Creating a new “whole person” healthcare system

“Between April 2010 and March 2011, about 200 people across the state who were so mentally ill they posed a threat of serious harm to themselves or others were turned out on the street because no private psychiatric facility was willing to admit them, according to a new report.”

What happens when the specialty mental health system begins to crumble? As seen in the excerpt above, those who need specialty mental health services the most are being left with fewer and fewer options.

We have come a long way from the days where individuals with a mental illness were simply put away forever in a hospital or even worse, killed or tortured.

Often someone will ask me how mental health parity impacts our systems difficulty in taking care of those with serious mental illness. As I have written about before, mental health parity was a nice step in the right direction, but insufficient. From my defunct typepad blog:

“…consider the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. Those familiar with the law will know that the entire of purpose is to offer equity between mental health and medical/surgical insurance coverage. The elimination of lifetime limits on how many services can be accessed on the mental health side is the most significant change found in the Bill. The Bill was an important step towards treating mental health and medical conditions with equity from an insurance perspective, but the Bill itself was a first order change and did nothing to change the healthcare system at large or the rules that govern that system, a second order change.”

As the report in Virginia points out:

“To deny individuals an opportunity to receive the services, at the level of care deemed clinically and legally necessary, places each person at risk not only at the time of the immediate crisis but may create avoidable risk for the person and the community later.”

And we know when there are not services in place to take care of individuals with more severe mental health needs, they are placed in assisted living facilities often experiencing abuse and neglect. Surely the “warehousing of people with mental illness” isn’t a good idea.

Make no mistake, there must be some form of a safety net for the most serious of mentally ill. While we have made substantial progress in how we treat mental health, the mental health system continues to struggle. No doubt there are several reasons for this struggle; however, one has to consider how this mental health conundrum would be different if we did not see mental health as such a separate construct from health. What happens if mental health is viewed similarly as any other medical condition? Surely this would help with decreasing mental health stigma, right?

But alas, we are back to my biggest point, and part of the reason this occupy healthcare movement is so critical- there exists a chasm between the system that we have, and the system that we want.

We must have a system that can treat all aspects of the whole person. When we do, hopefully stories like the ones above and below will no longer be told.

“Children who are hallucinating, feeling suicidal, or suffering other acute mental health problems are increasingly being turned away from some Massachusetts hospitals’ psychiatric wards, a problem the hospital industry acknowledges and blames on insufficient insurance payments to cover treatment of such sick children.”

When we think of what the occupy healthcare movement looks like, we must conceptualize anew the way that care is currently delivered, in silos, and think about what a truly comprehensive and integrated care system could be.

Dr. Miller has his doctorate in clinical psychology and is an Assistant Professor in the Department of Family Medicine at the University of Colorado Denver School of Medicine where he is the Director of the Office of Integrated Healthcare Research and Policy. His core task is to integrate mental health across all three of the department’s core mission areas: clinical, education, and research. Opinions expressed here are his own and not those of his employer.

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