First we need to change our viewpoint from punishment for mental illness to treatment for mental illness and addiction. Let's let all the people imprisoned for low level, non violent crimes (small amounts of drugs, petty larceny) out of prison and use that money to fund mental health treatment. Let's stop paying private prisons because the motivation is profit not rehabilitation. And let's ban assault rifles.

Thank you for highlighting a pervasive issue that faces families like mine who have struggled to find appropriate mental health care. I am not surprised by this woman's story. I have notebooks full of names, referrals, recommendations, and discussions regarding trying to get the proper care for my daughter. I am lucky. I have the resources to pay some out of pocket. But, it has cost tens of thousands of dollars and forced a lot of sacrifices. Blessedly, we did find a network of care and various treatment modualities that have been nothing short of miraculous. But, it was a long, hard road and should not have to be the norm. It is a national crisis.

Thank you. This sadly is so true. And I work for the Department of Mental Health (DMH).

Excellent synopsis of a story that could fill an entire encyclopedia, with that many sub-different topics.  The insurance industry, including medicare, has created a national mental health crisis by their policies and procedures.  The problems are so pervasive and deeply embedded that it is not at all clear how to extricate ourselves from the system.  The policies and procedures have become so extreme that they have a decided flavor of hostility towards both patients and providers of mental health care.  Those practices have left the field looking like a bombed-out battlefield.  Men have left the field in droves.  Some estimates are that women outnumber men by more than 15 - 1.  This particular problem is undoubtedly related to reimbursement rates, which are at least a quarter century out of date.  As noted in the article, the most experienced practitioners don't take most of the insurance.  And if a therapist is found who will take insurance, the insurance company expects reports which are too intrusive.  Under the guise of managing care, they have created narrow expectations of what treatment should be which simply do not fit the reality of how therapy works.  They look for information to identify loopholes which would justify discontinuing coverage.  Meanwhile, sensitive personal information is then in a computer file in an insurance office.  This problem is extremely important to our collective well-being.  Even for people who don't directly need mental health services, it is increasingly clear that those who do need treatment can harm those who don't need those services. This problem deserves to have a constant light on it until there has been a massive transformation.  

Even worse, when your child attains eighteen years of age you are even more powerless to help because if your child refuses treatment (and mental illness is cruel that way, in that when they are sickest they are often at their most resistent to intervention) for a psychotic illness you can do nothing about it. On top of that, the only way to get even minimal treatment is to refuse to take them home so that, when they are off meds and delusional enough that they attract the attention of bystanders, shop owners or law enforcement, the only place to take them is the hospital (although you do run the risk that a poorly trained cop or one who is lazy just takes them to the lockup). Even then, the attitude of the mental health hospitals is 'treat 'em and street 'em' as soon as they are functional enough to promise to take meds (note, I did not say comply, just promise).

Bravo, Kevin!

THis is true.

i can get an MRI or an orthopedic consult for a patient tomorrow, but I can't get a patient outpatient mental health services for months.

COMPLAINTS TO INSURANCE COMMISSION MAKE A BIG DIFFERENCE FOR MENTAL HEALTH ACCESS Mass law requires health plans to have reasonable access to ALL mental health provider types and ALL modes of MH treatment. Complaints to the Insurance Commissioners about not getting access for yourself or your child are taken very seriously and result in the health plan finding you care as well as pressure to maintain proper mental health networks. http://www.mass.gov/ocabr/docs/doi/consumer/css-complaint-form.pdf

Well written. This is something to consider during the next round of budget cuts. It seems that Dept. of Mental Health is always the first target for budget cuts. Why? Because people living with mental illness are an under-represented segment of our population. Also, it is easy to criticize mental health treatment in general, as the efficacy is harder to measure than that of treatment for physiological medical conditions. Keep in mind that one of the most important roles of the mental health professional is observation of patients and continual support to manage decompensation and avoid major crises like these shooting sprees. Insurance companies can ask for proof of improvement or limit the number of sessions allowed all they want, but they are not addressing the real problem. Money should not take precedence over health.

This enormous problem needs to be part of today's discussion around gun laws. Kevin speaks of the true issue here behind these mass shootings (oh, and a good bit of the homeless problem too)

This is so true, the stigma of emotional illnesses are treated like the Dark Ages. I remember having a

severe bout of depression and went to the outpatient facility in a hospital. They proceeded to put me

in a room in what seemed like a non-functioning part of the hospital and started tip-toeing around me.

I was left alone for quite some time, made me feel so different and weird, like this illness was not treatable

and I should be quarantined. I then met with some thirty something who was very ill equipped to even

speak to me. I sat there wishing I had a severe outbreak of a common disease, I so wanted to be part

of the treatable medical world, going home with a prescription in hand that the pharmacist would not whisper

about. It was through my own persistent efforts that I received good care over the years but there were

many false starts, uneducated doctors and a host of people who shunned me during my "episodes". Get real

if you think that this society handles mental illness like the real disease that it is.

