[Catalyst 2017]

INCarceration
by Rishi Suresh
Healthcare Reform
FOR THE Mentally Ill
Neuropsychiatric illnesses are some
of the most devastating conditions
in the world. Despite being noncommunicable,
mental and neurological
conditions are estimated to contribute
to approximately 30.8% of all of the
years lived in disability. 1 Furthermore, in
developed nations like the United States,
mental disorders have been reported to
erode around 2.5% of the yearly gross
national product, which fails to account
for the opportunity cost of families who
have to take care of patients long-term. 1
If left untreated, many patients with
neuropsychiatric illnesses cannot find
gainful employment; their aberrant behavior
is stigmatized and prevents forward
professional and personal advancement. In
fact, about three times as many individuals
living with mental illnesses are in prisons
rather than rehabilitative psychiatric
institutions. 2
Though the Affordable Care Act has
substantially decreased the amount of
uninsured individuals in the U.S., there
are still millions of people who fall into
something called the Medicaid gap. 3 People
in this group make too much money for
Medicaid, but too little money to be able
to qualify for government tax credits in
purchasing an insurance plan. In an attempt
to fix this ‘hole,’ the federal government
offers aid to states in order to expand their
Medicaid programs as needed. 4 States that
have accepted the Medicaid expansion
sponsored by the federal government,
have seen sudden reductions in their
populations of uninsured people, which has
directly improved quality of life for the least
fortunate people in society. However, in the
many states that continue to reject federal
aid, the situation is considerably worse—
especially for the mentally ill.
Mental health patients are especially
vulnerable to falling into the Medicare gap.
Many patients suffering from psychiatric
conditions often are unable to find serious
employment. According to a report by the
Department of Health and Human Services
in March 2016, there are 1.9 million lowincome,
uninsured individuals with mental
health disorders who cannot access proper
healthcare resources. 5 These impoverished
psychiatric patients are originally eligible for
Medicare. However, once their treatment takes
and they become employed, they might pass
the Medicare income threshold. If their private
health insurance does not cover the cost of their
psychiatric treatments, patients will relapse,
creating a vicious cycle that is exceptionally
difficult to break out of. 6
“About three times
as many individuals
living with mental
illnesses are in
prisons rather
than rehabilitative
psychiatric
institutions.”
Furthermore, many psychiatric illnesses often
initially present during adolescence or early
adulthood, which is right around the time
students leave home to go to college. So, during
initial presentation, many students lack the
proper support system necessary to deal with
their condition, causing many to drop out of
college or receive poor grades. Families often
chalk up these conditions to poor adjustments
to a brand new college environment at home,
preventing psychiatric patients from properly
receiving treatment. 6 Alone, many students with
psychiatric conditions delay seeking treatment,
fearing being labeled as “crazy” or “insane” by
their peers.
Under the status quo, psychiatric patients
face significant barriers to care. As the
Medicaid gap is unfortunately subject to
political maneuverings, it probably will
not be fixed immediately. However, the
United States could fund the expansion of
Assertive Community Treatment programs,
which provide medication, therapy, and
social support in an outpatient setting. 7
Such programs dramatically reduce
hospitalization times for psychiatric
patients, alleviating the costs of medical
treatment. Funding these programs
would help insurance issues from being a
deterrent to treatment.
In the current system, psychiatric patients
face numerous deterrents to receiving
treatment, from lack of family support to
significant social stigma. Having access to
health insurance be a further barrier to
care is a significant oversight of the current
system and ought to be corrected.
WORKS CITED
[1] World Health Organization. Chapter 2: Burden of
Mental and Behavioural Disorders. 2001. 20 3 2016
.
[2] Torrey, E. F.; Kennard, A. D.; Elsinger, D.; Lamb,
R.; Pavle, J. More Mentally Ill Persons Are in Jails and
Prisons Than Hospitals: A Survey of the States .
[3] Kaiser Family Foundation. Key Facts about the
Uninsured Population. 5 8 2015. 25 3 2016 .
[4] Ross, Janell. Obamacare mandated better mental
health-care coverage. It hasn’t happened. 7 8 2015.
24 3 2016 .
[5] Dey, J.; Rosenoff, E.; West, K. Benefits of Medicaid
Expansion for Behavioral Health. 28 3 2016
[6] Taskiran, Sarper. Interview. Rishi Suresh. Istanbul,
3 3 2016.
[7] Assertive Community Treatment https://www.
centerforebp.case.edu/practices/act (accessed Jan
2017)
DESIGN BY Evelyn Syau
EDITED BY Jacqueline Locarno
CATALYST | 27