So, even if President Reagan was a great man, it was during his presidency that treatment for our nations most vulnerable went from bad to worse.  The following article is a reprint because I found it expresses my concerns adequately and one month after the horrible shootings in Tucson, people seem to be more receptive to learning about this issue.

Ronald Reagan, Mental Health, and Spin . . .

Man Behind the Myth

By Phyllis Vine

For the next twelve months, the Ronald Reagan image machine will be turning out countless vignettes of the nation’s 40th president, the man neighbors called “Dutch.” He will be described as no-nonsense yet kindly, remote but avuncular, a movies-star-turned-politician, and remembered as a local lifeguard rescuing people in troubled waters. With dashing good looks, a sonorous tone that became the voice of General Electric, and an affable smile, even those who disagreed with his policies will say he was genuinely kind-hearted.

So what did this mean practically for policies about mental health? Here we need to  ask how the image departs from the reality.

Contrary to the spin about trimming government, which he called “the problem,” we all know he oversaw increases in federal spending that exploded the national debt, and grew the size of the government he impugned. Another part of the reality, rarely the image, is how he attempted to savage the  entitlement system and roll back supports for people with a mental illness.

When Ronald Reagan arrived in Washington, he inherited the Mental Health Systems Act of 1980. One of the last achievements of Pres. Jimmy Carter, this was passed by the House 277 to 15, in the Senate, 93 to 3. With as many critics as there were special interests, it was far from perfect. Yet it expanded the federal government’s commitment to services, to research, to training professionals, and to patient rights. It identified stigma as an impediment to seeking and receiving services.  It established parity in Medicaid and Medicare. It recognized the link between physical health and mental health. And it dedicated $800 million over 4 years to redress the gross neglect of the commitment to mental health in earlier administrations.  In short, it moved an agenda that minimized homelessness, the reliance on expensive nursing homes, jails and prisons, and one that to more hopeful choices for those who needed help.

The Mental Health Systems Act was a milestone. It came on the heels of four years of hearings and a presidential task force benefiting from First Lady Rosalynn Carter’s active involvement.  Philosophically it affirmed Pres. John F. Kennedy’s Community Mental Health Centers, an attempt to thwart hospitalizations. It fit into the safety-net values championed by Pres. Lyndon B. Johnson with the passage of Medicaid and Medicare.

Still, by 1980 the nation needed more for those with a chronic illness. Many failures accompanied the attempts to close the miserable hospitals, often little more than warehouses, to help patients succeed in the community. The neglect of government support conspired to form a patchwork system with notable gaping holes. A 1977 GAO report said, “Government needs to do more.”  Congressional hearings in 1979 re-affirmed the need to strengthen impoverished services and the failed policies.

Although not perfect, the Mental Health Systems Act responded to these problems. For the first time since the National Institute of Mental Health became part of NIH in 1949, mental health was front and center in federal policy.

Then came Ronald Reagan. Within a month, the Office of Management Budget announced it would curtail the budget of the National Institute of Mental Health (NIMH), phase out training of clinicians, interrupt research, and eliminate services.  Cutbacks to staff followed; chaos ensued. Experienced people left, others remained in government service but were forced into menial jobs. Trained professionals were reassigned to labs to dissect dead rats; science writers were reassigned to typing pools. The Mental Health Systems Act would disappear. Instead, the Omnibus Budget Reconciliation Act (1982) would merge money for mental health programs into block grants, and with fewer dollars going to the states.  They had the discretion to use them however they saw fit, often to perpetuate programs already deemed problematic. The pretense for all this was the president’s concept of a “new federalism.”

“Many of our dreams were gone,” wrote Rosalynn Carter in Helping Someone with Mental Illness. “It was a bitter loss.”

This could have been enough, but it was not. Pres. Reagan attempted to restrict criteria for determining eligibility for SSI, thought to be a safety-net. Nearly 2.6 million people were receiving insurance because their disability prevented them from working. New evaluations for eligibility led to widespread terminations. Of those who were terminated, about half appealed, and in two-thirds of the cases, administrative law judges reversed the decision. The process took nearly a year, during which time they, and their families, were deprived of promised help.

