ACCESS TO MENTAL HEALTH CARE

Fewer than one in three adults with a diagnosable mental disorder, and even fewer children with disorders, receive any mental health services, according to the U.S. Surgeon General’s 1999 Report on Mental Health.

Given that poor behavioral health contributes so significantly to the burden of disease and disability, it is extremely important to ensure that services are available and accessible. Unfortunately, many people cannot or do not seek treatment for mental health problems. The most important consideration is whether consumers have the opportunity for a good outcome. When those opportunities are systemically denied to consumer groups, there is an access problem that needs to be addressed.

There are three types of barriers to mental health care:

Financial - Consumer groups most impacted by financial access issues are:

• Consumers without public or private health care coverage who cannot pay for service out of pocket. It is estimated that 1/5 of the 1.2 million people in NJ without health care coverage have mental illness or a mental health related issue. This is why Family Care, (health insurance for working parents who cannot pay for health insurance out of pocket and whose employers do not offer health insurance coverage) is so important.

• Consumers with public or private health care coverage who have very little disposable income. Increasingly, consumers are being required to pay out of pocket for mental health care services. This shifting of health care costs can lead to a crushing burden for those with chronic illnesses. This is why opposing co-pays for Medicaid Fee For Service is so important.

• Consumers who do not have a biologically based mental illness who have private insurance that does not cover their illness. This is why behavioral health parity is so important.

Structural — Structural barriers are impediments to mental health care directly related to the number, type, concentration, and/or location of mental health care providers and services. (A consumer may have the best behavioral health care insurance that money can buy, but if s/he lives in an area where there are no mental health care services, s/he has a structural access issue.) Areas in mental health that are most impacted by structural access issues are:

• Children’s Mental Health Care. Nationally, there is a serious dearth of the kinds of services that children with behavioral health care issues need to get better. This is why the Partnership for Children is so important.

• Community Mental Health Services for Adults. The availability of behavioral health care in the community has not kept pace with the number of consumers who have been de-institutionalized over the past four decades. This is why Redirection II, maintaining the optional benefits package for the Medicaid Mandatory Population, and behavioral health insurance parity are so important.

• Public and private health insurance that limits access to mental health medications. Mental health medications are non-interchangeable and it takes years for most consumers to find the medication(s) that work best for them. In addition, changes in body chemistry can impact the effectiveness of a medication that may have worked well for many years. Doctors must have access to the full range of available psychiatric medications. This is why opposing Preferred Drug Lists in Medicaid FFS and any other form of insurance coverage is so important.

Personal and Cultural — These barriers may include belief systems which inhibit people who need medical attention from seeking it, or once they obtain care, from following recommended post-treatment guidelines.

• The Institute of Medicine has concluded that even when members of a minority group have the same incomes, insurance coverage and medical conditions as whites, they receive notably poorer care. Biases, prejudices and negative racial stereotypes may mislead doctors and other mental health care providers. Unconscious racism is every bit as dangerous as the most overt forms of bigotry. This is why A2297 sponsored by Assemblywoman Bonnie Watson Coleman (D15) and Gordon Johnson (D)/ S411 sponsored by Senator Bryant and Senator Diane Allen which would require physicians to have cultural competency training as a condition of licensure, is so important.

• Stigma, ignorance and denial cause an estimated 2/3 of people who have a mental health problem (and their families) to not seek treatment.

For the above reasons, many consumers do not, or cannot access treatment until they face an emergency. Instead of having an opportunity for a good outcome, they end up in homeless shelters, screening centers, emergency rooms and hospitals. They face catastrophic financial difficulties, are less productive at work and school, increase their likelihood of abusing substances and committing suicide, or get displaced to other systems such as welfare, criminal and juvenile justice, child welfare.

How can we assure that everyone who needs mental health care has access to the appropriate care? For starters:

• Secure and expand funding of mental health services
• Maintain, improve and increase public health insurance (Medicaid, Medicare, Family Care)
• Oppose any limitation to psychiatric medications in health care plans
• Fully fund the Partnership for Children
• Fully fund Redirection II
• Improve and increase both outreach and information
• Improve insurance coverage to eliminate inequities (behavioral health parity)
• Provide behavioral health care professionals opportunities for greater awareness and education about personal and cultural barriers to behavioral health care.
• Rely on “evidence based guidelines” to determine what care is given.

For consumers young and old, rich and poor, black and white, mental health care is not discretionary, it is necessary.

CONSUMER ADVOCATES OF THE MONTH

Over the past few weeks, MHANJ staff has been making individual visits to the 23 members of the two budget committees to share with them the impact Governor McGreevey’s Proposed FY ’04 Budget will have on NJ’s children and adults with mental illness. On most of those visits consumer advocates accompanied us to tell legislators their perspective on the budget, share what was going on for consumers in their districts, and provide an example of what consumers can be and do with a little help from government. We thank Voneceil Hodges, Maureen Mayer, Wayne Vivian, Tim Onucki, Yasmin Halim, Brian Yuille, Kelli Cochran-West, Rosetta McNicholas, Jack Bucher, Michael Wilson, Shalet Richardson, Linda Valentine, Grace Yang, Linda Evans, Sam Laskin, Joe Cinko, and Helen Williams. Your presence showed legislators the reality of recovery of the mental health consumer. Your willingness to publicize your illness showed legislators the courage of the mental health consumer; your advocacy and unwillingness to turn your back on other consumers in need showed legislators the compassion of the mental health consumer; and, finally, your voices showed legislators that you will not be silent.

KUDOS AND CREDENTIALS

Congratulations to consumer-providers Cary Haimer, Valerie Fox, and Maureen Mayer for passing the Certified Psychosocial Rehabilitation Practitioners Exam.

Join MHANJ’s Legislative Network! Contact
C. Chin at 973.571.4100 Ex. 37  or cchin@mhanj.org