Save mental health reform

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The recent election and impending repeal of the Affordable Care Act (ACA, “Obamacare”) once again casts a cloud of uncertainty over our healthcare system. Our team is concerned about the impact that repeal would have on people with mental illness. The Trump administration, however, has indicated that certain popular portions of the ACA may be left in place. This creates an opportunity for advocates to fight for the ACA’s extensions to mental health care, especially as this has historically been a bipartisan issue. These provisions include:

Mental health parity extensions to the individual and small group markets: The ACA extends the 2008 Mental Health Parity and Addiction Equity Act signed by President George W. Bush to an additional 62.5 million Americans. This requires equal coverage and cost for mental and physical treatments, thereby preventing insurance companies from discriminating against people with mental illness.
Inclusion of mental health and substance abuse treatment as an Essential Health Benefit: For the first time, this requires all individual and small group insurance plans to provide mental health and substance abuse treatment. This also bans annual or life-time treatment limits.
Allowing children to stay on their parent’s insurance until age 26: This increases insurance coverage for young adults, which is important because many of the most severe forms of mental illnesses like schizophrenia and bipolar disorder first emerge in this age group.
Banning discrimination based on preexisting conditions: Insurance companies used to exclude the sickest patients by charging them very high premiums or rejecting their applications for coverage outright. The ACA bans both of these practices, which were frequently used to target people with mental illnesses.
Expanding Medicaid and the social safety net: These provisions are particularly important for people with mental illness who are disproportionally represented in the vulnerable population served by Medicaid. These expansions address some of the root causes of homelessness, incarceration, unemployment, and inequalities in care. John Kasich and Chris Christie both chose to expand Medicaid in their states along with nearly a dozen other Red states including Mike Pence’s Indiana.



http://savementalhealthreform.org/

While in theory this all sounds great, it will do nothing if 75% of mental health providers do not take insurance of any kind.

In my area, psychiatrists run about $90-$200/45 minutes. The same with psychologists.

Anyone who is decent (not just running a 15 minutes med check script mill) takes no insurance. I have called 8 shrinks in my area since my psychiatrist quit. None take BC/BS and/or Medicare

Currently I am stuck at the a university hospital mental health clinic. I see a resident 20 minutes a month. If I have a problem, I get whatever clown is on call who doesn't know me from Adam, or go to the ER to be screened by a psychiatrist social worker who doesn't know me from Adam either. How is that any different from rolling into random ER and be at the mercy of whoever is there?

This is what passes for mental health care in the US. Unless your family has deep pockets or monster insurance, there are no talk therapies.

All the shrinks around here want the worried well. The executive's kid that didn't make it into Princeton. The mom who is feeling unsatisfied with her life. The middle manager who is afraid of success. Those are the folks who plunk down $150/hour cash and talk about their issues. Most likely they will not be firing up the phone at 3 am with a problem. It is easy money with people who are most likely in the psychiatrist socioeconomic bracket. Nice people who have issues, but aren't hearing voices or carving swastikas into their arms on a bad medication day.

If you have bipolar disorder, schizophrenia etc...you are f****d. Those 8 psychiatrists I called don't treat those types of patients. If you have had 1 suicide attempt, they don't want you either. Dual diagnosis patient or active eating disorder, sucks to be you.

Hooked on heroin, too bad so sad.

People said during the 1990s mental health care hit the skids. They didn't see anything yet. At least I had a psychiatrist who didn't view me as a 15 minute medication check. Who at least worked with me with medication adjustments.

My family practice doctor could do what the psychiatric resident is doing. How much skill does it take to scroll through the PDR and play pill roulette? Family practice doctor told me he would write the scripts. I just have to decide if I want that.

Pluses

1) my GP is s**t tons cheaper that the psych clinic.
2) He actually KNOWS me, and remotely seems to give a s**t.
3) He could admit me to inpatient psych and request his psychiatrist of choice.

Downside? I'm struggling to find one.

You can have 100% mental health coverage, but if all the psychiatrists that take the insurance are the bottom feeders of their graduating classes, or like running a 15 minutes med check script mills, you'd be better off with nothing.

They need to scorch earth how mental health care is doled out in the US. Coverage is the least of the worries.