About 340,000 people would lose their insurance before public outcry and courts halted the process. Sen. John Heinz, a liberal Republican from Pennsylvania, told the New York Times the policy was a “meat grinder.” Sen. Carl Levin, Michigan Democrat, said the reviews caused “unconscionable suffering.” In June 1983 HHS Secretary Margaret Heckler announced she would halt suspending about 135,000 people until the government could improve standards for “functional psychotic disorders.”

By then, however, the nation was doubting the president’s kindness. A1982 Louis Harris survey found nearly three-quarters of the respondents said the president was hard-hearted toward the poor.

These are the facts. And they add up to a roll-back of opportunities for people already struggling with a psychiatric illness.  Whatever spin accompanies the birthday celebrations for Ronald Reagan, we should not create yet another mythic figure, larger than life, more pure than Ivory soap, or with qualities he did not have.  He may have portrayed himself as everybody’s lifeguard, but he seemed willing to let people with a psychiatric illness sink.

Originally appeared in MIWatch.org

The law included a six month extension of higher Medicaid federal matching funds for states – a major contribution towards some of the drastic slashes in mental health coverage in Arizona.

Recent budget slashes (I prefer that term over cuts as I feel it’s much more descriptive) in the state’s healthcare system for the poor have forced many people to search for alternatives to afford their medications. Some are going to Canada, while some have been fortunate to be able to get discounts directly from the pharmaceutical companies. I applaud the efforts of some of the drug companies to help and I wish they would all step up.

While illegal immigration and calls to enforce the border by sending in troops occupies the headlines, our state’s most vulnerable citizens are doing the best they can just to survive.  In my world they take priority over someone who has illegally crossed our borders to look for a better way of life.  Helping disabled and seriously mentally ill people is not only money well spent, it’s the “right” thing to do!

How Did Your Member Vote?

View the House roll call vote on final passage of HR 1586

Both McCain and Kyle voted no when the bill went through the senate.

Read further details on the provisions in HR 1586 designed to support state Medicaid programs into 2011.

But, this catastrophic Gulf oil spill has gotten me down.  I can’t imagine what it must be like for people who live in the area affected. And that area is growing day by day.  If you listen to some doomsday “sayers” this is just the beginning of a global crisis that could change the world as we know it. One can’t help but get nostalgic thinking about the days most of us have spent frolicking on white sand and splashing in the ocean. Some of my favorite childhood memories are from family vacations spent on the beach.  Many times it was on a Gulf of Mexico beach.  Same is true for my daughter, except that it was usually the Sea of Cortez.

What I can say for a fact is that the Gulf of Mexico is experiencing the biggest threat to it’s environment in history and it makes me want to cry.  When I first heard of the oil spill, I had this sinking feeling in my stomach.  Some how I knew intuitively this wasn’t just another oil spill. Now, almost two months later most of the world knows it’s the worst environmental disaster in history.  Scary part is, we still don’t know how to stop it.

A few facts we do know:

• 11 people lost their lives in the initial explosion
• Efforts to cap it or plug it have been unsuccessful
• Relief well may or may not work
• Dispersant’s being used are toxic
• Skimming works in a very small area
• Small portion of the oil is being recaptured
• Thousands of people’s livelihoods have been disrupted

No one really knows how this will end. President Obama said in his speech on Tuesday that we should all pray.  Some made fun of that suggestion.  It reminded me of the bumper stickers that say “Visualize Peace,”  or the adage “the power of positive thinking.”  So,  I think we should all visualize a clean Gulf – it can’t hurt! Thinking about a clean beach and aqua blue seas can definitely lighten my mood!!

“Thinking outside the box” was a phrase heard repeatedly and for many attending that answer was not enough to calm their fears. For a population accustomed to difficulties  finding appropriate mental health care that particular phrase has become a mantra.

One question about how the non-title XIX residents will be covered if they are currently in the Arizona State Hospital was never answered.

Of major concern to me is the misguided thought by some in Phoenix that people that are currently taking some of the more expensive, newer anti-psychotics, mood stabilizers and anti-depressants  can now be administered some of the older, less expensive drugs to save money.  What he forgot to say when talking about the older, less expensive medications is that they don’t work for some people.  Hence the reason for being prescribed the newer, more effective medications. Plus, the newer medications don’t have some of the debilitating side effects  that the older medications cause.  (Although, I must admit all of these medications do have some sort of negative side effect)

Even when a certain medication is successfully treating some of the symptoms today,  next week, next month or next year it may loose it’s efficacy and a new medication will need to be introduced; most likely a newer drug.

