Davis: The second class body part


Every few years there is some sort of event that sparks interest in trying to improve this country's inadequate mental health non-system. If a person has lots of money to spend on mental health care then they can at least have access to the best care and they will not be constrained by insurance company limits.

The rest of us have to rely on the health insurance system. When it comes to mental health care, relying on insurance companies for help is almost like hiring your enemies to protect you. The recent mass shootings in the country have given a little attention to the poor state of mental health care. Politicians will hold a few hearings and people will try to do something and then nothing will really change.

When mental health parity laws were passed proponents somehow believed that would help make better care available. All it did was to put mental health treatment into the same fetid pool of other types of treatment where insurance companies decide when you are cured and how long it should take to fix things. That kind of approach is bad enough in the world of non-mental health medicine, but it is even more deadly when dealing with addiction disorders and diseases of the brain.

I was reminded of how little this country has done to improve mental health treatment when I read a comment by an outgoing high level mental health bureaucrat as cited on October 29 in the Washington Post. "Speaking on his second-to-last day in his job as director of the National Institute of Mental Health, Thomas Insel said his 13-year tenure had convinced him of two 'abiding truths.' 'One is that we can do much, much better than what we're currently doing,' he said. In the field of mental illness, unlike any other disease, 'there is this unconscionable gap between what we know and what we do.' At the same time, he said, disorders of the brain are complicated and understanding them at a deeper level requires investment in more science 'if we're going to come up with treatments that are going to be more effective."

I'm sure that this guy is a dedicated professional but is that the best he can do after 13 years of running the National Institute of Mental Health than to say we can do much better? It is a sad commentary on the will of the power brokers in this country to improve access to quality mental health care.

The Post story goes on to note that, "Months of deadly mass shootings have prompted renewed momentum in Congress for mental health reform, advocates and lawmakers say. On Tuesday, more than 30 mental health and medical organizations sent a letter to HELP Chairman Lamar Alexander (R-Tenn.) and ranking minority-party member Patty Murray (D-Wash.) calling for a greater effort "to provide more effective prevention measures, more timely access, and improve the continuity of care within our mental health system."

Those kinds of pleas are meaningless and will result in nothing of importance. We do need to ask politicians to help fix the problem but we need to be more specific.

Capacity is one issue, but the most important factor that needs to be addressed is insurance company practice. We need to force politicians to change the rules governing insurance company coverage of mental health disorders by not allowing insurance companies to decide how long it takes to provide adequate mental health care.

Nurses and doctors should not be spending hours on the phone, as they now do, justifying their treatment plan to insurance company gatekeepers. If they were able to use that time for treatment everyone would be better off.

In the end it all boils down to money and the pursuit of a more equitable health care system. It will cost more to properly provide adequate mental health treatment and all sectors of society need to step forward and make a commitment to funding before we can make any progress. Until we do, too many Americans will never have a chance to live a better life.

Richard Davis is a registered nurse. He writes from Guilford and welcomes comments at rbdav@comcast.net.


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