The California Primary and The Mental Healthcare Crisis

(This is a political article I wrote days before the CA primary. There was so much I could get into just about CA government and society. I focused on some laws/policies that had national relevance, though.)

The presidential primaries have put a spotlight on healthcare, mass incarceration and increasing poverty in the U.S. A related issue isn’t receiving adequate attention, however. That being insufficient access to mental healthcare treatment for people who have a serious mental illness (SMI).

According to NAMI, 1 in 4 adults– approximately, 58 million Americans– lives with a mental health disorder in any given year. 1 in 17 lives with a SMI such as schizophrenia or bipolar disorder I. If not treated effectively, SMI is oftentimes severely debilitating. It can lead to joblessness, homelessness, poverty, incarceration and even the premature loss of life.

This reality has been exacerbated the last few decades as state hospitals and treatment centers have closed and healthcare costs have skyrocketed. For example, in 1955, there was 1 psychiatric bed for every 300 Americans. In 2010, there was 1 psychiatric bed for every 7,100 Americas.  According to a recent report released by the Treatment Advocacy Center (TAC), only 3.5% of the state hospital beds that existed in 1955 were still in operation by the first quarter of 2016.

In California, the situation is particularly stark. According to a 2012 TAC report, the state eliminated 16 percent of its beds between 2005 and 2010, leaving just 14.2 public psychiatric beds per 100,000 people – far below the 50-bed standard considered necessary to provide minimally adequate mental health treatment. In 25 counties in the state, there were no psychiatric beds at all.

For too many people with SMI, jails and prisons become their homes and treatment centers. In 2007, 19 percent of CA state prisoners were mentally ill. By 2012, 25 percent were. Given that people with SMI often suffer from severe delusions and hallucinations, conditions in jails and prisons, which can include periods of solitary confinement and/or abuse from guards, can end up making an inmate’s psychosis worse, thus reducing the chance for successful recovery.

This abysmal situation in CA persists, despite increased national attention on people with SMI. With presidential campaigning in CA underway, it’s worth looking at what, if anything, the candidates propose to do for SMI treatment and care.

Like healthcare in general, for people with SMI, access to mental healthcare largely depends on coverage, funding and parity laws that prevent discrimination. On these issues, it’s pretty clear that both Democratic candidates, Bernie Sanders and Hillary Clinton, take better positions than the Republican frontrunner, Donald Trump.

Both Clinton and Sanders want to expand healthcare coverage to more Americans. This would undoubtedly benefit people with SMI, since many are poor and unemployed and suffer from concurrent medical/physical ailments that require attention, treatment and monitoring. Both also have expressed support for helping people with substance abuse problems when talking about people with mental illness.

In comparison, Trump is vague when speaking about his healthcare policies, but his website lists ideas that are consistent with economic conservatism. Trump wants to eliminate Obamacare and incentivize competition between insurance and pharmaceutical companies. On mental health specifically, his website just states the need for eliminating privacy laws that prevent family members from receiving information about their sick loved one’s condition and care. While a worthwhile idea, overall, his views, if implemented, would leave too many people with SMI remaining uninsured and vulnerable to the ongoing predations of profit driven corporations.

Regarding parity laws, both Sanders and Clinton support President Obama’s landmark law banning discrimination in treatment against people with mental illness. Seven years after the law was passed, however, recent research shows that insurance companies are still finding ways to deny or stall treatment. Lax enforcement of the law is partly to blame and both candidates, presumably, would support increased and robust enforcement. They have failed, however, to emphasize this or call on President Obama to do so. If prodded, Sanders would probably point to this behavior by insurance companies as more reason to institute single-payer healthcare, as part of his call for a “revolution in mental health.”

Most relevant of all to the gross shortage of psychiatric hospitals and treatment centers is the Institutes for Mental Disease (IMD) exclusion. Instituted in 1965, the IMD places severe limits on Medicaid expenditures that would go towards psychiatric facilities and substance abuse centers. Consequently, this has contributed to facility closures and increased the incentive for states to send psychotic patients and/or patients with addiction problems to regular hospitals, in order to be at least partially reimbursed by Medicaid. This does little to nothing to address one’s psychiatric illness and leaves patients at the mercy of an already under-resourced hospital and overworked hospital staff.

Repealing the IMD would definitely be welcomed by many states and family members of people with SMI. In the least, presidential candidates who claim to have the best interest of the mentally ill and disadvantaged in mind should be mentioning the nature and extent of the problem. After all, to do nothing or continue to do too little has proven to be economically wasteful, politically wrongheaded and societally inhumane. Who will be the first candidate to take up the call?