The state’s crisis system which had up until recently seen some positive advances is now experiencing limited funding as well.   It was suggested at the meeting that family members “step up” to the plate and do what they can to cover the shortages like manning all night crisis phone lines, etc.  on a volunteer basis.  Hum…….I guess that might work if their loved one isn’t in a crisis because their newly prescribed medication is working!

I don’t consider myself a “tax and spend” liberal, but if I had to choose one side I would definitely fall on the side of being a liberal because I believe we need to take care of our most vulnerable.  In this case, those vulnerable 310,000 people that fall below the national poverty level, but aren’t destitute enough to qualify.

Talk about insanity……as I have said before, these people will be forced to go to emergency rooms when they need care, or in the case of a person with a serious mental illness that can’t pay for their treatment something even worse could happen. Also, according to the article, with proposed cuts the state could be loosing 42,000 jobs!

Most of us are struggling in today’s economy, that’s a fact, but we are all in this together.  At least, I thought we were.  Yesterday two out of three local school districts lost their appeal to voters to approve budget over-rides.  If voters won’t approve a a very slight increase in property tax ($50 – $100 per year) to keep their school district’s head above water I’m not optimistic that they’ll vote to increase a “sin” tax for people that can’t afford health care.  Now, that’s a sin.

Below is an excerpt from the most recent “E-News” from the National Alliance on Mental Illness.

For many group health plans, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act went into effect on January 1, 2010. The new law requires most group health plans to cover treatment for mental illness and substance use disorders on the same terms and conditions as medical conditions such as diabetes, heart disease, cancer and asthma. Specifically the new law bars health plans from imposing durational treatment limits (caps on inpatient days or outpatient visits) or financial limitations (higher cost sharing, deductibles or out of pocket limits) that do not also apply to medical-surgical coverage.

The effective date of the new law is actually the beginning of the first new plan year after October 3, 2009. The new law applies to all group health plans sponsored by employers with 50 or more workers.

• View NAMI’s factsheet on the new law
• View a Powerpoint presentation on the new law

Is Your Health Plan in Compliance With Parity?

NAMI is seeking information from individuals and families on how the new law is working. This information is critical to informing policymakers in the U.S. Congress and the Obama Administration on additional steps that may need to be taken to strengthen the law and ensure adequate enforcement. In addition, it is critical for NAMI to demonstrate to the larger public that parity is making a real difference in improving coverage of mental illness treatment and expanding access to critical medical services for children and adults living with mental illness.

Governor Brewer wants to repeal the measures passed in 2000 requiring that all those below the Federal Poverty level be covered by the Arizona Health Care Cost Containment System, the state’s Medicaid System. If this is repealed, estimates of up to two thirds of the state’s citizens diagnosed with a serious mental illness will loose their coverage.

It’s obvious where they will go, or in worst case scenarios where these most vulnerable residents will be sent. Our emergency rooms will continue to be inundated with people seeking treatment for mild to serious symptoms and our prison system, already stretched to the limit will continue the latest trend as the nation’s mental health hospitals. Even the few lucky people that are able to afford an occasional visit to a private psychiatrist will have a difficult time paying for their medications. Many will have to make the choice between medication and food. Our homeless population already underserved and in crisis, will continue to grow.

Effective community based treatment is proven to be a more cost effective way to treat people living with mental illness. Hospitalizations and incarcerations are the most expensive, yet that seems to be where we are headed, especially now that the City of Tucson is also stopping funding for the mental health courts (another questionable cost saver). 

It seems like the dream of health care reform is turning into a nightmare.

If you believe, as I do, that mental illnesses are illness just like any other, than why was this man, who supposedly treated other people with brain disorders, not receiving treatment himself?  Did  anyone not notice how he was struggling?  According to the “God Blogging” post on this site, NPR interviewed others at Walter Reed who said he was. 

Which brings us back to the same problem, the same issues that continue to plague people with mental illness and their families.  Because of the stigma, because of the inattention by our health care system that doesn’t think the mind is part of one’s physical health, because of an overburdened mental healthcare system, because people suffering from a mental illness can feel isoloated and abandoned by their support structure, people with diagnosable brain disorders are falling through the cracks.  One again, as President Obama called this tragedy, “a horrific” catastrophe has occured in this country.

