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"Congressman Sullivan, Congressman Kennedy, Distinguished Guests, Friends: Mental health care at both the state and federal levels has been a passion of mine for over thirty-five years. I am honored to have this opportunity to present my views on the “Paul Wellstone Mental Health and Addiction Equity Act.” My primary purpose in being here this morning is three-fold: [1] to advocate on behalf of mental health parity [2]to emphasize the importance of inclusion of the diagnosis and treatment of alcohol and substance abuse disorders and[3] to underscore the relationship between mental illness and substance abuse. Thank you for including the treatment of drug and alcohol abuse in this bill. Substance abuse after mental illness is the most ignored and untreated disorder that impacts the lives and families of people worldwide. With the passage of this parity bill, insurers may no longer arbitrarily limit the number of hospital days or outpatient treatment sessions, or use higher co-payments or deductibles for people in need of mental health and substance abuse treatment. Passage of this legislation will also bring Americans to the level of health, mental health, and substance abuse treatment benefits - coverage that has been enjoyed by federal employees (including members of the US Congress and Senate!) for over six years. Parity in the Federal Employees Health Benefits Plan for both Mental Health and Substance Abuse Disorders began in 2001 for 8.5 million federal employees, retirees and dependents at a minimal cost –estimated at less than 1%. It's time to remedy that inequity for the American people. Oklahoma has been moving toward mental health parity and the Oklahoma Psychological Association is pleased to have the opportunity to work with our legislators to bring about needed changes. But we have miles to go. Our Oklahoma parity law passed in 1999 covers only "Severe Mental Illness” and requires parity only for the following mental disorders: schizophrenia, schizoaffective disorder, bipolar disorder, major depression, panic disorder, and obsessive-compulsive disorder. No provision is made for those suffering drug and alcohol addictions and abuse. This is an omission that must be addressed at both the federal and state level. The existing federal parity law was a good start. However, both the US House and Senate bills that propose to expand it, will provide covered services for far more Oklahomans. There is unquestionable research demonstrating a clear connection between mental health disorders and physical illness. When mentally ill folks also have a physical illness co-existing at the same time, we call that "co-morbidity". But the mentally ill also are at higher risk for experiencing drug and alcohol dependence, abuse, and addiction. Often this is an attempt by the mentally ill to "self-medicate" the overwhelming symptoms of their mental illness. This co-morbid condition is often overlooked or ignored by treating professionals even though studies have consistently shown that nearly half of those with one mental disorder meet criteria for two or more disorders including drug and alcohol abuse.
Data provided by the American Psychological Association's Practice Organization indicates that employers and the nation take a huge hit in the pocketbook because of behavioral health problems: Anxiety's total cost amounts to $42.3 billion annually. Eighty-eight per cent of the cost per worker suffering from anxiety is attributable to decreased
productivity. in direct medical costs, Seven per cent ($5.4 billion) in suicide related
mortality
costs, and sixty-two per cent ($51.5 billion) in workplace costs. billion for alcohol, and $98 billion for drugs. Lost productivity accounts for $162 billion [66%]of the total cost. The Surgeon General's office reports that in general, 19% of the adult population in the United States has a mental disorder at any given time. Six per cent have addictive disorders alone, and 3% have both mental illness and some form of addictive disorder. It is estimated that over a quarter of a million Americans are denied treatment of an addiction each year. Substance abuse is associated with a high risk for suicidal behaviors in both adolescents and adults. What is the death toll from the denial of treatment for addiction? Your esteemed colleague Congressman Jim Ramstad estimates the number at 150,000 persons. Various studies indicate that untreated addiction and mental illness costs the American economy $550 billion annually. No amount of money can compensate for the broken families, abandoned and neglected children, and destroyed lives caused by untreated addictions. These costs are avoidable and unnecessary. My psychology practice is made up primarily of adolescents and their families and of geriatric patients. These two populations consistently are noted in the research literature as high risk groups for both drug and alcohol problems as well as suicide. According to statistics provided by the Oklahoma Department of Mental Health and Substance Abuse Services, suicide is the second leading cause of death for Oklahoma’s youth ages 10-24. The vast majority of all those who die by suicide have a mental illness—often undiagnosed or untreated. About 50% of students age 14 and older and with a mental disorder drop out of high school before graduation. This is the highest dropout rate of any disability group. In addition, each year over 6,500 students in Oklahoma’s colleges and universities will drop out of school because of problems related to alcohol. This will cost these institutions over $11 million in tuition revenue. Hundreds of Oklahoma’s youth are placed each year in child welfare or in juvenile justice systems due to unmet intensive out-patient and in-patient mental health and substance abuse treatment needs. The Oklahoma Department of Human Services will expend almost $200 million (one dollar in seven) of the budget of Oklahoma’s largest state agency on mental illness and