain from work in a factory or on the land.
Surveys suggest that the incidence of serious mental illnesses such as schizophrenia (a condition characterised by hearing voices and withdrawal from society) and bipolar disorder (which causes extreme, uncontrollable mood swings) is fairly constant at between 1.5% and 3% of the population around the world. By contrast, the incidence of milder forms of mental disorder varies much more between and also within countries. This is true for common depression, anxiety, post-traumatic stress disorder, attention-deficit disorder and many others. In the rich world, these conditions taken together affect about 20% of the population at any point in time. America’s federal government estimates that in 2013 about 44m of the country’s population of around 325m suffered from some kind of mental illness, with depression and anxiety the most common.
The OECD, a club of mostly rich countries, reckons that the direct and indirect costs of mental illness already exceed 4% of GDP in some places. A report from the Harvard School of Public Health and the World Economic Forum says that between 2011 and 2030 mental illness worldwide will cost over $16 trillion in output forgone (in 2010 dollars), more than physical ailments such as cancer, heart disease or diabetes (see chart). But such predictions should be treated with caution, for reliable numbers on mental illness, both within and across countries, are very hard to come by.
This is because, in the absence of a proper understanding of mental illness, the various disorders, syndromes and character traits that are labelled as such are really just thoughtful descriptions of changeable symptoms. In America, health-insurance companies rely on the definitions provided by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) to determine what counts as sickness and what is merely within the usual range of variations from the norm. Each edition of the DSM removes some disorders and adds others. (The WHO maintains its own system, called the International Classification of Diseases, or ICD, whose definitions differ from the DSM’s.)
The most recent edition of the DSM lists around 300 mental illnesses. But the symptoms of mild depression are so different from the disabling effects of the severe sort that the two things probably ought not to share a name, and neither has much in common with, say, post-traumatic stress disorder (PTSD). This special report will try to make sense of this tangle by looking at the main afflictions of the brain at different stages of life. The first sort affects children as their brains develop; the second shows up in adolescents and younger adults; and the third appears as people get older and their brains begin to waste away.
Chasing a chameleon
The choice of definition, which is itself subject to change, has an effect on the diagnosis. But the thing doctors are trying to pin down is also inconstant. At the beginning of the 20th century it was common for people in the West to be diagnosed with nervous disorders. These have been replaced by conditions such as anxiety and depression. Soldiers in the first world war suffered shellshock, which could cause loss of the power of speech and, in some cases, partial paralysis, with no apparent physiological basis. By the middle of the 20th century other varieties of distress caused by battle had taken over. More recently PTSD has become an increasingly common psychiatric diagnosis for returning soldiers, displaying slightly different symptoms.
Symptoms change not only over time but from place to place. “To say that someone has a conduct disorder does not mean the same thing in Mozambique as it does in Manhattan,” says Shekhar Saxena, who runs the mental-health arm of the WHO. In some places hearing voices is considered normal, even desirable when part of a religious experience. In other it might be cause for prescribing antipsychotic medication. The difference is subjective: psychiatrists are usually interested only in voices that are distressingly insistent or say something unpleasant.
Other factors that affect the incidence of mental illness include people’s willingness to talk about it. Some might not want to admit that they are having problems. On the other hand, eligibility rules for welfare payments may provide an incentive for being diagnosed with anxiety or depression.
Diagnosis is also sensitive to advances in pharmacology. The current popularity of antidepressants, which are taken by one in ten Americans at any one time, has a lot to do with drug companies’ success in coming up with a form of drug delivery that is safe and does not have nasty side effects. Antidepressants that act on serotonin, a neurotransmitter that affects mood, have been around since the dawn of the jet age, but became widely used only once drugs such as Prozac, which were convenient and considered safe (and therefore easy for family doctors to prescribe) were developed. Until then, doctors had been fairly free with tranquillisers. In the 1950s Miltown, the brand name for meprobamate, a mild calming drug, was taken by about one in 20 Americans, mostly for anxiety.
