Dear Madam or Mr. President,
A woman stands in the emergency room of a hospital, pacing back and forth, screaming at the voices in her head. This image is repeated everyday, in every city, all over this country. An image of a woman who has nowhere else to turn, a hospital without a bed to give. It is bleak, painted in black and white, and at the moment, there is little hope of color.
Schizophrenia is treatable. Incurable, but treatable. Bipolar disorder is treatable, PTSD is treatable, OCD is treatable, panic disorders are treatable. And yet, those with serious mental disorders account for 26% of the adult population of homeless shelters. 70% of youth in prison and 20% of state prisoners have a mental health condition. Only 40% of adults with mental illness received treatment last year. Less than half. Suicide is the tenth leading cause of death in the United States. Second for 15-24 year olds.
The safety net of America’s mental health system is failing. Failing to the extent that over 42 thousand people committed suicide in 2015. Suicide is preventable. Mental illness is treatable. Failing to the extent that 20% of adults seeking mental health services were unable to receive them. Failing to the extent that one in five adults with mental illness are uninsured. Lack of insurance, lack of treatment providers, lack of funds to pay for treatment, and lack of available treatment types- from evidence based medication to therapy and psychosocial services such as rehabilitation, peer supports, housing and employment- are just four of several systemic barriers to those seeking help. This is unacceptable.
Even among the insured, it can be extremely difficult for those seeking treatment to receive it. Federal and state laws require parity between insurance for mental and physical health services. However, the law is blurry at best, and does not require private insurance to provide mental health coverage, only that those that do provide coverage equal to that of physical health services.
Medicaid, however, is a different story. Federally, state Medicaid programs must cover physician care, laboratory services, partial hospitalization and EPSDT (Early and Periodic Screening, Diagnosis and Treatment) for those under 21. Medicaid covers almost 27% of all mental healthcare spending in the United States, providing mental healthcare services not typically covered by private insurance, including case management, peer support and psychiatric rehabilitation. However, there is one gross exception. Under a federal law known as the IMD Exclusion, Medicaid is prohibited from providing payment for adults (21-64) in primarily psychiatric hospitals or treatment facilities with more than 16 beds.
One in five adults lives with a mental health condition, but there is only one psychiatric bed per sixty every sixty people in the United States. Due to lack of beds, those suffering from mental health conditions end up in ER’s and jails, often released or discharged without treatment. When law enforcement become the first responders to mental health emergencies, necessary resources are diverted from other public safety issues, and jails become the largest mental health facilities in the country. The IMD Exclusions worsens an already acute shortage of hospital beds, of any sort. Abolishing it would help eliminate ER and jail overcrowding, providing those who need it with the help they need to re-stabilize after or during a mental health crisis.
Luckily, there is unprecedented agreement among policy makers concerning mental health reform. Bills H.R. 2646, and S. 2680 will provide resources for suicide prevention, promote early intervention and treatment, improve integration of mental and physical health care and improve coordination between the federal agencies serving people with mental illnesses. H.R. 2646 has passed the House, while S. 2680 has just recently been introduced and is still awaiting legislation. If these bills ever reach your desk, I strongly encourage you to pass them into law.
We are sitting in the middle of a crisis. People are suffering, suicide rates are the highest they’ve been in thirty years. Millions of people are going without care, leading to homelessness, incarceration and disability, rather than fulfillment and recovery. And so we return to the women standing in an emergency room, where she will be held for 24 hours and released without care, because there are no beds available. This woman is the one in twelve, one of the eight percent of emergency room visits. The bed that is not available is one of the 4,500 eliminated from 2009-2012. The floor she paces is an emergency room in a no-name hospital in a no-name town. Her image is generic, she is not unique, she is one of many, this broken woman. She is a mother, a daughter, a sister, a friend. She used to play piano, before she got sick. She is a person, and yet, no one helps her.
Statistics from the National Alliance on Mental Illness, information on legislation from Congress.gov