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Financial Barriers Hinder Integrated Healthcare for Mentally Ill

Jul 8, 2008
As of late in the medical field, there has been evidence showing the growing importance of integrating physical and mental healthcare. Currently, these two fields are separated with little connection between the physical and mental health of each individual patient. However, there is a need for a connection between these two fields as it has been shown many mental health problems lead to physical health issues as well. This leaves one to question why mental and physical healthcare are not integrated.

One of the most prominent reasons for the lack of physical and mental health integration is the lack of financial support for those with mental illnesses to gain adequate physical healthcare. There are many complexities leading to this problem. One of the factors related to the issue is whether or not behavior health problems can be treated as mental illnesses. Some states address behavior health issues as mental health issues, leading to a reduction in spending on behavioral health services. However, this is only one of many barriers put in front of those with mental health problems seeking integrated physical and mental healthcare.

Another factor affecting those with mental health problems is a lack of insurance. Many with mental health problems are uninsured, putting them at a dramatic disadvantage for receiving integrated healthcare. Community Mental Health Centers (CMHCs) are not nationally required to serve those without insurance, putting the uninsured at a great disadvantage when looking for mental healthcare. However, a mandate is being considered to require CMHCs to treat those who are uninsured. Since this mandate is a matter of state policy it varies between states. Even though many states have already implemented this mandate, there has still been a decrease in non-Medicaid funding to CMHCs at the state level. This has led to more patients choosing Community Health Centers (CHCs), thus giving them a lower quality of mental healthcare.

Medicare coverage also leads to many financial problems for those with mental illnesses. Medicare at first led the way to supporting integrated healthcare with some successes in granting payment for behavioral health services provided they were not under psychiatric diagnosis. However, there still remains the problem of those diagnosed by a psychiatrist. Also, Medicare has a large gap between mental health and physical healthcare coverage. Much larger co-pays are required for mental health visits than physical health visits. Such differences force many to either pay high prices for mental healthcare or settle for mental health diagnosis through physical health providers.

Medicaid also produces problems when providing mental health coverage. The Medicaid situation is one of the most complex when dealing with the integration of mental and physical health. There is a need for policy to be developed in each state between the state and CMHCs as well as CHCs. These policies would be made with the State Medicaid Agencies (SMAs) along with the State Mental Health Authorities (SMHAs). The number of conversations required alone allows for a long process preceding gaining adequate mental and physical health coverage through Medicaid. One of the most needed policies are ones addressing behavioral health coverage through Medicaid. The issues addressed within Medicaid compensation include the cost of physician, physician assistant, nurse practitioner, clinical psychologist as well as clinical social worker. There is questioning as to what of these multiple expenses Medicaid should cover, if any at all.

These financial barriers cause a gap between the physical and mental healthcare of those with mental illnesses. It is important to close this gap as there is a need for beyond basic physical healthcare for those with mental illness. Such barriers should be assessed by the state as well as mental and physical health institutions in order to find the best solutions allowing for care of the whole person.
About the Author
The author is the Director of Marketing and Communications at The National Council. The National Council for Community Behavioral Healthcare is a not-for-profit 501(c)(3) association. For more information, visit http://www.thenationalcouncil.org.
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