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'Good news from D.C., but not the State House'



Last modified: Sunday, May 02, 2010
When President Obama signed the health care bill into law, the legislation was rightly hailed in some parts of New Hampshire as a major step toward giving Americans and small businesses more control of their health care. The landmark legislation builds upon what works in our current health care system and lays a strong foundation for continued efforts to improve access and quality of care for all Americans, particularly for the thousands of people in New Hampshire currently without health insurance.

What may have been overshadowed in the hubbub around the bill's passage are some of the benefits that the legislation will have for people with mental health and substance use problems. The disorders themselves often get overlooked and go unnoticed, even though they are as common and as life threatening as many physical ailments. In fact, an estimated 26 percent of Americans ages 18 and older - about one in four adults - suffer from a diagnosable mental disorder in a given year. Major depressive disorder or depression is the leading cause of disability in the U.S. for ages 15-44.

The health care reform package, the most sweeping piece of health care legislation in more than 40 years, will go a long way toward expanding access to care for mental health and substance use problems. The new law includes parity for mental health and addiction services and helps protect patients with pre-existing conditions by banning discriminatory health insurance industry practices. The health care reform law will also establish a new requirement that coverage for dependent children must be available up to age 26 and will provide additional funding for school-based health clinics. Both provisions are critically important in light of the fact that mental health conditions often strike during the adolescent and young adult years but most will not receive treatment until many years later, if at all.

As of April 1, the law allows states to apply for federal funding to expand their Medicaid programs to cover low-income people earning up to 133 percent of the poverty level, or about $14,400 for an individual and about $29,300 for a family of four. This provision will greatly aid many people in New Hampshire who are unemployed or struggling financially.

With May being Mental Health Month, one would think that mental health organizations would be celebrating the bill's many positive provisions for people with mental health and substance use disorders. But while health coverage in the bill will not go into effect for several years, New Hampshire and other states across the country are enacting major budget cuts on mental health services that are taking a heavy toll on consumers, families and provider agencies.

Partly in response to difficult fiscal circumstances, states have been forced to cut mental health funding several times, while community mental health centers and other providers are simultaneously reporting a substantial increase in demand for mental health and addiction treatment services.

A recent survey by the National Association of State Mental Health Program Directors Research Institute clearly illustrates this crisis. For fiscal years 2009 through 2011, states cut funding for mental health care by a total of $1.6 billion. In many cases, the cuts represented more than a 20 percent across-the-board reduction in spending. At the same time, almost 60 percent of states reported a skyrocketing demand for community-based mental health care and crisis services.

The reality is that as New Hampshire significantly reduces community-based services for its citizens living with mental health and addiction disorders, the people and their illnesses do not go away.

Instead, these people wind up in more expensive treatment settings such as emergency rooms, psychiatric hospitals, nursing facilities and homeless shelters. Others end up in jail or elsewhere in the costly criminal justice system. In the end, their chances of recovery are much lower, while costs associated with their treatment are much higher.

The state's shortsightedness is particularly counterproductive given that we know that treatment works. In fact, more than two-thirds of people with addiction achieve recovery with proper treatment.

So while we wait for provisions in the federal health care law to go into effect, state legislators in New Hampshire need to step forward and lift up a growing number of people living on the economic brink while dealing with debilitating mental and physical illnesses. New Hampshire's budget cuts are rapidly cutting away our state's mental health safety net just when it is most needed.

(Louis Josephson is CEO of Riverbend Community Mental Health in Concord.)