The Mental Health Hole

8 Problems with Our Health Care System #6

Fortunately for the mentally ill, humans have become more enlightened over the years. As recently as the 17th century, the mentally ill will regularly burned at the stake. They would later be confined to almshouses or jails where they could be kept separate from the rest of society. Eventually, reform efforts would lead to the creation of publicly funded mental health institutions. Ultimately, these too would be undermined when states would begin locking up criminals and any other deviant in the same institutions. To say that mental illness carried a stigma would be an understatement.

In the 20th century, the medical profession would gain a better understanding on mental illness and things would begin to approve. The Works Progress Administration (WPA) during the New Deal would build an unprecedented number of new mental health hospitals, where the mentally ill would be treated. As doctors gained more knowledge of the illnesses, there would be a surge in the growth of outpatient facilities. The mentally ill would begin to integrate with society. Psychiatry and psychology had become accepted medical practices. At the behest of employers, insurance companies began providing benefits for treatment.

Ultimately though, the cost of mental health care was problematic. Therapy and drugs are expensive. Even though most insurance programs cover mental health treatment, they do so with higher co-payments and a lower overall limit on payment amount. It didn't help that many mental health care facilities began to game the system by recommending hospitalization for people who did not need it. Something would have to be done.

The insurance companies would take it upon themselves to reform insurance for mental health care since their customers, large employers, insisted that the benefits remain. The biggest change was the application of managed care, a dubious idea when each individual and their treatment is somewhat unique. Beneficiaries were now forced into small networks of doctors and therapists. The insurance companies began denying claims at a rate far higher than for other medical areas. Payments were further limited. The ranges of treatment options were further limited. The number of days that an insurance company would pay for hospitalization was dramatically reduced. Rather than attack those that were gaming the system, the insurance companies went after mental health in its entirety.

Now, an individual with severe mental health problems faces a high likelihood of financial ruin. They are just another group that has been let down by the current system.

Source - Sick: The Untold Story of America's Health Care Crisis --- and the People Who Pay the Price by Jonathan Cohn