Who knows what was going on in Hasan’s head……Certainly listening to war stories from our returning Veterans experiencing Post Traumatic Stress Disorder was not an easy thing to do, but why is it that no one saw the signs, especially when he was set to deploy at the end of the month? Maybe Major Hasan will be able to shed some light on our questions.

I’m talking about the Army’s plan to train 1.1 million of it’s soldiers in emotional resiliency and I think it’s a step in the right direction. Never tried before, the training is meant to improve performance in combat and (hopefully) deter mental health problems that affect at least 20% of returning troops from Iraq and Afghanistan.

Another pilot program currently planned for bases in Hawaii, Alaska and Washington removes a requirement that soldiers getting mental health treatment notify their commanders.  As discussed in previous posts, stigma surrounding mental illness is pervasive everywhere and the army is no different. 

Post Traumatic Stress Disorder resulting from combat has been linked to violent behavior including homicide and suicide. Naturally there is some resistance to this kind of therapy, but I think it’s a step in the right direction.

President Obama shared his vision for health care reform—and stressed his support of mental health parity—at a New Hampshire town hall meeting on Aug. 11.

Linda Becher, an audience member, specifically asked the president about access to mental health care and its impact on society. The president acknowledged the seriousness of mental illnesses and the reality that many existing insurance policies do not cover them on the same terms as physical illnesses. President Obama also expressed his desire to include mental health care as part of health care reform.

Watch President Obama speak about mental health care at 48:43 or read the transcript below.

QHello, Mr. President. My name is Linda Becher (ph). I’m from Portsmouth and I have proudly taught at this high school for 37 years…I’ve been lucky enough to have very good health care coverage and my concerns currently are for those who do not. And I guess my question is if every American who needed it has access to good mental health care, what do you think the impact would be on our society?

THE PRESIDENT: Well, you raise the — (applause) — you know, mental health has always been undervalued in the health insurance market. And what we now know is, is that somebody who has severe depression has a more debilitating and dangerous illness than somebody who’s got a broken leg. But a broken leg, nobody argues that’s covered. Severe depression, unfortunately, oftentimes isn’t even under existing insurance policies.

So I think — I’ve been a strong believer in mental health parity, recognizing that those are serious illnesses. (Applause.) And I would like to see a mental health component as part of a package that people are covered under, under our plan. Okay? (Applause.)

This all sounds good, but I don’t know if  we will see any kind of health care reform if some of the fear mongering doesn’t subside. Terms like “death panels” certainly don’t help to move the legislation, in any form, forward.  Personally, I like what I hear about Switzerland’s health care system…..A basic plan is provided and they have the option to “upgrade” at their own expense if they choose.  That’s all I want……basic coverage for everyone!

Here’s what healthcare reform will do:

* Health care reform will stop insurance company abuses like  refusing to pay a claim or give you coverage because of “pre-existing” conditions. (Been there)
– Your out-of-pocket expenses will be capped. (Methinks bankruptcies will decrease!)
– Insurance companies won’t be allowed to charge women higher rates than men (been there) or drop you if you get sick.
– Insurance companies will have to cover your children until age 26 instead of dumping them at 19. (been there – they should at least  be covered under family plans while they are in  college!)

* Health care reform will hold down rising costs. (been there – I now have less than adequate coverage because I can no longer afford my old plan)
– A public health insurance option will force private insurers to compete and will lower costs for everyone. (yeah!)
– By requiring companies to pay their fair share, we’ll stop them from dumping their health care costs on the rest of us. (when I owned a small business I offered health insurance to my employees……it helped keep my personal premium cost down!  Now I understand that’s not necessarily the case if there is one employee with expensive health issues – that’s wrong, too!)

* Health reform means affordable health care will be there for you, no matter what. If you lose your job, or your children lose their coverage. (  we have all heard stories about kids moving back in as adults!) 

- When you retire affordable health care will be there for you. (it’s called Medicare and it was vehemently debated and accused of being “socialism”  when passed)

THE REALITY:   health care costs are spiraling out of control, and we all deserve quality and affordable care. Health care reform simply can’t wait.