The free market and mental healthcare

[Deleted]

Can anyone make the case that they are compatible?

I'm dealing with some heavy family stuff right now involving a relative's struggle with mental illness. Unfortunately, the mental illness has played a part in this person's inability to obtain employment that provides health insurance. Private health insurance isn't accessible right now, both due to pre-existing conditions and financial constraints. And that makes it hard for the person to get treatment. It's a terribly vicious cycle.

Because I see a lot of things through a political lens, I keep coming back to this. I feel very frustrated and defeated with our healthcare system in this country, particularly as it relates to mental health.

I don't even kid myself into thinking the ACA is actually a comprehensive solution to this problem. But knowing that all too often, those who need the care the most have the least amount of access to it just makes me feel ill.

Sorry. This post is mostly rambling. I just need to vent a little.

[pugz]

((hugs)) it is so frustrating.

there are resources out there, though not as available in rural areas. In cities you can look for a community mental health clinic, they often have free or sliding scale services.

for those with severe and persistent mental illness programs like SSD and medicaid are an option and a gateway for services, although applying (and qualifying!) are easier said than done.

even though we are supposed to have mental health parity under the law passed in 2008 many people even with insurance slip through the cracks because the programs and psych beds just aren't available with so much demand.

[pescalita]

I'm sorry bridey.

I don't think mental healthcare exists in anything like a free market before or after ACA if that's what you're asking.

I do wonder if it would work at all in theory. Small providers like therapists, lawyers, tax planners - they have to charge a lot to keep afloat and that's not something that's affordable by most. Maybe those services would be provided in a larger commercial manner, like a therapist booth at the Walmart?

[chichimi]

I think a major problem lies with how mental illness is viewed in this country-that is, many people dont even believe it is a real thing. Reactions to depression or anxiety are met with 'cheer up' or 'just relax'. There is such a bootstraps mentality to pull yourself out of your funk and get on with your life. I think there is very little compassion for those battling a mental illness and that leads to apathy in lack of care.

[Deleted]

Aug 13, 2012 9:42:18 GMT -5 pescalita said:

I'm sorry bridey.

I don't think mental healthcare exists in anything like a free market before or after ACA if that's what you're asking.

I do wonder if it would work at all in theory. Small providers like therapists, lawyers, tax planners - they have to charge a lot to keep afloat and that's not something that's affordable by most. Maybe those services would be provided in a larger commercial manner, like a therapist booth at the Walmart?

No, my issue is that for all the talk about healthcare and free markets, I just really, really don't see how it works for mental health. I have problems with it when it comes to physical health as well, but how is someone who can't keep a job because he has untreated bipolar disorder or major depressive disorder supposed to be able to afford mental healthcare?

My relative is applying for an assistance program, but getting someone with severe depression to even apply for a program is a battle.

Being able to just walk into a clinic and get treated without all the hoops would be so much better for us as a society, IMO.

[teflep]

Aug 13, 2012 9:43:40 GMT -5 @chichimi said:

I think a major problem lies with how mental illness is viewed in this country-that is, many people dont even believe it is a real thing. Reactions to depression or anxiety are met with 'cheer up' or 'just relax'. There is such a bootstraps mentality to pull yourself out of your funk and get on with your life. I think there is very little compassion for those battling a mental illness and that leads to apathy in lack of care.

I agree with this assessment. I think it was just a year ago, or so, that Mike Wallace and others did commercials about depression and that was, what 2010-11?? If it is taking us so long with one illness, what about others? People don't know what the resources are, where to go, etc and I think that is a huge issue.

[teflep]

And I am so sorry your family is having this...prayers and good thoughts to you all.

[chichimi]

Sorry didnt really finish my thought here. How it relates to the free market...
As long as healthcare is being negotiated in a free market, people are going to want to pick and choose coverages based on what they want. Many people tout an emergency only type plan and then basic care would be paid OOP. Because mental health care is not valued, I think people will negotiate out coverage to get costs lower. I think this will mean that because there are less in the insured pool, costs will raise for those who do need the services. One might hold out hope that eventually the mental health providers would transition to a model that makes care affordable OOP but that is a long shot. They have the same grad school loans and practice costs so there is a limit to what they can cut in cost.

[sandipluschris]

Behavioral Health care will never be accessible (to the degree it is beneficial) in the free market. There is so much stigma attached to mental health and those that suffer from mental health issues. Most people can’t see the value in adding that coverage to a plan and a carve out plan will be costly. The bigger problem is that mental health issues left untreated lead to such serious physical health issues that it drives up the cost of health care in general. It’s a vicious cycle that most people don’t want to spend any time thinking about.