substance abuse. Congressman Jim Ramstad has again been quoted as saying in testimony just this past Tuesday (March 27, 2007) before the Subcommittee on Health of the House Committee on Ways and Means "I am absolutely alarmed by the dwindling access to treatment for chemically dependent people. Over half of the treatment beds that were available 10 years ago are gone. Even more alarming, 60% of the adolescent treatment beds are gone. We must reverse this trend." I couldn't agree more! On a personal note, I would like to tell you of an experience I had a few years ago. I was the admitting psychologist of a 15 year old male at Mercy Health Center in Oklahoma City where I was on emergency room call. He presented with a history of depression, low self-esteem, and suicidal thoughts. His concerned parents brought him to the Emergency Room around eleven o’clock at night because he had been severely withdrawn, morose, and tearful all day. Checking on him after he had gone to bed for the night, his mother found the young man semi-conscious and delirious in his street clothes in bed surround by several empty prescription drug containers that had contained sedatives, pain killers, and sleep aids. Once he was medically stabilized, I admitted him to the psychiatric unit of the hospital for evaluation and treatment. I saw him at 8:00 AM the next morning. He acknowledged his intent to kill himself and described his descent into depression and suicidal thought over the past few weeks. I met with the treatment team on the unit and a treatment plan was developed. A few minutes later, I was told by a hospital employee that while my patient had excellent health insurance coverage with mental health benefits, he had only been pre-certified through the insurance carrier for three days of in-patient treatment. The first difficulty was that the patient was admitted late Thursday night. The second difficulty was that insurance coverage started the moment he walked through the emergency room doors and the insurance carrier considered Thursday as Day 1 of his three day treatment. The next difficulty I faced in treating this young man was that I had to have him ready for discharge by noon on Sunday. Do you begin to see the problem? The hospital employee suggested I call the insurance carrier directly and describe what I just told you and ask for an extension of his in-patient hospital stay. That's when things really got difficult. Calling the number I was given to contact the insurance carrier, I was connected with a "case manager" - a person I suspect who had no psychological training and even less empathy for me. She was firm. My patient's mental health coverage was limited to a lifetime 30 days in-patient treatment-no matter what the circumstances. Depression in adolescents, according to her guidelines called for a maximum three day in-patient stay. Exasperated at her unwillingness to negotiate with me, I said something to the effect of "So you are telling me that if -according to my professional judgment- my patient on Sunday is not ready for discharge, I have to discharge him anyway with the distinct possibility that he may make another suicide attempt, and this time likely be successful?" I will never forget her reply. "No, doctor. I'm not telling you to discharge him. I'm just telling you we won't pay for his stay beyond noon Sunday." Mercy Health Center kept its adult and adolescent in-patient treatment in place as long as they could, but eventually closed the unit and replaced it with a skilled nursing facility with beds that pay for themselves. That's tragic. But that's what hundreds of adolescent in-patient treatment facilities do across the country each year. If my patient experienced diabetes or kidney failure instead of depression, I believe there would be no arbitrary number of days in his lifetime he could be admitted and treated for the disorder, nor would it be difficult to extend his hospital stay if his condition was not stabilized in three days. When I have suicidal adolescents in my practice today, I struggle to find adequate placement in an inpatient facility for them. Beds for adolescents with emotional, behavioral, and/or substance abuse problems are rare in this state. My other concern regards my geriatric patients - probably because I am rapidly approaching that age category! Senior citizens have the highest suicide rate of any age group according to the American Psychological Association. These suicides account for twenty per cent of all suicide deaths! According to the U.S. Surgeon General, thirty-seven per cent of senior citizens in primary care settings experience depression in one form or another. Addiction or substance use disorders-particularly alcohol or prescription drug abuse-affect seventeen per cent of the US citizens over the age of sixty-five. We know that the need for mental health services for the nation's elderly will significantly increase as the baby boom generation "matures." Many will face stresses due to physical health problems and their subsequent limitations. Loneliness is a significant cause of depression and elderly people turn to alcohol and prescription drugs to ameliorate their symptoms or resort to the ultimate destructive act: suicide. In substance abuse as in other areas of health care, individual disorders are always the simplest to study and treat. But co-morbidity is reality for many individuals. We must address the existence of alcohol and drug abuse co-existing with mental illness. The Paul Wellstone Mental Health and Addiction Equity Act does that.
In the brief time I have been
allotted today, it has only been possible to explore the tip of the iceberg.
Mental health parity must address the inclusion of coverage for substance
abuse disorders and co-morbidity. Your sustained and unwavering support for
America’s mentally ill does not go unappreciated in the Heartland of
America. Thank you for being here and thank you for listening to our
concerns."
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