Obamacare and Mental Health

A version of this article appeared in National Journal Daily on Wednesday, October 15, 2013.

In the last year, the shootings at Aurora, Newtown, and the Navy Yard have fueled a conversation about what the country should do to keep people who suffer from mental illnesses from becoming a danger to society.

But when unarmed Miriam Carey was killed after leading police on a car chase to the U.S. Capitol—which ended with officers firing multiple shots at her vehicle—it highlighted the fact that people battling mental illness are more than just the perpetrators of tragic shootings.

Two U.S. Capitol police officers were put on modified duty following the death of Miriam Carey. Carey -- who struggled with depression -- was shot in her vehicle after leading police on a chase to the Capitol complex.
Two U.S. Capitol police officers were put on modified duty following the death of Miriam Carey. Carey — who struggled with depression — was shot in her vehicle after leading police on a chase to the Capitol complex.

A discussion about limiting access to guns for people with mental illnesses wouldn’t have changed Carey’s fate. But policy action to improve patients’ access to insurance and reduce the cost of treatment options could have filled a void for Carey and the other Americans whose inner struggles ended in moments of national pain.

To be sure, not all mentally ill patients are violent. Dr. Eliot Sorel, a clinical professor of psychiatry and behavioral sciences at the George Washington School of Medicine and Health Sciences, said that while the news stories illustrate a problem in health care, they also create a stigma around mental illness. He said that not all people who commit violent acts are mentally ill, and those of them who are are typically not seeking medical help.

“The severely mentally ill who are not in treatment are the ones who are potentially violent, and we need to attend to this,” Sorel said.

Increased access to mental health services is one component of the Affordable Care Act, and insurance coverage in the health law’s exchanges begins Jan. 1 for those who sign up by Dec. 15. The full implementation of the ACA, according to a February 2013 Health and Human Services report, will provide first-time access to mental health services for 32.1 million Americans.

The new health law requires all insurance plans in the exchange and in the individual and small group markets to treat mental health services equally with other forms of care in terms of copays and deductibles. Traditionally, insurance companies did not cover—or required higher out-of-pocket costs for—mental health services. Sen. Debbie Stabenow, D-Mich., proposed the parity requirement as an amendment, which was passed and added to the ACA, reflecting the existing requirement for mental health care parity in large employer-sponsored plans.

“After each one of these tragedies, everyone talks about improving mental health services in America,” said Stabenow, who is working now on legislation to heighten the quality of care for uninsured patients seeking mental health treatment in community centers. “It’s time to finally take action to do that.”

Lack of insurance and high costs of care are the biggest reasons mental health patients don’t seek treatment, according to a study released in this month’s Health Affairs, a top health policy journal.

“People with mental illnesses are more likely to have lower incomes,” said Kathleen Rowan, a doctoral student at the University of Minnesota and the primary author of the study. “That’s because mental illness might be limiting in terms of the work they are able to do or the hours they are able to work. And so many people face cost barriers in terms of access to care.”

The law will open the doors to affordable care for many of these individuals, Rowan said, through the subsidies on the exchange and the expansion of Medicaid.

Stabenow’s communications director, Cullen Schwarz, said that had the Navy Yard shooter had access to treatment, there could have been a different outcome. People who go without treatment after experiencing their first psychotic episode are 15 times more likely to commit acts of violence than those who do receive treatment, he said, citing a study in Schizophrenia Bulletin, a psychiatric journal.

“It’s not that we’ll always stop these tragedies from happening,” Schwarz said, “but we can certainly strengthen mental health services and reduce the number.”

The next obstacle, Rowan said, will be whether the scope of services and the number of doctors are able to meet the increased demand for mental health care.

For lawmakers, one solution might be adding incentives for physicians, nurses, psychiatrists, and other health care providers to adopt an integrated, team-based approach. Sorel said collaborative care restructures the system in a way that meets the total needs of mental health patients and creates communication between providers who could potentially stop the patients from taking violent action.

“You know what our biggest provider of mental health services is?” Sorel said. “U.S. jails and prisons. That’s the result of us not attending to this need.”