The use of psychiatric medication itself sometimes seems like an epidemic in the rich world, but it can go down as well as up. In the late 1990s France was the world leader in malaise, with about 30% of its citizens taking psychiatric drugs, but since then the numbers have come down. Cognitive behavioural therapy, a form of short talking therapy that aims to break self-destructive patterns of thought and replace them with something more positive, has been found to work at least as well as pills for treating mild depression and is becoming more widely available.
Do not despair
Because mental illness is so hard to pin down and measure, it is easy to lose sight of how debilitating it can be. One widely used yardstick is the “Disability-Adjusted Life Year” (DALY), which the World Health Organisation defines as one lost year of “healthy” life free from physical or mental disability. Mental illness now accounts for a significant chunk of DALYs (see chart).
A more objective measure used in most health systems is the suicide rate. In Detroit, where a high murder rate, high unemployment and many abandoned houses meet any definition of a stressful environment, the Henry Ford Health System, which looks after much of the city’s population, has cut suicide among its patients by systematically assessing their risk.
In 2009, with the effects of the financial crisis still reverberating, the Henry Ford Health System managed to bring the number of suicides among its patients down to zero, an impressive achievement for an outfit that in 2013 counted 3.2m outpatient visits. There is no way of stopping those who are determined to kill themselves—“when someone is telling you that they want to make it look like an accident so their family gets the life insurance, then you know it’s really serious,” says Doree Ann Espiritu at Henry Ford. But many suicides are opportunistic acts of despair that can be prevented by putting netting under bridges, making it harder to jump onto subway lines and controlling access to large quantities of painkillers.
Because of the link between economic development, ageing and mental illness, the coming decades are likely to resemble an age of unreason. That is why Geel, which has been caring for people with such conditions for half a millennium, is worth paying attention to. What is striking about the town is how thoroughly normal it seems: the town square with its fake Irish pub; American pop music playing at a polite volume on the main shopping street. Mental illness, so often frightening, seems ordinary here. Geel’s system embodies principles for dealing with it—dignity, openness, kindness, patience—that should be embraced by societies everywhere.
Sources
Baron-Cohen, Simon, “The essential difference: Male and female brains and the truth about autism” (2004) Congressional Budget Office, Rising demand for long-term services and supports for elderly people (2014) Curry, John, Good news in the battle against military suicide, American Journal of Psychiatry (2015) Frank, Richard and Glied, Sherry, “Better but not yet well: Mental health policy in the United States since 1950” (2006) Goffman, Erving, “Asylums: Essays on the social situation of mental patients and other inmates” (1961) Hayashi, Mayumi, “The care of older people: England and Japan, a comparative study” (2013) Hinshaw, Stephen and Scheffler, Richard, “The ADHD explosion: Myths, medication, money and today’s push for performance” (2014) Hogan, Michael et al., The president’s new freedom commission on mental health (2003) Kleinman et al., “Deep China: The moral life of the person” (2011) Moncrieff, Joanna, Efficacy of antidepressants in adults, British Medical Journal (2005) National Institutes of Health, Recovery after an initial schizophrenia episode (research project, ongoing) Nazeer, Kamran, “Send in the idiots: Stories from the other side of autism” (2006) OECD, Making mental health count: The social and economic costs of neglecting mental health care (2014) Phillips, Michael, China’s new mental health law: Reframing involuntary treatment, American Journal of Psychiatry (2013) Porter, Roy, “Madness: A brief history” (2002) Ramachandran, V.S., “Phantoms in the brain: Probing the mysteries of the human mind” (1999) Silberman, Steve, “Neurotribes: The legacy of autism and the future of diversity” (forthcoming) Styron, William, “Darkness visible: A memoir of madness” (1989) World Health Organisation, Mental Health Action Plan (2013-2020) World Health Organisation, “Mental health Atlas” (2011) Yu-Tao Xiang et al., Mental health in China: Challenges and progress, The Lancet (2012)
This is a great New York Times article looking at how to approach mental health care when you can't even really keep up with your regular bills. The lede:
IMAGINE this situation. You fall into a deep malaise. Friends say you need help, but you don’t have insurance (or the insurance you do have has very limited mental health benefits), and you worry that extra bills will only add to your malaise. So you do nothing.
