Win some, lose some

Mental health has been very much in the news for the past month or so. Some of the news has been encouraging, some has been distressing, and some has been chewy food for thought. Here are some of the highlights:

We win one. Finally.
In Washington, DC, this month, the economic bailout plan got a lot of attention. There was a provision attached to the bill that got far less attention, yet helped to bolster the chances for passage of the controversial legislation. The Mental Health Parity Law had been lingering, if not languishing, on Capitol Hill for 12 years. It was the personal crusade of the late Senator Paul Wellstone and Senator Pete Domenici. After Wellstone's death in 2002, Domenici continued to keep the bill in play with lobbying support from advocacy groups such as NAMI.

The health insurance industry fought this legislation tooth and nail. Ultimately, though, the tragedy that is the US economy presented exactly the right circumstance that made the law a reality.

Under the Mental Health Parity Law, insurance companies and employers will no longer be allowed to make a benefits distinction based on a patient's type of illness. Until now, insurers have been allowed to provide fewer benefits for mental illness, or, to charge more money for treating these illnesses than, say, epilepsy or asthma. Whereas hospitalization for a chronic heart condition might be covered for 60 days of inpatient care, a mental illness--with preapproval only--would max out at 25 days per year.

By making mental health care parity law, the government has also paved the way for lessening stigma through legitimization. It won't be quite as easy for insurers to make arbitrary decisions when doling out benefits to consumers of psychiatric and addiction recovery services.

And you lose some.
While listening to NPR the same week that the mental health parity legislation was in play, a story blipped by on the news so quickly, I had to Google it later to make sure I had absorbed the irony. I am sure this story made the news only because of and as a counterpoint to the mental health parity story.

Keeping in mind that health care in this country has little to do with compassion or patient wellness and everything to do with profit, this news gem sparkled like CZ under the bright lights of the Home Shopping Network.

Out west in Denver, the University of Colorado Hospital announced that it will no longer maintain inpatient psychiatric services. The 18-bed inpatient psych services ward sees approximately 750 patient admissions each year; by eliminating this department, hospital administrators say they can accommodate an additional 300 admissions annually. Hospital spokespersons stated that this is in no way a financial decision, it's just that other patients need the beds more than the psych patients do. Could that be the patients whose illnesses are more lucrative for that hospital?

Dr. Greg Stiegmann, vice president of clinical affairs at UCH, said that since the new facility opened roughly 15 months ago, the hospital has been at 100 percent capacity and finding spaces for patients has become increasingly difficult. Upon further reading, I was surprised to learn that University Hospital is a brand-new, billion-dollar facility. I cannot comprehend how, with a decade of planning, ongoing needs assessment, and years of construction, the people in charge of this hospital grossly underestimated how many patient beds the hospital would need at opening and going forward, allowing for population growth in the area.

So, what did the administrators do? They looked at the patients to determine which ones would be the easiest to jettison while allowing the greatest financial gain. The NPR story (which I cannot find!) included a blurb of an administrator stating that it is the hospital's hope that the affected patients will find care within their communities. Errrr....Would that be on the benches in the city's parks?

This story is happening all across the United States. According to hospitalconnect.com, government figures show that, nationwide, psychiatric facilities have decreased by more than 14% in the last decade. The number is expected to keep climbing.

Sometimes we shrug
From CNN: http://www.cnn.com/2008/HEALTH/10/21/Healthmag.suicide.increase/index.html
After a decade-long decrease, U.S. suicide rates have started to rise, largely because of an increase in suicides among middle-aged white men and women.

Overall, the suicide rate rose in the early 1980s, then dropped each year from 1986 to 1999. From 1999 to 2005, however, the rates have increased 0.7 percent annually.

In all, 32,637 people killed themselves in the United States in 2005, a rate of 11 per 100,000 people.

Too bad the newly-in-crisis won't be able to get help at the hospital.