Monday, February 24, 2014

Affordable Care Act/ACA Fails Seriously Mentally Ill

Many 'mental health' advocates claim that the Affordable Care Act (ACA, a/k/a "Obamacare") combined with "mental health parity" will ensure people with mental health issues get care. The ability to keep a child on your insurance until age 26 will likely help many, since serious mental illness affects people in their late teens, early twenties. Maybe other provisions will help the higher functioning. But as the analysis below shows, overall, it makes things worse for the most seriously ill: those who need long term hospitalization.  Unfortunately, the impact of ACA on the most seriously mentally ill has been largely ignored by 'mental health' advocates.

Sunday, February 23, 2014

What is serious mental illness in adults and what is not?

Serious mental illnesses are a small subset of the 300 mental illnesses that are in DSM. While it is fair to debate where the line between serious mental illness (SMI) and poor mental health is, the extremities are clear. The Center for Mental Health Services defined SMI as

mental illnesses listed in DSM that “resulted in functional impairment which substantially interferes with or limits one or more major life activities.” (CMHS 1999)

 By all accounts, serious mental illnesses include “schizophrenia-spectrum disorders,” “severe bipolar disorder,” and “severe major depression” as specifically and narrowly defined in DSM. People with those disorders comprise the bulk of those with serious mental illness. However, when other mental illnesses cause significant functional impairment they also count as a serious mental illness.  

According to the National Institute of Mental Health, serious mental illness is relatively rare, affecting only 5% of the population over 18. Serious mental illness includes schizophrenia; the subset of major depression called “severe, major depression”; the subset of bipolar disorder classified as “severe” and a few other disorders.

Schizophrenia (NIMH defines all schizophrenia as “severe”):  1.1% of the population (FN 1)
The subset of bipolar disorder classified as “severe”:  2.2% of the population (FN 2)
The subset of major depression called “severe, major depression”:  2.0% of the population (FN 3)

Therefore total “severe” mental illness in adults by diagnosis: 5.3% of the population (FN 4)

US mental health spending and mental health non-profits focus almost exclusively on people who do not have serious mental illness, rather than those who do. This is the single major problem with the US mental health system. Money is not lacking. Prioritization is.

Friday, February 21, 2014

Please send letter in Support of Helping Families in Mental Health Crisis Act

If you are part of any organization (state or local NAMI, MHA, Prison Reform, Consumer Group, etc) that wants to help persons with serious mental illness, please send a letter on your letterhead, to Rep. Tim Murphy urging passage of Helping Families in Mental Health Crisis Act (HR 3717). They want as many letters of support from organizations as possible.

You can see the NAMI/NYS letter below and use it as a model. You can see other letters (ex. NAMI National, American Psychiatric Assoc., etc) at