Mental Health Spending – A Low Priority for Government

Law_Politics2.jpgThe 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)

  • ParityFanatic

    I can not easily accept the fact that 8.5 million Federal employees have full mental Health parity in THEIR Health Ins. program since 2001 & no one in Congress has the Poltical will to force a vote on mandating parity in the private sector for groups of 50 or more.
    This is another example of the Haves & Have not mentality in this country.
    The only thing that counts to our Representatives is the next political contribution from the next special interest.
    If mental Health parity is good enough for our Government employees, it should be good enough for we private sector patsies.

  • Elise Stobbe

    Well said! Isn’t Medicare under the federal umbrella? Why doesn’t it have parity?

  • Well said,i applaud your blog,mental health consumers are the least capable of self advocacy,my doctors made me take zyprexa for 4 years which was ineffective for my symptoms.I now have a victims support page against Eli Lilly for it’s Zyprexa product causing my diabetes.–Daniel Haszard

  • parityfanatic

    Many people are confused regarding Medicare Coverage.
    Psychiatric Hospital admissions in the Psychiatric Department of a General Hospital ARE treated identically to all other illness or accident admissions.
    A 190 day lifetime Hospital Psychiatric admissions limit does exist but only to a Pure Psychiatric Hospital. Most people do not get Psychiatric care from a Hospital that only treats Mental illness.
    As for Doctor care (Part B)
    In-patient Psychiatric fees are paid at 80% of approved amounts.
    The discrimination occurs regarding outpatient psychiatric care fees, Medicare Part B pays at 50% of approved amounts.
    Outpatient physician fees for OTHER illness is paid at 80% of approved fee. This should be 80% for outpatient Psychiatric as well.
    Medicare is still superior to most private sector plans.
    Most Medicare enrollees purchase a Medigap plan. Most Medigap plans pick up the 50% not covered by Medicare B for outpatient Psychiatric fees.
    Don’t forget the current $952.00 Part A deductible per benefit period & the 124.00 Annual Part B deductible.

  • Elise Stobbe

    Most SENIORS purchase a Medigap plan for mental health coverage to pay the other 50% of outpatient psychiatric visits, but the majority of mentally ill are not over 65 and my understanding is that Medigap plans are not offered to the under 65 crowd? Correct me if I’m wrong. Also, many severely mentally ill are not working and cannot afford Medigap coverage.

  • parityfanatic

    Normally a person would be 65 or over to enroll in Medicare Parts A&B.
    However,An individual who qualifys for Social Security Disability (SSDI) after collecting that benefit for 24 months would be enrolled in Medicare. SSDI requires 5 months of total disability expected to be disabled for a year or longer & unable to do any substantial gainful activity to qualify for the monthly benefit.
    Someone with a Serious mental illness who had worked prior to the onset of the disability should eventually qualify for SSDI. In other words, we do have millions of disabled people under 65 who eventually qualify for Medicare. A Medigap would definitely help these seriously ill Americans.
    I am not suggesting that Medicare helps young people with manageable mental illness.
    A great idea would be to expand Medicare to people under 65. We need real coverage for All americans & the private sector runs away from the mentally ill.
    Someday the USA will have a national Health Ins program for all.
    Just don’t hold your breath waiting!

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