NC should get out of mental health care business
Published November 27, 2013
by Marc Landry, News and Observer, November 27, 2013.
There is seldom any good news about mental health care and the treatment of addicts in North Carolina. Many experts and relatives of the mentally ill denounce the state for failing to provide adequate care, facilities and programs for the mentally ill and those addicted to drugs or alcohol.
On the other hand, reviews of the state’s efforts at mental health care reform that brought treatment closer to the community have concluded that the mentally ill were poorly served and that millions of dollars were wasted.
In short, the state is wasting a lot of taxpayer dollars giving poor and inadequate services to a significant number of its residents in need of medical care.
No one ever asks the question that strikes me as being basic: Why is our state providing mental health care and treating addicts when it has no such programs or facilities for people who are suffering from heart disease, cancer, diabetes or any other type of physical illness and when our state has most definitely not demonstrated any great skill or aptitude at doing so?
I can think of two explanations.
In less-enlightened times, the mentally ill were essentially warehoused for their own protection and that of the rest of society in institutions called asylums. Housing the mentally ill became a state function in much the same way incarcerating criminals did. The state merely substituted a diagnosis or medical opinion for a sentence.
The other explanation is somewhat less historical. The delivery of medical care in our country has evolved in a rather haphazard way with many different delivery systems serving different constituencies.
Governments serve the poor, the elderly, the military and the mentally ill. Those constituencies have one thing in common: Health insurers are not interested in serving those segments of the population.
The poor are never an attractive market for any service. The elderly, the military and the mentally ill have or are likely to have a greater than average need of medical services. As such, health insurers don’t see them as profitable and have yielded to governments the function of providing them with health care.
With the enactment of Mental Health Parity and Addiction Act of 2008 and the Affordable Care Act of 2010, mental illness and addiction treatment are to be treated on an equal footing with physical disease and injuries in most health insurance policies.
Since most North Carolinians will be required to have health insurance that covers mental illness and addiction treatments without lifetime limits, those who need such care or treatment should be in a position to seek it in the same way as the physically ill.
The state of North Carolina currently owns and operates three psychiatric hospitals in addition to its three long-term substance abuse facilities. It also purchases services on behalf of the mentally ill and addicts from hundreds of providers.
I see the enactment of the Affordable Care Act and its mandates as a historic opportunity for the state of North Carolina to disengage itself from providing services it appears to be singularly unable to deliver in an effective way for the patients and in a cost effective way for the taxpayer.
I am not advocating that the state immediately put up “For Sale” signs at all of its mental health facilities or cease providing services to the patients currently under its care. However, society’s views of mental illness and addiction treatment are evolving, and the law is evolving as well. North Carolina should catch up so that, over a period of a few years, the distinctions between physical and mental illness disappear in fact and practice as they have in law.
Those who speak for the mentally ill and those addicted to drugs or alcohol are quick to say that those are diseases, just like cancer or diabetes. I agree.
To those who would argue that there is something unique and peculiar about the mentally ill and addicts and their treatment, I would reply that Washington has addressed the question and has decided otherwise.
November 27, 2013 at 9:32 am
Lee Brett says:
There is so much wrong with this that I don't know where to start.
Mr. Landry draws a comparison between physical illnesses like heart disease and diabetes, and mental illness. Surely, he says, we should not treat mental illness any different than physical illness.
Landry argues that the Affordable Care Act, which now provides coverage to all people, has removed the need for state mental health services. His reasoning is that mentally ill people now have insurance -- problem solved!
Anyone who knows anything about severe mental illness knows that the insurance aspect is only one part of a much, much more complicated issue. Many people with severe mental illness are already covered under Medicare. The issue is not coverage, the issue is treatment. Many people with severe mental illnesses do not voluntarily seek or comply with treatment, because their conditions cause them to believe that they are not sick. Our closure of state mental hospitals was supposed to usher in a new era of outpatient-based, patient-driven services in the model Mr. Landry apparently re-envisions here. Guess what happened? People with severe mental illnesses ended up on the street. They ended up in prison. They ended up back in the hospital for short crisis-oriented stints, and then right back to square one.
I am sure Mr. Landry's intentions are good, but I fear that the damaging effect of this article may be felt for the mentally ill. People with little knowledge of mental illness or our mental health system may -- like Mr. Landry -- conclude that mental health services are just another burdensome, expensive, and useless government program. I would encourage Mr. Landry to learn more about this subject before he makes so radical a proposal.
November 27, 2013 at 12:53 pm
Thayer Jordan says:
Mental illness is not just drug addicts, or those who have mental problems, but they are people who are depressed, or have some other mental problem. My wife and I, both have Epilepsy, which some consider a mental disease, but it isn't, it's a nurological disorder. We have a program that pays for most of our rent, Cardinal Innovations Healthcare, which covers the whole state. For those who are fortunate to be on it, it's a blessing. While I agree that mental illness is a problem, what would happen if N.C. did close the ramaining mental hospitals? Where would those people who have severe mental illness problems go? Would our state be like another Coneticut, where a mentally Ill person goes out and shoots innocent children? How about all those other crazy people out there, who kill their own mother, or father? N.C. Has a big problem with Mentally Ill people, but we should not cut out the hospitals if it's helping these people who have mental illness to get better treatment, what the state should cut, is high tax's on the poor, or stop taxing gas, food, etc., like Tennesee does.
