Thursday, April 25, 2013

How Congress Fits into Mental Health Patient Dumping Scandal

Earlier this month, President Obama released his federal budget proposal. Yet while most pundits initially focused in (perhaps justifiably) on the President's pre-concessions on Social Security, there was another aspect of the White House Budget Plan that's steadily been gaining more attention. Here, take a look at this.

The new budget plan will propose $130 million for programs that train teachers and other adults to help recognize early signs of mental illness, referring them to help when they detect such warnings. That includes $55 million for a new program called Project AWARE (Advancing Wellness and Resilience in Education). That will give states and local school districts grants to administer such programs, while also collecting data on how well they work.

Another $50 million in funds would go toward training masters-level mental health specialists such as psychologists, nurses and counselors who work in schools. The idea is to expand the mental health workforce to prepare for the demands of millions of Americans who will gain health insurance coverage under the Affordable Care Act.

“We can’t take 12 years training doctors and post-docs to meet the need in 2014,” the administration official said. “We’re taking a very promising and practical approach.”

Another $25 million would be put towards helping schools, where violence is pervasive, to address the trauma experienced by children and test violence prevention strategies.

Obama touched briefly on the importance of expanding mental health services in a Monday night speech on gun violence, at the University of Hartford in Connecticut.

“We have to tell Congress it’s time to strengthen school safety and help people struggling with mental health problems get the treatment they need before it’s too late,” he said.

In total, the President is requesting an additional $235 million for mental health care. And especially considering all the recent attention on the intersection of health care policy and gun violence, one would think there's renewed interest in fixing this. And indeed, there is. There's even been talk of legislation in Congress.

But then again, we are talking about the 113th Congress. So of course, that means productive legislation gets sidelined while pointless "tea party" circle jerks become the center of attention. And indeed, that's what may soon be happening again as House Republicans demand even more votes to repeal the Affordable Care Act.

At a Wednesday panel organized by the Heritage Foundation, conservative Republicans lamented that it’s been too long since they had the opportunity to vote to wipe out the Affordable Care Act in its entirety — and that the newest members haven’t had the chance yet.

“We need to get a vote on full repeal, and I’ve asked leadership for this. I’m a cosponsor of Michele Bachmann’s bill … that just goes straight at it for full repeal,” said Rep. Steve Scalise (R-LA), the chairman of the influential and deeply conservative Republican Study Committee. “We need to continue fighting for repeal. We need a clean vote on repeal.”

Rep. Mick Mulvaney (R-SC) urged leadership to hold a repeal vote so freshman members can serve up the same anti-Obamacare talking points for their conservative constituents that more senior Republicans enjoy.

“If you’re a freshman — the guys who’ve been up here the last year, we can go home and say listen, we voted 36 different times to repeal or replace Obamacare. Tell me what the new guys are supposed to say,” he said. “We haven’t had a repeal or replace vote this year.”

“We have not had a chance as freshmen to do that,” said first-term Rep. Trey Radel (R-FL). “Even if it’s just symbolic — and even if we understand that process-wise we are not going to be able to say, okay we want repeal, it’s done, and it’s over. But this is the issue that so many people around the country who love the Republican Party are frustrated with.”

Never mind that the Affordable Care Act (ACA) has already been saving lives and cutting health care costs since implementation began in 2011. And never mind that House Republicans have voted at least 36 times to repeal the ACA since 2011. And never mind that the 112th Congress wasted $50 million in taxpayer money and 88 hours on their many failed ACA repeal attempts.

So how does that fit into this story? ACA actually expands mental health care for 62 million Americans. Pay attention to what Dr. Richard Friedman, Professor of Psychiatry at Weill Cornell Medical College, wrote for The New York Times last July.

One of the health care act’s pillars is to forbid the exclusion of people with pre-existing illness from medical coverage. By definition, a vast majority of adult Americans with a mental illness have a pre-existing disorder. Half of all serious psychiatric illnesses — including major depression, anxiety disorders and substance abuse — start by 14 years of age, and three-fourths are present by 25, according to the National Comorbidity Survey. These people have specifically been denied medical coverage by most commercial insurance companies — until now.

From an epidemiologic and public health perspective, the provision that young people can remain on their parents’ insurance until they turn 26 is a no-brainer: By this age, the bulk of psychiatric illness has already developed, and there is solid evidence that we can positively change the course of psychiatric illness by early treatment.

Mental disorders are chronic lifelong diseases, characterized by remission and relapse for those who respond to treatment, or persistent symptoms for those who do not. In schizophrenia, for example, relapse is common, even with the best treatment. It makes no sense to tell someone with this condition that his lifetime mental health benefit is just 60 days of inpatient hospitalization.

Psychiatric illness is treatable, but it is rarely curable; it may remit for a while, but it doesn’t go away. That is why the current limits on treatment are as irrational as they are cruel — the discriminatory hallmark of commercial medical insurance.

No more. The Affordable Care Act treats psychiatric illness like any other and removes obstacles to fair and rational treatment.

And House Republicans are still hellbent on repealing the Affordable Care Act.

Here in Nevada, we've been rocked by the patient dumping scandal that's been growing since James Flavy Coy Brown was found disoriented and suicidal in a Sacramento, California, homeless shelter. He was discharged from Rawson-Neal Psychiatric Hospital in Las Vegas in February despite needing more treatment. And he was placed onto a Greyhound bus bound for Sacramento with only a three day supply of medicine, some peanut butter crackers, and a few cans of Ensure.

Governor Brian Sandoval (R) insists that this was a mostly isolated incident and it's all better now. However, officials throughout California are viewing Governor Sandoval's recent statements very skeptically. And they're not alone. Today, US Senate Majority Leader Harry Reid (D-Searchlight) finally weighed in. And let's just say he's not pleased.

“I’ve got enough problems back here, trying to take care of issues in the federal government so I am not going to intertwine myself with issues in Nevada as it relates to state government,” Reid said.

“But I think it is unfortunate that people would be given a bus ticket and not given the proper care they need before they leave – not before they leave but before they are sent out of the state.” [...]

When it was suggested that lack of funding was the root of the problem, Reid said Nevada has been cutting back on mental health for decades.

“Since Gov. (Mike) O’Callaghan has been governor (1971-79), there have been cutbacks on mental health services in Nevada, which is unfortunate,” Reid said. “They have had a lot of cuts and that has been too bad.”

Nevada’s issues about funding mental health facilities begin in Congress, Reid said.

“Of course, it spins down,” Reid said. “When we cut back things here, it makes it difficult for the state Legislature, Gov. Sandoval to do their job because we are cutting back here.”

Reid doesn’t see mental-health spending getting any better in Congress.

“I was talking on the floor today and it is going to get worse,” Reid said. “The Republicans are happy where we are. They have one goal in mind and that is to cut spending. Nothing else matters.”

And that gets us back to what's happening in Congress now. For all the talk of preventing gun violence by expanding mental health care, most Republicans in Congress are now pursuing the opposite. And on top of that, they want to repeal the very Affordable Care Act that stands to improve mental health care nationwide.

We've discussed before how state health care budget cuts likely contributed to the patient dumping scandal. Recent federal budgets have probably exacerbated this. And if the "tea party" gets its way in Congress, we can only look forward to even more mental health care headaches in the future.

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