And that’s what many people do. According to a recent survey by the federal Substance Abuse and Mental Health Services Administration (Samhsa, pronounced SAM-suh) , the leading reason that people with mental health issues don’t seek treatment is cost. They fear the fees.
It doesn't have to be that way, though. You can take a variety of free and low-cost steps to improve your mental health -- making one small change in your routine per week, joining a support group, joining an online group, and so on. And if you still need help, the article suggests a number of mental health care options, from seeking out providers with sliding fee scales, school psychologists, crisis hotlines, and the likes.
Continuing on from my post of 3/17/15 on the Kafkaesque nature of the VA bureaucracy, their motto seemed to be, "If we find a problem in the system, we'll come up with a ridiculous solution that may make the problem even worse. Or at the very least, create awhole new setof problems."
For example, not too long ago there were a couple of serious foul-ups at the VA Memphis hospital that were caused by patients being mis-identified by staff and given the wrong treatment. This sort of thing can have disastrous consequences, of course, and it happens from time to time in almost all hospitals. It is quite a serious issue. Of course, in these cases dire consequences are most likely to result with surgery or in a busy emergency room; such events are fairly rare in outpatient clinics.
The VA solution: Every doctor was instructed to verifyeverypatient's full social security number and full name immediately at the beginning ofeverysingle appointment. We were told to do this, not just for patients we did not recognize, but even for our regular patients who we have been seeing for years! And we were told that we had to document that we had done this - again every single time - in the patient's electronic medical record (EMR). No one anywhere else does this.
That may seem like a small although illogical request that wouldn't take much time. The trouble was, we were asked to document a whole bunch of other things almost every visit. Most of these things were completely irrelevant to the visit at hand. For instance, there are so-called "clinical reminders" to ask about certain information at most visits whether it concerned the reason for the patient's visit or not (example shortly).
With limited time to see each patient and to document the relevant information in the EMR, this added a significant amount of time to a visit that would then not be available to actually evaluate the patient's progress for the problem that was being actively treated.
Most of the clinical reminders were checklists, about which I have complained many times on this blog. One particularly ridiculous clinical reminder was a requirement to perform a depression screening checklist, the PHQ-9. This is just what it says it is - ascreeningtest to see who should be evaluated further for depression.
It is meant to be used by primary care docs and other non-psychiatric physicians to determine who should be referred to a psychiatrist for these further evaluation, and who does not need one. It is meant to cast a wide net, meaning a positive test does not mean that you have a clinical depression - only that you might and should therefore be screened further.
The VA wanted thepsychiatriststo ask their patients to fill one out! If a patient isalreadybeing evaluated by a psychiatrist, the purpose of PHQ-9 is no longer operant, so filling one out is completely pointless and an utter waste of time. Unless, of course, someone is such a bad psychiatrist that they think a psychiatric evaluation does not include an evaluation for depression.
I refused to do the PHQ-9's, because I perform a complete bio-psycho-social psychiatric evaluation when I first see a new patient, and I was not going to short change my patients by further shortening our already limited time together by asking questions I already knew the answer to, or was about to go into far more detail about than is possible with a PHQ-9.
Actually, there was at least one psychiatrist on staff who didnotdo a complete evaluation of every patient. Because this psychiatrist did not make waves, that clinician was allowed to practice what I consider to be piss poor psychiatry for years. Then the doc left. I will discuss what happened in that situation in Part III of this post.
Today's guest post is by Michael Cahill, of the Vista Health Solutions blog. He describes the expected effects of “Obamacare” for patients of mental health practitioners. While a lot of it sounds pretty good, what remains to be seen are the reimbursement rates for psychiatrists, especially for psychotherapy, which are abysmally low under Medicaid. With a huge doctor shortage anticipated (there has been no increase in the number of residency training slots in almost twenty years), this could become a big issue. Having coverage does not do anyone much good if they can’t find a doctor who accepts their insurance. But those insurance company CEO’s can not afford any cuts to their multi-million dollar salaries! ~ DA
By this point you’ve certainly heard about the Affordable Care Act, sometimes more commonly referred to as Obamacare.
