2003-11-08 --  A Vision for the Mental Health System

Thanks to Physicians for A National Health Plan's Don McCanne for this
article and comment.

American Psychiatric Association  A Vision for the Mental Health
System  April 3, 2003

http://psych.org/news_stand/visionreport040303.pdf


Exerpts follow:

There is clearly great disparity between the funding of treatment for
psychiatric care and medical/surgical illnesses. In the U.S., the
burden for disease accounted for by mental disorders is 20 percent,
whereas only 5-7 percent of all health expenditures are directed
toward treatment of these disorders. Based on a relatively high
prevalence rate and level of associated disability, major depression
is the leading cause of disability in the United States for all
disorders. Since we now have excellent epidemiological information on
the prevalence rates of all mental disorders in the United States,
there is a quantitative basis for determining DALYS (disability
adjusted life years) associated with specific disorders. It is clear
that additional funds are warranted to bring funding more in line with
the 20 percent of DALYS associated with mental disorders. This
approach lends itself to the monitoring of prevalence rates, the
treatment costs of these disorders, and the cost benefit in reducing
DALYS associated the allocation of resources. This is an
evidence-based approach to reformulate budgetary priorities at a time
of scarcity to provide a rationale for increased funding for treatment
of mental disorders.

Introduction of nondiscriminatory insurance coverage ("parity") for
mental disorders is one significant step in making those additional
resources available. Many individuals with disabling anxiety and mood
disorders predominantly belong to insured population groups, and any
reduction of YLDs (years of life lived with disabilities) associated
with depression, for example, will come as the result of improved
access to appropriate treatment. Increased ability to access insurance
benefits that provide reasonable coverage for mental illness
(including private, Medicaid, and Medicare) would increase patient
choice of mental health provider and reduce the burden on the public
system. Reductions in state funding have resulted in a massive cost
shift of care to the criminal justice system; incarceration is a
costly, ineffective, and inhumane method for dealing with individuals
with severe mental disorders. Reallocation of criminal justice funds
to treatment for mental disorders would address the source of the
problem by providing an evidence-based strategy to reduce DALYS
associated with low prevalence severe disorders and all other
disorders treated in the public system. Such a comprehensive health
and human service reform would result in allocating resources more in
line with the 20 percent of DALYS associated with mental disorders.


Twelve Principles for a Vision for Our Nation's Mental Health System

1. Every American with psychiatric symptoms has the right to a
comprehensive evaluation and an accurate diagnosis which leads to an
appropriate, individualized plan of treatment.

2. Mental health care should be patient and family centered, community
based, culturally sensitive, and easily accessible without
discriminatory administrative or financial barriers or obstacles.

3. Mental health care should be readily available for patients of all
ages, with particular attention to the specialized needs of children,
adolescents, and the elderly. Unmet needs of ethnic and racial
minorities require urgent attention.

4. Access to mental health care should be provided across numerous
settings, including the workplace, schools, and correctional
facilities. An emphasis should also be placed on the early recognition
and treatment of mental illness.

5. Patients deserve to be treated with dignity and respect. When they
are clinically able, they are entitled to choose their physician or
community-based agency and to make decisions regarding their care.
When they are incapable to do so, they should receive the treatment
they need and when able, they should choose future care.

6. Patients deserve to receive care in the least restrictive setting
possible that encourages maximum independence with access to a full
continuum of clinical services, including emergency/crisis, acute
inpatient, outpatient, intermediate level, and long-term residential
programs.

7. Since mental illness and substance abuse occur together so
frequently, mental health care should be fully integrated with the
treatment of substance abuse disorders and with primary care and other
general medical services.

8. Support must expand for research into the etiology and prevention
of mental illness and into the ongoing development of safe and
effective treatment interventions.

9. Efforts must be intensified to combat and overcome the stigma
historically associated with mental illness through enhanced public
understanding and awareness.

10. Health benefits, access to effective services, and utilization
management must be the same for people with mental illness as for
other medical illnesses, preferably funded by integrated financing
systems. Although states are the ultimate locus of responsibility for
the public safety net, the federal government and the private sector
employers must also support an increased investment in the mental
health of Americans.

11. Funding for care should be commensurate with the level of
disability caused by a psychiatric illness. Disability occurs both in
the severely and persistently mentally ill and in patients with other
unforeseen psychiatric conditions who suffer despite having previously
been productive and functional.

12. More resources should be devoted to treatment and to training an
adequate supply of psychiatrists, especially child psychiatrists, to
meet the current and future needs of the population.




Comment:  The dual problems of uninsurance and underinsurance
contribute significantly to the continuing crisis in impaired access
to adequate mental health services. A universal, comprehensive,
publicly-funded and publicly-administered system of social insurance
would move us a long way toward reducing the financial barriers to
adequate mental health care.

We really do need to totally reform the way we pay for health care in
our nation.

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