Mental Health Spending – A Low Priority for Government
The power of stigmatization of the mentally ill is so strong that it keeps mental health low on the list of public priorities for spending. One of the barriers to treatment for the mentally ill is the inability to pay for it, and another is how to access it. Policy-making and funding decisions for mental health by federal, state and local legislators result in inadequate government-funded mental health care facilities, insurance reimbursement, community programs and treatment specialists available.
Mental health does not usually have parity with physical health benefits in private insurance policies, making it expensive for anyone, even if fortunate enough to be insured. Even those on Medicare have limitations on benefits and reimbursements not at parity with physical conditions. Many others have insurance, but mental health treatment is not covered.
Perhaps the individual has no insurance and does not qualify for government programs like Medicaid. There is treatment available based on income level. Government community-based facilities usually have sliding-scale payment arrangements, but have long waiting lists and limitations on what they can offer. Again, this is the result of inadequate funding for mental health care indicating that our legislators and policy makers stigmatize and discriminate against the mentally ill.
As in most politics, power (and funding) generally flow towards the already powerful. The marginalized and stigmatized population of moderately to severely mentally ill and substance abusing folks out there, though large in numbers, are not generally well enough organized or well funded to make much of an impact on those in power. Despite the few groups lobbying for compassionate care for mental illness, there are many other powerful groups chasing down other (sometimes worthy, sometimes not) funding agendas. It is all too easy for well-healed politicians to ignore the mentally ill. (1)
Policy makers are “people too”, with their own biases. Their attitudes about the mentally ill reflect those of the general population. Some are enlightened and educated about mental illness, but many are not. The result has been under-funded community systems and symptomatic people on the streets and in jail. Policy makers need to realize that the public ultimately pays more for untreated mentally ill people because of the high costs of housing them in mental hospitals or jails. With more funding for mental health, the collateral benefits and return of investment can be very high, as many negative external impacts of mental illness can be avoided, such as allowing treated mentally ill individuals to maintain or regain employment which contributes to society.
Given the tremendous costs in human and economic terms, given that these diseases touch a fifth of all Americans, you would think we would be mobilizing resources to address the mental health needs of this country. Instead we seem to have a system that blames mental illness on the mentally ill and ignores the impact on society. (2)
What Can Be Done
Destigmatizing mental illness can help remove financial barriers to treatment. Public attitudes need to be transformed, so that mental illness is viewed as a real disease, equal to physical illness.
Write to your government representatives and express your opinions. Mental health advocacy information can be found at both the National Mental Health Association (NMHA), and National Alliance for the Mentally Ill (NAMI) websites.
(1) Dombeck, Mark Ph.d. Health Policy and Advocacy. “Counting the Mentally Ill: The Needs Haven’t Changed, Only Their Definitions“. (March 1, 2002).
(2) Texas Medical Association. Mental Health Policy in the 21st Century. “Remarks of Congressman Patrick J. Kennedy“. University of Texas Southwestern, Department of Psychiatry. (Jan. 28, 2002)