How to Fix a Broken Mental-Health System
Congress has a chance to overhaul the provision of care, making treatment more available to those who desperately need it.
.. Every day, when I am walking to work, or just walking through the streets of downtown Washington, I encounter homeless people on the street. The homeless cover many categories, but prominent among them are those with serious mental illnesses. They know no boundaries of race or education; there was a prominent story last year in the Washington Post of a homeless man with schizophrenia who told a judge that he didn’t need a lawyer, that he was a lawyer. When the judge reacted with bemused skepticism, the man informed the judge—accurately—that they had been in the same class at Harvard Law School (which also included Chief Justice Roberts!)
.. our focus has been far more on less serious illnesses like anxiety and depression than on the most serious mental illnesses, and our deep and understandable concern about civil liberties has gone too far when it comes to those who either don’t recognize they are ill or have deep psychoses. For them, freedom of choice can mean homelessness, jail, or worse.
.. 90 percent of beds in state hospitals have been eliminated, leaving only the streets, jails, or prisons for those with serious mental illness.
.. But they face another problem—getting adequate reimbursement from insurance companies—including from Medicaid and Medicare. Thanks to the yeoman efforts of the late Senator Paul Wellstone, along with Pete Domenici, the law provides for parity in insurance coverage for mental-health and physical-health services, a provision that was underscored in the Affordable Care Act. But as lots of people who have tried to get reimbursement from their providers for psychiatric care could attest, parity in theory and in practice are two different things. And even where providers cover the services, the reimbursement rates are often well below what is provided for physical health issues.
.. The best hope for the Stabenow-Blunt bill is to incorporate it into the opioid-crisis bill now in a conference committee