Health Plan Omits Long-Term Mental Care Some Patients Need Years of Follow-Up, Their Advocates Say
Roger Signor Post-Dispatch Science-Medicine Editor, St Louis Post-Dispatch (MO)
In south St. Louis, the hallucinations of schizophrenia once forced Dan Hiles, 36, to live on the streets for six years before he got the care he needed.
In Wood River, manic depression put Bill Barger, 37, in the hospital 15 times in an 8eight-year period.
In Bellefontaine Neighbors, schizophrenia and manic depression disabled Beth Deaver, 21, leading to many hospital stays over six years.
Even so, Hiles, Barger and Deaver have made remarkable recoveries. In addition to medicine, a key to their getting back on their feet has been community programs that offer follow-up therapy and education.
But such long-term care for the chronically mentally ill may be in jeopardy under President Bill Clinton's plan to reform health care.
If the plan is passed, all Americans would get standard mental health benefits by 1996:
Up to 60 days of hospital care a year.
A maximum of 120 days a year for rehabilitation and other support services.
Up to 30 psychotherapy sessions a year.
Patients would also share some medical expenses, paying 20 percent of the cost of prescription drugs.
"Sixty days a year for hospital care? That's terrible," said Hiles, who works at Peter and Paul Mental Health Services, a program in south St. Louis for homeless men. "That's not enough for our guys who are really sick."
Hiles spent six years among the homeless before he was taken to the state-run Malcolm Bliss Hospital in St. Louis. There, his schizophrenia was diagnosed and properly treated.
After two years in the Peter and Paul program as a resident, he was well enough to work there. "If I hadn't had this place, I would have ended up in the streets again," Hiles said. He doubted that 120 days a year for such residential programs would help many chronic mental patients.
"Most people stay here for one or two years," Hiles said.
Barger agreed. He said he has needed daily support services for several years to break his cycle of repeated hospitalizations.
"I have a case manager, Warren Land, who handles my finances, helps me shop and takes me to group therapy," Barger said.
"Every day I go to the Community Counseling Center in Alton, where I work mornings and go to therapeutic meetings in the afternoon to teach me how to cope with my illness.
"I had been paying $150 for a three-month supply of my medicine," sBarger said. D"It didn't leave me much money, so the doctor dropped my medicine that prevents side effects from my main medicine."
Through a Wood River-based agency, Crisis Services of Madison County, Barger found that he could get free medications from the Veterans Administration because he'd served in the Marine Corps. "That has made a big difference," he said.
"If you pay 20 percent for the cost of medicines in the new plan, that would be hard on most people with mental illnesses," he said. 15,000 Chronically Ill
At any given time, 15,000 chronically ill Missouri residents need mental services that the state provides. The state spends $205 million a year for 25 community mental health centers, which now serve 5,000 persistently ill patients, state officials say. About 1,400 patients are in state hospitals or permanent residential-care programs. The state pays another $18.4 million for their care.
The Illinois Department of Mental Health spends about $400 million a year for the mentally ill - most of which goes for hospital care. Both Missouri and Illinois spend almost all their budgets on the chronically ill. …