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Tuesday, August 4. 2015
Mental health care and treatment in America is a hodge-podge of state, federal, charitable, and private programs. That is not a bad thing that there is no "system," because caring can not be a "system" and because there are no cures for the most severe ailments like autism, schizophrenia, dementia, and so forth. That's why mental health care is not a problem in America any more than it is everywhere on the planet.
There is no better place on earth for those with manageable problems under the mental health umbrella than in the US. Perfection is unobtainable, because it can not be defined, and some people will always be beyond effective help if only because they refuse it.
Because so many problems lack cures, and so many patients resist possibly positive amelioration, what people lobby for are governmental and private "services," not utopian fixes. As always with medical issues, lobbyists lobby for their fad interests and fad approaches.
There is no "mental health industry." I do not necessarily agree with the premises of the article, but I do agree with this: "Congress needs to understand that throwing money at mental health is not the same as delivering effective treatment to the seriously ill." Caring, like education, is not intrinsically expensive.
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Looks good to me. My #1 overwhelming headache day and day out with the SMI is homelessness, the second is medication nonadherence.
New Hampshire is one of the very few states that has a robust version of the mandatory treatment program. We can set conditions of discharge for individuals displaying dangerousness for up to five years. The conditions are usually take meds, keep appts, don't abuse substances. We have to meet a high legal standard to enact this. It helps some, it's not magic.
Be forewarned: Disability Rights and ACLU tend to hate these programs. They know that with budget constraints, patients who won't take meds can wait us out until we have to discharge them, and conditional discharge gives us more leverage.
BTW "early intervention" and other such crap wastes money twice, because staff actually working with patients have to keep going to listen to them at required trainings.
I have a small business in high priced CT. We've had most of the mandated features of Obamacare for years so far as our small group insurance went. But still our rates skyrocketed and I was trying to figure out why. We pay our employees out of pocket 100% so I have a clear picture of where money goes. My conclusion was the mandated coverage of drug and alchohol in-patient rehab drove our costs. When we think about mental health coverage/costs most patients do not get near the expenditure of the addicts. YOu could cover months of psychiatric/therapist meetings for the cost of one rehab stint. I don't know how it got that way, but maybe Betty Ford was the instigator!
It is a bottomless pit and what some want is for the government to pour money into it in a vain attempt to fill it. You can "fix" a broken arm, strep throat, pregnancy, etc. But you can't "fix" bi-polar. What they are after is an endless stream of money to pay for psychiatric visits, medication, disability pay, etc. but the problem will never be "fixed".
I am sure some would argue that mental health care should be paid for just as medical health care is. I don't think the government (at least the federal government) has the constitutional right to take money from tax payers and give it (or give taxpayer paid insurance) to people who for whatever reason need it and don't have it. It may be the "Christian" thing to do. My response is then let churches do it. It may be the kind and caring thing to do. My response is then to make the funding voluntary. It may be a case of if the government doesn't do it then no one will. Fine. End welfare, Obamacare and all forms of redistribution of wealth.
Mental health parity laws are founded on the idea that there is no clear demarcation between physical and psychiatric illness. The latter are also physical/medical. If your position is that they all should be paid for privately, you should be trying to sell the idea entirely on that basis, that we shouldn't pay for cardiac care, prenatal care or anything else. That would be logically consistent, but you won't convince many people of it.
Yet right after saying that, you move to claiming that mental health care is somewhow different, and less worthy of our attention.
As for not fixing things, that is true of many other things people take medication for: diabetes, hypertension, pain and inflammation, skin conditions, blood conditions, many, many others. There is no logical basis for setting psychiatric illnesses in some separate category. The difference is that it is very expensive and that's why people don't want to pay for it. Overnight stays ramp up costs very quickly. But that's the real objection, and diverting to other reasons seems a mere excuse.
At root, people still don't think of psychiatric illnesses as quite real. Because they know folks who manipulate around diagnoses, they tell themselves that a whole lot of illness could be eliminated by just setting limits and making people straighten up and fly right. Again, if it were the manipulation that bothers people, then they would be equally upset by back pain, a notorious category for malingering and disability.
@Dirtyjobsguy. Don't get me started on substance rehabs. They don't do much for the patient. What they provide is comfort to others that they have "done something." Having an uncle who will bring you to AA for 3 months has a better track record.
Yes, "mental health care is somehow different, and less worthy of our attention". Yes it is a bottomless pit and rarely ever successful. Yes, I am opposed to tax payer funded mental health treatment.
As you noticed I am also opposed to federal funded public health care. I believe it is contrary to the constitution and worse it destroys the best health care system in the world.
As I said I am not opposed to helping those in need. I am opposed to forcefully taking peoples money to help those in need. If mental health care is so necessary and so successful then let the mental health community provide it for free OR let charities fund it. Do not get caught in the tax and spend trap of mental health care.
You are defining successful as whether it is something that can be cured. Most communities define successful as "he's not threatening my customers anymore" or "she can go back to work now," or "she's not jumping off a bridge," or "he can shop and cook for himself again so that someone doesn't have to come in an do it," or "he's not a fire hazard with his cigarettes now."
That's what treatment does. It's not like the community isn't getting anything back for the money. I notice you haven't objected to the government taking your money for jails, even though they don't have a great "cure" rate either. Or county nursing homes - you could object to those too, I suppose, because it's the government taking your money and no one gets cured. If you don't pay for mental health care, you're going to pay elsewhere. TANSTAAFL.
"If you don't pay for mental health care, you're going to pay elsewhere."
Is that it? If that arguement fits the problem some activist wants to throw money at then I must be taxed and pay for it? I disagree. First many mentally ill people "can" become self sufficient and they don't need to have a $150 and hour mental health worker to make it happen. Most people who are "dependent" on government assistance were created by the very programs intended to help them. If someone is so mentally challenged that they cannot function in society and put others at harm then they should go to jail or mental facilities. The belief that you can spend trillions in a vain attempt to "help" millions who somehow cannot help themselves is bankrupt. Let them fail and then let them pay the price of failure. "Millions for jails not one cent for welfare/disability".
To be clear there are two issues here:
1. We are not helping people by doing for them that which they should be doing for themselves. IMHO it was NEVER about helping them it was always about rewarding a constituency. Let people alone, stop helping them, if they screw up let them suffer the consequences.
2. I believe it is unconstitutional for the federal government to tax,borrow and oppress the productive to provide health care, food, housing, cigarettes & booze, etc. We never should have allowed it and it was snuck by us with the same glib arguement that you are making. Since the war on poverty began in the mid 60's the nubers of our poor have more than doubled and most of them live high on benefits that exceed what an average worker can earn. We were all snookered into this and now the elite in power want to take more to buy more voters. Our country is on the verge of bankruptcy because of this unconstitutional redistribution of wealth and we will all probably be forced to endure a great depression worse then anything in our history because of it.
Let people take care of themselves or fail. stop trying to fix everything with other people's money.