The legislation is the Obama administration’s landmark attempt at reforming the American healthcare system. After surviving 37 repeal attempts, the most recent of which took place last month, and a Supreme Court challenge, the major parts of the law are still intact and set to go into effect next year on Jan. 1, 2014.
One group that stands to enjoy some of the best benefits of the Affordable Care Act are those individuals with mental illness. The law takes aim at the current pseudo separation of mental health and physical health. It tries to bridge that gap to improve treatment and make it more affordable, while also placing an emphasis on prevention and early detection.
Here are five ways that the legislation will change mental health treatment in America:
1. No more “pre-existing” conditions
People with a serious mental illness diagnosis have long been disproportionately affected the routine denial of health insurance coverage because of a “pre-existing” condition.
For years insurers in most states could deny coverage to anyone because of their medical history. Often this left people who needed coverage the most out in the cold with no way to pay for their medical care. In cases where they were actually sold health insurance their premiums were often much higher than a person’s without their history.
Because of these practices millions of people living with severe, debilitating diseases were unable to get the treatment and help they needed to get healthy and stay healthy.
Now that policy’s days are over.
Since the law's 2010 passage these folks with a pre-existing condition have been able to receive health insurance coverage through a state by state high risk insurance pool.
Come 2014 when the last big phase of the Affordable Care Act becomes law, insurance companies will no longer be able to deny coverage to people with pre-existing conditions or charge them more than they would a healthy person.
Respectively these policies are called guaranteed issue and commuting rating. States like New York and Massachusetts have had these policies on the books for a number of years, allowing medical coverage to expand to a great many people.
Critics have complained that these policies will raise rates nationwide to levels that still put insurance beyond the reach of many people. However many of those people will also be eligible to receive a premium tax credit if their yearly income falls between 133 and 400 percent of the federal poverty live.
More on how that tax credit works in a little bit.
2. More Access to Medicaid
As part of the Affordable Care Act the Obama administration passed legislation that would expand access to Medicaid. Medicaid is a federally subsidized health insurance program for low income and disabled individuals who are not insured through their spouse or employer and cannot afford to purchase health insurance.
Each state runs their own Medicaid program, and the eligibility requirements differ from state to state. Usually there is a minimum threshold of age and/or income.
The Affordable Care Act legislation proposed to expand Medicaid eligibility to people at 133 percent and below of the federal poverty line. It also would allow single childless adults to apply for Medicaid.
After last summer’s Supreme Court ruling on the Care Act states were allowed to opt out of the Medicaid expansion if they so chose. So far 26 states have said they will accept the expansion, while 13 have said they will reject with. The other 11 states are still deciding about what to do.
Historically Medicaid has provided an array of mental health treatments and services that have been superior to many of the services offered by private traditional health insurance plans. It’s also an especially helpful program to those with a serious mental illness as many are unemployed and could not afford to pay for insurance.
3. Plans sold through the state health insurance exchanges have to cover mental health treatment.
All health insurance plans sold through the state public health insurance exchanges, or just exchanges for short, will have to include coverage for a list of essential benefits in 10 categories. One of those categories is mental health and substance abuse services.
The exact details of which treatments and services will be offered is left up to the states. Each state will have a slightly different list of exact services, which is still being finalized.
Digging into the legislation, it requires that the mental health and substance abuse coverage be on par with medical/surgical coverage. For people with mental health disabilities this will be a big relief if they are searching for an insurance plan through the state exchange.
They won’t have to worry about slogging through pages of benefits summaries to see if the treatment they need is covered. The essential benefits in the exchange will also cover rehabilitative and habilitative services, as well as ambulance service, prescriptions, and inpatient services.
