A separate and unequal system




PEOPLE WITH MENTAL ILLNESS FACE LEGAL DISCRIMINATION




Chapter 1


Stigma against the mentally ill is so powerful that it's been codified for 50 years into federal law, and few outside the mental health system even realize it.
This systemic discrimination, embedded in Medicaid and Medicare laws, has accelerated the emptying of state psychiatric hospitals, leaving many of the sickest and most vulnerable patients with nowhere to turn.


Advocates and experts who spoke with USA TODAY describe a system in shambles, starved of funding while neglecting millions of people across the country each year.
The failure to provide treatment and supportive services to people with mental illness – both in the community and in hospitals – has overburdened emergency rooms, crowded state and local jails and left untreated patients to fend for themselves on city streets, says Patrick Kennedy, a former congressman from Rhode Island who has fought to provide better care for the mentally ill.
The USA routinely fails to provide the most basic services for people with mental illness -- something the country would never tolerate for patients with cancer or other physical disorders, Kennedy says.





Former congressman Patrick Kennedy: "We have a wasteland of people who have died and been disabled because of inadequate care."
(Photo: H. Darr Beiser, USA TODAY)
"Mental health is a separate but unequal system," Kennedy says. "We have a wasteland of people who have died and been disabled because of inadequate care."
Although most people with mental illness are not violent, the USA's dysfunctional, long-neglected mental health system is under a microscope because of mass shootings in which the perpetrators had serious psychiatric problems. In a series of stories in the coming months, USA TODAY will explore the human and financial costs that the country pays for not caring more about the nearly 10 million Americans with serious mental illness.
Stigma, a common thread in this series, forces many to live in shame rather than seek support, even as their lives unravel. Yet patients who want help often can't find it, says Kennedy, who has acknowledged his own struggles with bipolar disorder and drug addiction.


“'There is no other area of medicine where the government is the source of the stigma.' ”
REP. TIM MURPHY, R-PA.
Stigma even shaped the crafting of the Medicaid law a half-century ago, because Congress didn't want to "waste" federal money on mental illness, says Ron Manderscheid, executive director of the National Association of County Behavioral Health & Disability Development Directors. "People were operating under the belief that mental health was a black hole for money," Manderscheid says.
An obscure provision of the Medicaid law specifies that funds may be used for hospitals treating physical conditions but generally not for mental health, says Tim Murphy, R-Pa., a child psychologist who has introduced legislation to ease these restrictions.
The Medicare law discriminates against those with mental illness, as well, by limiting the number of days that patients can receive inpatient psychiatric care. Medicare imposes no such limits for physical health, says Mark Covall, president and CEO of the National Association of Psychiatric Health Systems.
By denying hospital care to the mentally ill, Murphy says Congress set two standards for health, effectively telling the country that the mentally ill are less deserving of a decent life than others. By forcing the mentally ill to live with sickness, confusion and disability, federal law reinforces the assumption that the mentally ill are incapable of leading functioning, safe, successful lives.
"The federal government has set so many barriers to getting care, which they have done with no other type of illness, and it is wrong," Murphy says. "There is no other area of medicine where the government is the source of the stigma."
Without federal support, states haven't been able to afford to keep their psychiatric hospitals open. States closed 10% of their hospital beds from 2009 to 2012, says Robert Glover, executive director of the National Association of State Mental Health Program Directors.
Private hospitals have reduced their psychiatric beds, as well, because Medicare and Medicaid typically pay less for inpatient mental healthcare than for medical care, says Ron Honberg, national director of policy and legal affairs at NAMI, the National Alliance on Mental Illness.
"It's just pure discrimination," Covall says. "It's penalizing the poor and disabled."
Mental health advocates have had more success reforming the private insurance system.
The Affordable Care Act, for example, requires that health exchanges provide equal mental and physical health coverage.
While in Congress, Kennedy led the fight to require private insurers to provide equal coverage for physical and mental health, resulting in a 2008 "parity" law that applies to policies issued after July 1. Kennedy has joined in lawsuits against insurance companies to force them to comply.


“'If I have diabetes, there is no stigma to that. But if my brain doesn't work, why am I supposed to be ashamed of that?'”
PASTOR RICK WARREN





Pastor Rick Warren, a best-selling author, couldn't get long-term care for his son, Matthew, who suffered from depression for many years.
(Photo: Robert Hanashiro, USA TODAY)
Although Medicare has corrected some of its unequal payments in recent years, it isn't affected by the parity law, Kennedy says.
The federal government hasn't yet issued rules governing how the parity law affects Medicaid, the largest provider of mental health services in the country.
Pastor Rick Warren, a best-selling author, struggled to find long-term care for his son, Matthew, who suffered from depression for many years. "At one point, we were counseled that Matthew needed extended, long-term help in a long-term care facility," Warren told USA TODAY. "When we began to look for one, we couldn't find one."
Warren, founder of Saddleback Community Church in Orange County, Calif., began speaking out about mental illness after Matthew killed himself last year, at age 27. Warren compares the stigma of mental illness to that of AIDS and HIV. In both cases, people are blamed for bringing suffering upon themselves, he says.


​
"If I have diabetes, there is no stigma to that," says Warren, who is making mental health one of his key ministries. "But if my brain doesn't work, why am I supposed to be ashamed of that? It's just another organ. People will readily admit to taking medicine for high blood pressure, but if I am taking medication for some kind of mental problem I'm having, I'm supposed to hide that."


Pasted from <http://www.usatoday.com/longform/news/nation/2014/06/25/stigma-of-mental-illness/9875351/>