by Cindy Sanders

Ralph J. Ibson

Last month, Ralph J. Ibson, vice president for government affairs for the National Mental Health Association (NMHA), listened as Dr. Larke Huang, PhD, outlined key issues and findings on the state of mental health in America during a Congressional Briefing (see sidebar on page 18).

Huang, who had served as one of the commissioners appointed by President George W. Bush to the New Freedom Commission on Mental Health, rolled out disturbing statistic after disturbing statistic on the number of Americans who suffer from a mental or emotional disorder and the nation's response to these individuals.

"I was struck by an observation," said Ibson. "The data she was citing made it very clear we have a crisis in mental health among juveniles in America. For any other disease, it would warrant a national campaign ... sadly that's not the case for mental disorders."

Ibson said Dr. Huang noted there are 30,000 suicides each year in the United States, but he added that number occurs against a backdrop of 650,000 attempted suicides serious enough to warrant an emergency room visit.

Factoring in the fiscal, physical and emotional toll of mental illness, Ibson said, "Our failure to make mental health a priority is in itself a national tragedy."

Despite a better understanding of causes and treatment protocols, Ibson said the stigma attached to mental illness remains pervasive and is something he battles regularly in his work on Capitol Hill.

One clear illustration can be found in the disparity that exists within healthcare insurance. Ibson said many people with private health insurance still have different access to care for mental health problems as opposed to other health concerns.

Citing an example of Parkinson's Disease versus depression, two illnesses that affect the brain and impact the body, he said it was a reasonably safe bet that those with health insurance would have pretty good access to care to treat their Parkinson's. However, he added, he would venture to guess that those suffering from depression would face a limit on outpatient and inpatient care and would probably find those services available only at a higher co-pay rate.

"Both illnesses, if left untreated, could lead to a decline in your health, and both could be life threatening," he pointed out. "The question is why should they be treated differently? Why is this tolerated?"

Legislation to combat mental and physical health insurance disparities was enacted in 1996. However, the NMHA contends that although the law established an important principle, its limited scope has kept it from producing any real, fundamental change. The law, which is slated to sunset on December 31, 2005, banned annual or lifetime dollar limits on mental health coverage stricter than those imposed on surgical or other medical care. The open loophole is that it didn't ban restrictions on the number of covered outpatient or inpatient treatment days or on assessing higher co-pays for mental health services.

To try to overcome these limitations, the Senator Paul Wellstone Mental Health Equitable Treatment Act, more commonly referred to as Mental Health Parity Legislation, seeks to truly equalize access to care for mental and physical health diagnoses.

Although named for the late Democratic senator, the legislation has enjoyed broad bipartisan support in both the 107th and 108th Congress. However, despite having a majority of the members of the House of Representatives in favor of the legislation and two-thirds of the Senate in support, the legislation has never been allowed to come up for a full vote in either house.

"For any other illness, it wouldn't take the four years or longer we've been working on this ... it would take four months," Ibson said, adding, "It is very much about the stigma (of mental illness)."

He marveled, "Even with a super majority in one body and a majority in the other, it didn't pass ... to me it's a metaphor to the larger problem."

Although the legislation hasn't yet been reintroduced, Ibson said the sponsors are very committed.

"Sound legislative ideas don't go away, and people will continue to push this because it's such a powerful issue and symbolizes so many of the problems facing people with mental illness," he noted.

Another key piece of legislation on which Ibson is working is the Mentally Ill Offender Treatment Act. In looking at the nation's mental health crisis, Ibson said one manifestation is the number of suicides ... another, the number of mentally ill filling America's jails and juvenile justice centers.

Citing a 1999 Department of Justice report, Ibson noted the vast majority of mentally ill inmates in the nation's prisons and jails were convicted of non-violent offenses. He also noted the alarming statistic brought out in the President's New Freedom Commission on Mental Health that cited 80 percent of the children entering the juvenile justice system have some form of mental disorder.

Ibson added that jails and justice centers are not equipped to be treatment facilities and that the "dearth of treatment capacity in communities" has had a direct impact the numbers of mentally ill who are incarcerated.

The Mentally Ill Offender Treatment Act, which has passed both bodies of Congress but has never been funded, was designed to combat this problem.

"The law envisions there would be grant money made available to allow communities to coordinate efforts," Ibson said. "We're urging Congress to provide money as authorized by the law that would enable communities to fund needed alternatives to incarcerating people."

He added money would be doled out in a two-phase approach with modest funds being made available to communities to create a strategy to combat the problem with more significant funding available to implement viable plans.

The programs, which would be open only to non-violent offenders, would seek to train police officers and other stakeholders in identifying offenders that could be diverted from the criminal track to a treatment track at a savings to the community considering the expense involved in housing inmates.

"It's kind of like preventative medicine," Ibson pointed out. "Deal with this in the earliest stages, and you necessarily reduce your cost."

The law authorizes $50 million a year to communities for such programming. However, Ibson said his organization realizes full funding is an ambitious goal. While continuing to push for the total package, he said the law could still make an impact even at a lower funding level.

"Any community that received some grant funding would be an important step forward," he stated.

Another area of legislative emphasis for Ibson is to restore Medicaid funding. Despite bipartisan efforts to fully fund the healthcare program, the final budget that passed both the Senate and House included a $10 billion reduction in Medicaid spending over the next five years.

"I think the notion that $10 billion in 'savings' should be ripped out of the Medicaid program is a very alarming one and fails to take account of the fact that Medicaid supports approximately 50 percent of state and local mental health funding," he said.

While recognizing the need for budget cuts, Ibson stressed, "I think it's important that in the months ahead that legislators revisit the assumptions that cuts of that magnitude can and should be made to a program so vital to the most vulnerable Americans."

Like many others involved in the healthcare arena, Ibson noted such cuts ultimately wind up as false savings by failing to account for the fiscal impact of patients flooding emergency rooms and seeking help much later in the progress of a disease when it is more difficult and more costly to treat.

"It's just not good public policy," he said of mandated cuts. "It's not good medicine, and it's not warranted."

In the end, Ibson said all of these policy issues go back to setting priorities ... facing the country's mental health crisis must be a real priority before positive changes will be seen.