Health Reform and the Uninsured Mentally Ill
Mahoney, Diana, Clinical Psychiatry News
As the war over health care reform rages on in Congress, more desperate battles are being fought daily by uninsured Americans with mental illness or addiction disorders.
Almost 50% of the people who received their most recent substance abuse treatment at a specialty facility in the past year reported using their "own savings or earnings" to pay their most recent treatment, according to 2008 National Survey on Drug Use and Health.
For most of the nation's uninsured with mental illness or addiction disorders, access to mental health services is a complicating factor. When services are available, "they frequently are not the right services," wrote the authors of the 2009 Report on America's Health Care System for Adults with Serious Mental Illness issued by the National Alliance on Mental Illness (NAMI).
The report was designed to measure the nation's progress toward the transformation of mental health service delivery outlined in 2003 by the presidential New Freedom Commission on Mental Health.
In a baseline "report card" published in 2006, the nation's efforts toward this goal received an average grade of D. Three years later, the national average still stands at D. Small improvements made in some states were offset by setbacks in others, while most of the states remained stagnant, the authors wrote.
"In America today, the people who must rely on [the public mental health care] system are actually being oppressed by it, and many years of bad policy decisions have left emergency rooms, the criminal justice system, and families to shoulder the burden of responding to people in crisis," NAMI executive director Michael J. Fitzpatrick said in a teleconference.
Uninsured children and adolescents are especially vulnerable to the lack of service access. A 2002 study looking at the unmet need for mental health care among U.S. children showed that 79% of all 6-to 17-year-old children in need of mental health services and 87% of uninsured children in need of mental health services, as defined by an estimator of mental health problems selected from the Child Behavior Checklist, did not receive them. This conclusion was based on data from nationally representative household surveys (Am. J. Psychiatry 2002;159:1548-55).
More recently, in a nationally representative study looking at the influence of health insurance on parent' reports of children's unmet mental health needs, nearly one-third of children with long-term emotional or behavioral conditions who needed mental health or counseling in the previous 12 months did not receive it, and parents of uninsured children were significantly more likely to report unmet mental health needs than those with children covered by public or private health insurance.
The findings suggest a need for expanding health insurance coverage to all children, particularly those with long-term mental health conditions (Matern. Child Health J. 2009;13:176-86).
Despite the progress that has been made in the development of evidence-based practices geared toward youth with mental illness, "these services are not often available in communities," the 2009 NAMI report said.
Also, unmet mental health needs in children and adolescents fuel the "school to jail" pipeline, according to Joseph J. Cocozza, Ph.D., executive director of the National Center for Mental Health and Juvenile Justice at Policy Research Associates in Delmar, N.Y. Often, untreated mental illness in adolescents "presents in misbehaviors that bring them to the attention of school police and the juvenile justice system," he said. Because schools often lack the resources to adequately address the student's needs, "they find it easier to have the youth arrested."
The statistics bear this out. According to data compiled by the National Council for Community Behavioral Healthcare (NCCBH), about 60% of juvenile detention inmates have at least one mental health disorder, and in at least 33 states, children and adolescents are held "without charge" in juvenile justice facilities while they are awaiting mental health treatment because of a lack of suitable resources. …