The Affordable Care Act and a prior 2008 federal law require that health insurance, including Medicaid, pay for mental and substance abuse treatment at parity with medical and surgical coverage, thus extending mental health and substance abuse coverage to an additional 62 million Americans.
Although it has taken many years, society has finally acknowledged that mental illness has a physical connection, often in both cause and effect. Unfortunately, two of the most common types of mental illness are cloaked in problematic names, which has further crippled recognition and enhanced the barriers to treatment of these diseases.
Anxiety in daily usage is a synonym for stress, worry, pressure, strain and tension. It is, however, ill-fated that we use this same word to describe what can be a difficult and debilitating disorder. Millions live in the constant turmoil of generalized anxiety disorder or in the prison of social anxiety locked away in their homes, unable to deal with everyday mundane activities like grocery shopping or calling the doctor’s office. Obsessive compulsive disorder consigns its victims to endless repetition of meaningless routines. PTSD revisits its sufferers with fresh horror of some past event. These conditions are grouped under the designation of the rather banal name of anxiety.
In common parlance, being depressed usually means being sad, unhappy, blue, low or downhearted. But clinical depression is vastly different from the temporary sadness over losing a boyfriend. Depressive disorders are among the worst human afflictions; sufferers wish they could disappear and their pain be blotted out. When intense, their suffering can overwhelm all other feelings and obscure hope and happiness. Abraham Lincoln was afflicted with melancholia, which was surely serious depressive disorder. He eloquently describes his intense misery in the most provoking terms.
The numbers are stunning: Anxiety disorders affect 40 million American adults every year, about 18 percent of all adults. In the U.S., depressive disorders afflict nearly 10 million adults (over 4 percent) and almost 3 million adolescents.
Anxiety and depression rob people of stability, positive relationships, happiness and even basic well-being. They cause marital discord and take heavy tolls on families. They dampen employee productivity and drive costly absenteeism in the workplace. Depression precedes and causes many suicides.
Diseases like schizophrenia and bipolar disorder are serious and heartbreaking conditions that when untreated can cast otherwise intelligent and competent people into unemployment, loss of family ties, insanity, homelessness, suicide and a host of other troubling consequences.
The fortunate who have health insurance can usually get significant relief through medical and psychological treatment. But those without insurance or other coverage, especially the indigent, have far less access to treatment. Rural and many urban hospitals alike estimate that about half of emergency department visits relate to mental health or substance abuse issues.
For many thousands of indigent Utahns, treatment is hard to find. Even if a mental health agency, clinic or hospital diagnoses mental illness and prescribes medication or therapy, the poor usually can’t afford that medication and therapy.
Utah’s counties are charged with providing mental health services to the public. Utah has over 60,000 people in the poverty gap who don’t qualify for Medicaid. Thus, the demand for services by people without Medicaid far outstrips what counties and charity care by hospitals and doctors can provide. County mental health agencies stretch dollars to the utmost, but there aren’t sufficient funds to meet the demand for in-patient evaluation and care, outpatient treatment and community-based care to keep patrons on their meds and out of the hospital. County commissioners find it beyond difficult to raise taxes to fund additional mental health services. There is essentially no constituency for such tax increases.
We all suffer the massive costs of broken families, unproductive lives, addiction that grows out of self-medication, and emergency room visits for mental health problems that cannot be addressed there. Irrespective of traditional funding channels, our community must pull together to meet this scourge that afflicts hundreds of thousands of Utahns and develop funding sources to finance treatment of the poor and those of modest means for mental illness. Our elected officials must lead out on this. Each of us must demand of them that we address this problem. How can we stand by and let so many of our brothers and sisters and their families suffer as they do?
Greg Bell is the current president and CEO of the Utah Hospital Association. He is the former Republican lieutenant governor of Utah.