Malpractice premiums are plaguing doctors
The New Freedom Commission on Mental Health, created by President George W.
Bush in 2002 to examine the condition of America's mental health system and
to make recommendations, released its long-awaited report on July 22. The report,
which has been embraced by organizations such as the American Psychiatric Association
and the National Mental Health Association, found the mental health system to
be "in shambles" and "broken."
The report, Achieving the Promise: Transforming Mental Health Care in America, recommends a fundamental change in how mental health is delivered in the United States. Instead of being so crisis-oriented and focusing on providing medication and managing symptoms, the commission stresses the need for an integrated system focused on prevention, early diagnosis and complete care. Department of Health and Human Services Secretary Tommy Thompson charged the HHS Substance Abuse and Mental Health Services Administration with coming up with a comprehensive plan to implement the report's recommendations.
The report could have remarkable and extensive effects on how the mentally ill are treated in the United States, if the national government follows through and applies the changes. Mental illness is too serious a problem and the system is too damaged to let the opportunity this report represents slip by.
Between 5 and 7 percent of American adults suffer from serious mental illness each year, and between 5 and 9 percent of children suffer from emotional disturbances. Mental illness is at the top of a list of illnesses that cause disabilities in the United States, Canada and Western Europe. According to the World Health Organization, mental illness, including depression, bipolar disorder and schizophrenia, accounts for nearly one-fourth of all disability across major industrialized countries. As the report states, "No community is unaffected by mental illness; no school or workplace is untouched."
The costs of mental illness are enormous; it indirectly costs the United States $73 billion a year, according to the New Freedom report. Most of this -- $63 billion -- is in lost productivity. The best way to reduce these figures is to catch mental illness before it gets out of hand, not just to suppress symptoms, which, obviously, has not been working so far.
Currently, only one-third of adults with a mental illness are working and, of those, most are underpaid. As a result, many have to rely on public assistance such as Temporary Assistance for Needy Families, Social Security Income and Social Security and Disability Income. In fact, 35 percent of SSI recipients and 28 percent of SSDI recipients have mental illnesses, and millions of the mentally ill are homeless.
One of the worst consequences of mental illness is suicide. Suicide is the leading cause of violent deaths worldwide; it's greater than homicide and war-related deaths combined. In the United States, 30,000 people die a year from suicide, and 90 percent of them have a mental illness.
The most disturbing aspect of these numbers is that 40 percent had visited their primary care physicians within a month of their death, but their illnesses were not caught.
The commission's biggest concern is the lack of integration between systems; it is far too fragmented, which leads to confusion and disparate treatments. The systems providing access to care, including Medicare, Medicaid, TANF and juvenile justice and criminal justice systems, have to be coordinated.
However, to coordinate the various programs is going to take money.
Unfortunately, the commission did not address this issue and funding for mental illness is being cut across the nation as states face budgetary crises. Even before budget cuts, mental illness funding never reached parity with its prevalence in society. The burden of mental illness in the United States is 20 percent, yet only 5 to 7 percent of health expenditures are directed toward disorders, according to the APA.
Millions of people with mental illnesses are already failing to receive the care they need. Health insurance companies and even Medicare treat mental illness with disdain. The Medicare co-pay for mental illness is 50 percent, compared to 20 percent for physical illnesses.
It is much easier, not to mention far cheaper, to prevent
mental illness than it is to treat it. The government can show it's sincere
in taking mental illness seriously by following the commission's recommendations.
Education programs to decrease the stigma associated with disorders, passing
legislation requiring parity between mental and physical health insurance coverage
and eliminating the disparate treatment experienced by minorities and rural
populations is essential to destroying the control mental illness has on the
United States.