Treatment worth time, money and action

By Dr. Steven Ronik
Posted on the South Florida Sun-Sentinel, May 21 2007

America is still reeling from the tragedy at Virginia Tech. As we move forward, the natural reaction has been to find fault. We search for the "answer" -- the evidence of what went wrong. While there are undoubtedly many factors that might have changed the outcome of April 16, there is an underlying issue that can't be ignored. While we know that people with mental illnesses are no more violent than the general population, some stark realities are before us to consider.

Mental illness affects almost 60 million Americans. That's an estimated one in every four adults and one in five children. Mental illness is more common than cancer, diabetes or heart disease, making it the leading cause of disability in the United States.

As Americans, we have become so frightened by mental illness, or the stigma associated with it, that we do a fairly good job at ignoring it. Unfortunately, so has our government.

Despite advances in medicine and therapy that make it possible to treat and prevent lifelong disability from mental illness with increasingly greater success, the health systems that do so are dramatically underfunded at all levels. Even Medicare discriminates against mental health treatment, as do private health insurance companies. Almost 90 percent of private health plans place limits on mental health care that they don't place on medical/surgical care.

In Florida, unfortunately, the problem of underfunding is exponentially worse. We rank 48 out of 50 states in per capita public mental health funding -- and whether you are rich or poor, serious mental illness can strike, and comprehensive services are only offered through the publicly-funded system.

To add fuel to the fire, Broward has been chosen as one of two counties to participate in Medicaid reform, which for all intents and purposes is simply a shift to Medicaid managed care. It means that, overwhelmingly, care is authorized by for-profit HMOs.

In fact, in this recent legislative session, the one protection consumers had in this area (which provided that HMOs spend at least 80 percent of their capitation rate on direct service) has been removed. Medicaid reform is intended to be "revenue neutral" but it would be wise to "follow the money."

Clearly less money is going to providers of service, meaning less service is available to our citizens in an already dramatically underfunded county and state.

The cost of all of this is horrific. Senseless tragedies. Wasted lives. Broken families. Increased crime. Lost productivity. Not to mention, losing our most basic and fundamental obligation -- to help those most vulnerable.

Mental illness didn't "cause" the tragedy in Blacksburg. But, it is an example of how our nation's funding priorities did not allow for a comprehensive system of early intervention, assessment, monitoring, and treatment. Many states, and especially Florida, have become a "fail first" system.

In other words, due to incredibly minimal resources, funding priorities are directed to those who have been most impaired and disabled -- creating a system that is too focused on inpatient care and emergencies.

There are solutions. Treatment works. There's no mystery anymore in helping people recover from even the most severe mental illnesses. Early intervention goes a long way in preventing further complications from what can be easily treated more minor mental illnesses. But the problem is of such magnitude that it will take a dramatic shift in our thinking and government action, recognizing the prevalence of mental illness and recognizing that treatment is indeed worth our time -- and our money

The author is chief executive officer at Henderson Mental Health Center.



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