[Deleted]

Aug 13, 2012 9:58:33 GMT -5 sandipluschris said:

Most people can’t see the value in adding that coverage to a plan and a carve out plan will be costly.

Plus, I don't see how insurance is the answer if your mental illness makes it such that maintaining gainful employment is difficult.

I'm just so frustrated and feel so helpless.

And any time I hear someone talking about the free market being the solution to healthcare, I just get angry. From where I sit, all that means is that my relative can't get the help he needs because he's poor.

[Deleted]

Bridey-

If the person can't work because of mental illness I would look to get them on SSDI (it is hard but possible) then they will qualify for medicare.

Sorry you are dealing with this

[atouchofklasse]

I agree with you that health care can't be solved by the "free market" for a number of reasons. Employer-based insurance comes with its own set of challenges.

I'm sorry your family is having these challenges.

[casmgn]

Definitely look into Social Security Disability and SSI. In my state at least, SSD qualifies you for Medicare (although there may be a long wait) and SSI qualifies your for Medicaid.

Also, check to see if there are any federally qualified health centers and/or community mental health areas in your relative's area. These provide care on a sliding scale according to the patient's ability to pay.

I know that it is very tough, hang in there.

[Deleted]

Thanks, cas. Sadly, I'm too far away to be helpful. Other family members are involved in trying to get him enrolled in assistance programs.

[casmgn]

Aug 13, 2012 10:43:03 GMT -5 @angryharpy said:

Thanks, cas. Sadly, I'm too far away to be helpful. Other family members are involved in trying to get him enrolled in assistance programs.

No problem. I would suggest the federally qualified health centers and community mental health centers to them just in case they aren't aware of those options. I wasn't until I had a similar issue with a family member.

[casmgn]

Also, they should look into their local NAMI or MHA chapter for support and guidance.

www.nami.org
www.nmha.org

ETA: I also recently learned that the Easter Seals also provides assistance to people with mental illness, so your family should check out their local Easter Seals chapter as well.

Catholic Charities also is very heavily involved in this space.

[ringstrue]

I'm sorry they are going through all this.

I'm fine with free market for certain things but I agree that it's place is not in the healthcare world.

[casmgn]

One last thought - it is crucial that your family reach out to others for help and support. Dealing with someone with severe mental illness is exhausting and debilitating. NAMI and MHA also offer support groups for family members, as may other organizations in their area.

[Deleted]

Aug 13, 2012 12:01:47 GMT -5 casmgn said:

One last thought - it is crucial that your family reach out to others for help and support. Dealing with someone with severe mental illness is exhausting and debilitating. NAMI and MHA also offer support groups for family members, as may other organizations in their area.

Thanks. My mom does go to one support group, and I went to my first last night. I have also let a few close friends know what is going on, and they have been very supportive.

[casmgn]

Aug 13, 2012 12:41:13 GMT -5 @angryharpy said:

Aug 13, 2012 12:01:47 GMT -5 casmgn said:

One last thought - it is crucial that your family reach out to others for help and support. Dealing with someone with severe mental illness is exhausting and debilitating. NAMI and MHA also offer support groups for family members, as may other organizations in their area.

Thanks. My mom does go to one support group, and I went to my first last night. I have also let a few close friends know what is going on, and they have been very supportive.

I'm glad to hear that. You'll get so beaten down if you try to deal with it all yourself. It's important to be able to talk to others to maintain your own mental well-being.

Speaking of your own mental well-being - make sure you stay aware of how you are feeling as well. It's easy to get swallowed up in all this, and you won't do anyone a favor if you don't stay healthy yourself.

[Deleted]

Thanks, cas. I really do appreciate the concern.

I am actually seeing both a psychologist and a psychiatrist for the extreme anxiety that has resulted from my shitty shitty job, so I have a chance to talk about this there, too.

[casmgn]

The episode I dealt with last year with my family member prompted me to see a psychiatrist and a counselor as well - I always knew that depression was kind of lurking back there (especially after the death of my mom), but I didn't realize that I also suffered from anxiety until the situation just brought it out full force. The combination of getting on meds and therapy made a world of difference, and made me able to deal with everything in a much better way than I did at the beginning.

Hang in there!

Also, I'm sure you already know this, but you can't be afraid of your family member getting mad at you (any of you) if it gets to a point where (s)he is really a danger to herself and you need to force them into care. Getting to that point with my family member (despite empty threats of them never talking to me again) was one of the major turning points.

[soontobeka]

I agree with chichimi about the "bootstraps" mentality towards mental health in this country. I am sorry that you are dealing with all of this.
As for help with your family member, I am not sure what part of the country they are in but I often who have my clients work with MHMR in Texas. I always had pretty good experience with them.

[Deleted]

soontobe, I'm going to PM you. Check in just a minute please!