4. Tax credits
With a large majority those with a serious mental illness also unemployed many, especially with the Medicaid expansion, will qualify for government assisted health insurance. But for those who aren’t eligible and want an exchange plan they might get a nice tax credit to offset costs.
If an individual’s yearly income falls between 133 percent and 400 percent of the federal poverty line (FPL) then they’ll qualify for a premium tax credit. For states that did not accept the Medicaid expansion the qualifying range is between 100 and 400 percent of the FPL.
So let’s walk through how this tax credit work. Bear with me here it does get a little complicated.
The credit is calculated based off of a maximum contribution toward their health insurance of 9.5 percent of their annual income minus the price of the second lowest Silver tier plan offered in that person’s region.
If your annual income is less than 400 percent of the FPL the percentage of your annual income decreases accordingly. This percentage is based off of a sliding scale, so the less you make, the less you have to pay.
Still with me?
Insurance plans sold on the exchange come at four different levels each with its own price and level of coverage. Although they all cover the same mandated services, they have different cost sharing levels. They are:
●Bronze level - 60 percent coverage
●Silver level - 70 percent coverage
●Gold level - 80 percent coverage
●Platinum level - 90 percent coverage
Those percentages refer to the amount paid in premiums versus the out of pocket expenses. A Bronze plan for example will have low monthly premiums, but higher deductibles and copays. While a gold plan will cost more each month, but come with low deductibles and copays..
Lets take a look at an example for how the tax credit might work:
Chris is a 32-year-old individual earning $22,000 a year. Because of his income level he doesn’t qualify for Medicaid and his job doesn’t offer health insurance. He wants to purchase a health insurance plan at the state exchange. The yearly premium cost of the unsubsidized, second to lowest level Silver plan in Chris’ area is $3,570. John’s income puts him at 189 percent of the federal poverty line, making him eligible for a premium tax credit.
Because Chris’ income is 189 percent of the FPL his maximum premium contribution is 5.79 percent of his yearly income, which is $1,273. Now to determine his tax credit we subtract $3,570 (the amount of the unsubsidized second-lowest Silver plan) from $1,273 (his maximum premium contribution or 8.27 percent of his annual income).
This gives Chris an annual tax credit of $2,297, which is paid directly to the insurance company that Chris picks at the exchange.
Something to keep in mind though is that the cap only applies for the premium at the Silver level. Don’t forget that there three other levels of plans at the exchange. You can still get the tax credit for the other plans, but the credit amount doesn’t change.
Take for another example that Chris wanted to purchase the Gold level plan. The premium for that plan would be more expensive than the Silver level premium from which his tax credit was calculated. But he would still receive the $2,297 premium tax credit. The same goes if Chris opts for a lower cost Bronze level plan instead of the Silver.
5. Preventative Care
Part of the philosophy of the Affordable Care Act, so to speak, is a shift away from addressing just the symptoms of disease and heading more toward preventing disease in the first place or detecting it early on.
Which means that the Affordable Care Act requires all insurers to cover preventive care services with no cost sharing (AKA deductibles, co-pays, coinsurance, etc.). This preventative care coverage includes things like regular checkups, screenings for diabetes and cancer, and help losing weight for those who obese or at risk for becoming obese.
People with serious mental illness are at great risk for such preventable diseases. Also included will be access to smoking cessation treatment and aids. Studies have shown that those with a mental illness are up to 70 percent more likely to smoke than those without.
The National Alliance on Mental Health estimates that one in four adults experience a mental illness during the course of a year. Altogether that’s 55.7 million people. For a nation of 350 million that’s a pretty startling number.
Right now it’s probably too early to tell what the ultimate impact of the Affordable Care Act will be on mental health treatment in America. But because of legislative items like expanding Medicaid and requiring coverage for mental health in the exchange, things are looking pretty positive.
Michael Cahill is Editor of the Vista Health Solutions blog. He has a degree in Journalism from SUNY New Paltz and previously worked as a reporter for the Poughkeepsie Journal and an editor for the Rockland County Times. Follow him on Twitter at @VistaHealth and @ElectronicMike