Friday, January 16, 2009

From the Weekly Dig: HEAD CASE: The dilemma of affordable mental health care

Interesting article on the coming Mental Health workforce crisis.  Comments to follow.
I haven't had time to post much this week, and was feeling a bit guilty about it, hence the quick post earlier in the day.  I found the article just before I went into a strategic planning session, thought it was interesting, and realized that I hadn't said much about workforce development lately.  Hence the link above.    The article, I thought, was a reasonably good attempt to get at the problem that neither legislation or a lawsuit will solve:  we can find lots of kids who would benefit from services, but we have an awfully hard time getting them to the services, even when the insurance is paying for it.  The heart of the article to me is quoted below:
But “coverage” does not necessarily mean “care,” according to Ann Stillman of M-Power, a mental health advocacy group based in Roxbury. None of the plans permit us the outpatient support that we need," she says. "The outpatient counseling visits are too limited, often hospital inpatient times are too limited. They aren’t the support system on an outpatient basis that we need to stay well." Toby Fisher, policy director for National Alliance on Mental Illness, agrees. "What we have found with folks with a mental illness is that often they have to wait long periods of time to get an appointment," he says. "Particularly with child psychiatrists, there seems to be a shortage of qualified psychiatrists willing to take that insurance."

When the Dig called 100 psychiatric treatment providers in Greater Boston who take MassHealth, posing as a patient with MassHealth insurance, we asked each office if they were accepting new patients. Of 100 providers, 51 were not accepting new patients and 26 required the patient to have a primary care physician at a specific hospital. Nine of the providers listed had disconnected numbers, doctors who had stopped practicing or had failed to supply the office’s new number. Six offices failed to return calls. Eight offices were accepting new patients.

Jennifer Kritz, spokeswoman for the Executive Office of Health and Human Services, says MassHealth has not received any complaints. "MassHealth sets access and availability standards for managed care plans, which do day to day operations for member claims, including behavioral health visits," she says. "By our regulations, those managed care plans are required to tell us if they aren't meeting our standards."

What is more interesting to me, though, are the comments that this article provoked.  One, on the Digg website, really show have much fear people have of the recognition and treatment of mental illness.  The authors rightly point out that Massachusetts has more mental health workers than does many other states, but then suggests that this leads to overmedication.  The point of increasing the social worker and psychologists is avoid over medication.  But, for some, that is just not the perception.
The other is from my friend Robbin, who is really mad and really thinks that most of the problems in the mental health system are the consequence of parental indecision.  Her tone is sharper than usual, and than I like to hear.  I hope that she is able to work out her issues with MassHealth.  We certainly need the folks to who to refer.

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