Great column! Rarraport's right, there is a stigma attached to mental illness and addiction. We rightfully feel sorry for those afflicted with diseases of organs, other than the brain, but when it comes to people with diseases of the brain we just write them off as crazy.

It's a challenge to pay for current healthcare which is more focused on the care of those with health issues other than mental illness. It's hard to imagine how mental illness and addiction care would be paid for, in our current system, but there should be parity. 

Part of the reason there are so few people taking insurance is that providers have no recourse to the constant cuts in our reimbursements except to leave panels.  As professionals, we cannot work together to address the power the insurance company has to unilaterally cut our rates--and I mean regularly, and consistently, year after year--because we risk being sued by the companies for "antitrust" behavior.  If we don't like the new contracts, they tell us that our recourse is to leave the panel--there is nothing else we can do.  I am a psychologist who takes one kind of insurance, for which I lose $35 off my already reasonable fee in every session I do for that insurance. I hate that people pay so much for their insurance and then can't use it, but if I took any more kinds of insurance, I really would go out of business, because my expenses go up while my reimbursement from them goes down.  I am not making a lot of money in my profession; I am not greedy and I am not milking my clients--I move them on as quickly as we both think is appropriate, or when the insurance decides they're done, whichever comes first. 

Please complain to your HR departments if you don't like the access you get--they can get the message to the insurance companies that their constant cutting of rates and harrassment of clinicians who take insurance, with no recourse for clincians except to leave, means that you as a client cannot get the services you are paying them to offer.  It is the company that buys your benefits that is the real customer the insurance companies care about, and the companies paying the bills can demand better treatment of clinicians.  No one else in this system, particularly clinicians, can do that. 

Nice article.  Mental health issues and substance abuse problems account for the vast majority of the current "gun problem" then any other factor. 

Thank you for writing this critically important story.  Unfortunately, the problem may only get worse given recent changes by Medicare and insurance companies.  The reduction in the length of a psychotherapy sesion, with accompanying rate reductions, is likely to lead to even more difficulty with therapists being able to take insurance (or stay in the field at all).  Therefore, children and adults may find it even more challenging to find the treatment they need.  Since working with children tends to include more unpaid out of session time coordinating with teachers, parents, and other providers, the strain may be particulary great for child therapists and those who need them.  In the current climate of cutting health care costs, I hope those with power understand that mental health clinicans have seen their reimbursements cut for years and and continue to experience reductions almost annually.  I don't expect things to change out of concern for therapists (who chose their profession) but hope it will occur for the sake of those with psychiatric disorders and for society as a whole. 

Coming a bit late to this thread, but wanted to add another variable: our public school system's culpability in creating mental illness in children with disabilities. In a nutshell: Schoolchildren with special needs learn differently. The law provides for special education services so that these students can learn at a rate commensurate with their abilities. But special education laws have been ignored at the local, state, and federal levels for decades. These children are routinely denied the services they need in order to learn. Result: failure, frustration, anger, alienation...and often development of SECONDARY psychiatric diagnoses. I am a special education advocate, and at least half of my cases right now involve children who have developed secondary psychiatric diagnoses as a result of repeated school failure that has gone unaddressed for many years. If our schools complied with our special education laws, the number of children and young adults with mental illness would be substantially reduced. Ellen M. Chambers, MBA Disability Advocate Pepperell, MA emchambers@ charter.net

I believe that JL Erwin3 is incorrect with regard to the Dept of Insurance Complaints by consumers who cant get access to behavioral health service. I believe they track the number of complaints and how long it takes to resolve them. Likewise, they contact the health plans quickly when a complaint comes in. I have found that health plans take those calls seriously and will work hard to get those complaints formally resolved quickly by finding care, often if it means going out of the network. The complaints that I was referring to for consumers who cant get timely access to behavioral health services are with the Department of Insurance http://www.mass.gov/ocabr/docs/doi/consumer/css-complaint-form.pdf

Likewise, I agree with TIMc that one can ALSO take an Unfair and Deceptive Business act approach to health plans. However, the DOI complaints for lack of access are taken seriously and responded to. As I said early, they are obligated to track and publish the number of complaints per health plan. Health plans dont want that data published. WHen Magellan had the contract for behavioral health for BCBSMA there were a high number of complaints and I believe that made a big difference for individual cases and on a larger scale. It is very easy to file these complaints. Try it out. The complaints that I was referring to for consumers who cant get timely access to behavioral health services are with the Department of Insurance http://www.mass.gov/ocabr/docs/doi/consumer/css-complaint-form.pdf