#Inauguration2013

  1. Rule No. 1: I will not use more than one tweet from each handle. This is mostly to limit me copying my feed into Storify and then hitting “publish.”
    Addendum to Rule No. 1: For every tweet included, many more were left out. Show some #FF to the gurus who kept the microblogosphere in business!
  2. Not going to lie, I’m secretly delighted that I couldn’t pick up @clararitger‘s Inaug credentials bc it means she’s coming sooner/sleepover.
  3. Friday, Jan. 18: In a last minute turn of events, I wound up arriving 24 hours earlier than scheduled so that I could pick up the #NotreDame student media credentials. NDtv pals @alliepriede and @NarratorVoice would land Saturday evening.
  4. What to do with an extra 24 hours? Eat delicious food, of course.
  5. Washington D.C. is home to some of the best food in the nation. Brenna – a NBC News Desk Assistant and 2012 grad – took me to Surfside in Glover Park, where I quite possibly dined on the best Mexican food in the northeast U.S.
  6. Saturday, Jan. 19: I met up with other Notre Dame alums – including Washington Editor for the National Review Robert Costa (@robertcostaNRO) – to see comedian (and fellow Irishman) Joe Kwaczala perform. He was hilarious, also, we were in a mall.
  7. Monday, Jan. 21: Malls are the hip and happening places in D.C., as you will witness below.
  8. An estimated one million people were standing in that crowd, and yes, I was one of them. If you want to find me, here’s a perspective shot taken by yours truly.
  9. An anti-abortion protestor somehow managed to get through security with a sign and wiggle his way up a tree. Capitol Police told me one reason the crowds were so bad was because they had to blockade the area around the tree in case he fell down. A ladder would not extend all the way up.
  10. Full audio of President Obama’s inaugural address now on @SoundCloud: at.wh.gov/h07E2 #inaug2013 Share favorite quotes w #InaugQuote
  11. I was very thankful for this audio, as the man in the tree was quite loud. Even louder were the chants from the crowd to “Shake the Tree!” to get him down. Walking up to strangers to ask them what they thought of the speech was fun because half of them either a) said they couldn’t hear it or b) said they didn’t know why I was media and standing among them. Frankly, I did not know either.
  12. #NotreDame student media taking over NBC News cc @NarratorVoice @alliepriede http://pic.twitter.com/74nIAB25
  13. That’s as legit as we get.
  14. Analysis: In second inaugural, Obama appeals to his progressive base nbcnews.to/SrYlSk #NBCPolitics
  15. Young people in attendance told me they were pleasantly surprised that Obama talked about climate change and LGBT rights. He got a favorable rating (expected) from those in the crowd who heard what he had to say.
  16. why was the president being inaugurated at a Beyonce concert?
  17. If only she hadn’t lip-synched, maybe she’d be more popular than the GOP at the ball…
  18. One thing Repubs seem privately confident about: O is a singular, historic figure. Loud chants of O-Ba-Ma today on mall isn’t the Dem norm
  19. Speaking of the ball and performances, they were aplenty. All live, too.
  20. fun. is doing their sound check at the DC Convention Center. @clararitger is pretty excited. #metoo #inauguration2013
  21. Fun. stole the show. Alicia Keys came a close second with her rendition of “Obama’s On Fire.”
  22. Alicia Keys Obama On FIRE 2013 Obama Inauguration Ball Changes Girl On Fire Performs
  23. Jeffrey Gerlomes of NDtv was with me at the event, and astutely recognized one young reporter’s media swag logo as of the Cronkite School of Journalism at Arizona State University.
  24. Arizona represents with @cronkitenews at #Inauguration2013. Lost cell service! #CNaz @JessicaGoldberg @Radnovich57 http://pic.twitter.com/KyANS1jP
  25. Vaughn Hillyard, center, is working in D.C. as a reporter and graduates in May. We shot stand-ups together, and Jeff interviewed him for Irish Eyes, a show on NDtv. All in all it was a great trip to D.C., spending time with fellow journalists and Notre Dame grads, and producing articles and news packages galore.
  26. Anyone free to be awesome and pick me up from the airport at 12:45? I have no cash for a cab #helpmeimpoor

On Manti Te’o Coverage

I’m not about to make any predictions about Manti Te’o’s complicity in the hoax involving once-dead, now-fake girlfriend, Lennay Kekua. I, like many of you, have read the coverage, watched and listened to the interviews, and seen the comedy, woven out of his unsettling controversy.

I don’t know if he knew.

I can’t explain the discrepancies in his and Deadspin’s stories.

I believe in innocent until proven guilty.

I feel strongly that there are more important issues worthy of discussion that should take the place of Brian Williams’ second slot.

So I have mixed feelings about sending more on this young linebacker into the ether presumably for the consumption of the Notre Dame haters. As former newspaperman – now Notre Dame faculty and staff member – Matt Storin (@MattStorin) tweeted on Jan. 17:

“It’s open season on Notre Dame, so get your gripes in now –new or old. True or false. The window will close soon. Don’t delay.”

He’s right. We made a laughingstock of ourselves in Miami and this is just the icing on the cake. True or false.

So when I’m looking at the coverage, I can’t help but notice three trends. First, Manti Te’o lied to his family and to the media, whether he knew about Lennay being fake or not. Second, this will hurt both Manti Te’o’s and the university’s football image, no matter who did and did not know what. Third, Manti Te’o must have a motive, and it might be his sexuality.

The story is not of the man who crafted a hoax to frame or potentially extort a Heisman candidate. It is of the victim who slipped up along the way.

I don’t know what Manti did and did not know. He shouldn’t have lied to the media and to his parents, but I understand his self-conscious reasoning that his relationship was abnormal. He has taken the fall for the hoax, but the university shouldn’t also be blamed. And his sexuality should not become a point of public debate. President Barack Obama prioritized protecting the rights of our “gay brothers and sisters” in his second inaugural address Monday. There’s no “but” to this one. No matter what Te’o did or did not know, on the point of tweeting and meme-ing his sexual orientation, the media is in the wrong.

Click to view source of featured image.