A woman recently walked into my Massachusetts office to talk about her daughter, who had been diagnosed with serious mental illness in 2007, when she was just 4 years old.
A decade later, the stories this mother shared with me are heartbreaking. The countless hospital visits. The fights with insurers and doctors and courts. The time her daughter was kept for 21 straight days in the emergency room as her family desperately searched up and down the East Coast for a single available treatment bed. The ache of watching the person you love most in the world struggle against a merciless disease.
This mother ended our conversation by looking me in the eye and saying, without a hint of bitterness or anger, “But we’ve been lucky. Compared to other people I know, we’ve been lucky.”
If this is luck in the American mental health system, all of us should be ashamed. With 1 in 5 of our neighbors suffering from mental illness, the time for tinkering around the margins of our broken system is over. American families and communities need deep and dramatic reform.
Instead, congressional Republicans are moving forward with efforts to make it harder and more costly for the average American to access mental health care. These efforts began last month, with a hastily drafted bill to repeal the Affordable Care Act. Although it thankfully failed to get the support it needed to secure a vote in Congress, its message to the mental health community was clear: be warned. The legislation, championed by President Trump and Speaker Paul Ryan, was the single largest attack on mental health care in recent history.
By removing guaranteed behavioral health coverage for those covered under Medicaid expansion, millions of people would have lost access to treatment for substance use disorders — in the midst of an opioid epidemic. By capping Medicaid spending for states, Trumpcare would have imperiled the largest insurer of mental health services in our country. The bill did nothing to address abysmal reimbursement rates for mental health providers. Nothing to infuse investment into the full continuum of care. And nothing to force insurance companies to stop skirting parity laws that require they treat mental illness as they do physical health.
Enough Americans spoke out against that dangerous bill that we were able to stop it in its tracks. But almost immediately, Republicans were back behind closed doors trying to revive it. Their second bill could soon see a vote on the House floor.
Unbelievably, it’s an even starker blow to those suffering from mental illness than its predecessor. The latest version of Trumpcare doesn’t just threaten access to behavioral health coverage for those on Medicaid, it threatens access to behavioral health coverage for everyone. Under the guise of flexibility, this bill would allow states and insurance companies to opt out of covering mental health care — not to mention other designated essential health benefits like maternity and emergency care. Premiums and deductibles would soar as a result. Any semblance of mental health parity would be extinguished. And current protections for those with preexisting conditions — which is particularly important when it comes to mental illness — would cease to exist.
This is not the debate Congress should be having during a mental health care crisis. We should be considering steps to vastly expand the transformative mental health reforms made by the ACA, not shrink them. It’s time to go even further.
We need deep investments across the entire continuum of care to connect patients with treatment before they reach crisis points. We need broader support for community health centers, which provide essential entry points for lower and middle-income Americans who struggle to find in-roads to our mental health system. We need increased Medicaid reimbursement rates to encourage a new generation of workers to pursue careers in the mental health field, dramatically increasing access in every community that needs it. And we need relentless enforcement of mental health parity to make insurers live up to the laws of this country, which already demand basic equity in the coverage and treatment of mental illness.
All too often, mental illness is relegated to the sidelines of our health care debates. It’s somehow still deemed less critical, less acute, less wholly devastating than physical disease. One in five Americans and the families who love them would tell you otherwise. From the depths of opioid addiction to the searing pain of eating disorders and the long, often lonely, road through anxiety and depression, we have abandoned too many people in a system that cannot meet their basic needs.
The 40 million Americans suffering from mental illness deserve better than the paltry “luck” of that young mother in my office. They deserve better than a health care bill that degrades them. They deserve a country that is there for them, without question or condition, in their time of deepest need.
Joe Kennedy III has served as the US representative for Massachusetts’s 4th Congressional District since 2013.
Imagine the care that could be added for 5 billion dollars. I’ve been struggling fir weeks but I don’t have it in me to go the ER and hope there’s a bed open. Plus it’s cold. Many of the homeless come off the street and are admitted. Some have told me it’s so they have a place to stay out of the cold. Can’t blame them. Without mental health coverage there are going to be many unpaid bills and many people that don’t make it through their mental illness. Ok this is all over but loosing coverage scares the beejeebers out of me.
I was first diagnosed with major depressive disorder around my 30th birthday. That was 1982 and I thought about the inadequacy of the system and how it couldn’t get worse but at least we could get into quality hospitals. Now there is no such thing as a quality hospital things have really sunk to the bottom. I am in my late 60s now and I seldom need mental health care now. But I truly worry about the newly diagnosed now
Bravo for your fight for mental health. As a psychiatrist who recovered from schizophrenia please add the importance of the recovery-based peer-delivered services. Peer services reduce hospitalizations and improve quality of life. SAMHSA has been their champion.
Thank you for your support of mental health care. I hope you will also add the importance of a recovery based service system delivered very well by peers who have been recovering from even the most severe mental health conditions. The peer delivered, recovery programs could be threatened if the Trump administration’s choice of Assistant Secretary for MH does not support SAMHSA’s leadership in recovery and peer support. I am a psychiatrist and was a member of the White House Commission on Mental Health. I recovered from schizophrenia and led education and peer support efforts that show that peer support and a recovery mission reduces hospitalization and improves employment. Recovery and peer support are important complements to clinical psychiatry and medication. I am based in Cambridge,MA and on faculty of U Mass Medical School.
I am a licensed clinical social worker in Texas and have provided mental health care as a practitioner, a non-profit director and a behavioral health liaison for a national insurance company. In the 38 years I have been in this field, I have done my best with a changing landscape. Medicaid and Medicare have served some but as many with those forms of insurance will tell you, it is quite difficult to find not only an inpatient facility but also outpatient facilities. The fees paid are lower than what you can earn if you do not accept insurance, so usually only beginners take those forms of payment. That means that people with serious issues will end up with a string of providers for mental health, most of whom are the least experienced for this most challenging population. With the changes being proposed and on their way to enactment, this will only get worse. There will be less money, fewer providers and more social issues. I appreciate your voice of reason. Thank you for being an advocate. If I may ever be of service feel free to contact me.
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