The Free Press, Mankato, MN

November 17, 2013

More work needed on mental health

WHY IT MATTERS: Even with improvement in insurance coverage, we have a long way to go in actual parity in care for the mentally ill.

The Mankato Free Press

---- — Finally, after five long years of dickering, the Obama administration has issued new regulations on how insurance companies will administer coverage of mental illness and substance abuse.

Long a hallmark of the late Sen. Paul Wellstone, the 2008 mental health parity law requires insurers in large group plans that offer mental health coverage be equal to what is offered for patients with physical illnesses. Now the Affordable Care Act provides that same parity for individual and small group health insurance plans.

In announcing the new regulations, Health and Human Services Secretary Kathleen Sebelius will end discrimination of mental health patients who faced higher out-of-pocket costs or limitations on hospital or doctor care compared to those with physical illnesses.

But the work is not complete. The National Alliance on Mental Illness noted the regulations don’t extend to Medicaid and, said NAMI’s executive director, “Some of our most vulnerable people are still being left behind.”

The continued struggle of people suffering from mental illness is not remedied with insurance reform. As we learned at a special state Senate joint committee hearing last week in St. Peter, the mental health services process is inefficient and cumbersome.

A peer specialist at South Central Crisis Center said it makes an already stressful situation even more difficult to endure.

The purpose of the hearing was to determine what the Minnesota Legislature could do to improve mental health care.

As reported by The Free Press, suggestions included subsidized housing and more financial support for long-term services. The Community Behavior Health Hospital in St. Peter has 16 beds for treating people in a mental health crisis, but there isn’t enough staff to cover those beds.

Another recommendation was shortening the legal process for committing someone. People have been placed on 72-hour hospital holds about 75 times in Nicollet County this year. Of those incidents, there were 23 commitment requests. Only 14 of those requests were approved by a Nicollet County judge during the legal process required for commitment.

People going through the commitment process are kept in a hospital setting because there is no other place, with space available, that is qualified to care for them. So the remaining nine people who weren’t committed were taking up bed space for no reason.

If the commitment process was shortened from around six weeks to a week, those people could be moved through more quickly and make room for people who need emergency services.

Nicollet County Sheriff David Lange noted that one time this year an inmate attempted to commit suicide. Mental health care facilities in the area wouldn’t accept the inmate because he was a prisoner.

While a discussion on how to improve the mental health system is needed, we need more action and commitment from state legislators. Those most vulnerable people don’t have much of a political voice and can be relatively ignored in the rush of other priorities.

Wellstone once said “Politics is about the improvement of people’s lives. It’s about advancing the cause of peace and justice in our country and the world. Politics is about doing well for the people.”

Our state lawmakers would do well to refer back to this vision and prioritize improvements in how our state cares for the mentally ill.

Other views on this topic:

“To my knowledge, there has been nothing in the last several years of a major nature like this that has been passed with such bipartisan support. On a policy level, this proves it can still be done.”

Pushing for parity was “a labor of love. That’s how we stay sober. We’ve got to give back, and that’s part of my giving back. I’m just grateful I was in a position to do so. Patrick [Kennedy] and I are going to continue our work together. We still have a long ways to go, especially on the stigma.”

U.S. Rep. Jim Ramstad, R-Minn., in an interview with MinnPost. Ramstad with U.S. Rep. Patrick Kennedy, D-R.I., pushed for parity in the U.S. House of Representatives.