Mental health care disparities increasing between rich and poor

[caption id="attachment_10938" align="alignleft" width="500"] Many homeless are mentally ill[/caption]

Carol Forsloff---A number of shooting incidents involving people who were, or are, mentally ill have again reminded people of the need to expand mental health evaluations and treatment; however, access to mental health care continues to lag far behind physical medicine.

And it is the poor who suffer the most, since 50% of psychiatrists refuse to take insurance, leaving many people with no alternative than to pay directly.  This is true despite the parity places on mental health care by the Affordable Care Act.  Many psychiatrists have opted out of taking insurance for mental illness.

The rich pay; the poor can't; and the problems related to mental health continue to grow, as frontline social service agencies continue to struggle with financial burdens following the recession.  In addition cuts in funding have created problems in having enough social workers available to meet the growing needs of the mentally ill.  More and more of these people end up on the streets or without services.  It is estimated that at least one-third of those living on the streets are mentally ill, and the numbers are growing, including those with severe illnesses such as schizophrenia.

A New Year's resolution to solve the problem of getting treatment for the mentally ill who can't afford private pay might be to increase funding for physician training with the recommendation that universities and hospitals promote psychiatry as a specialty, as fewer trained psychiatrists again reduces the possibility of people getting the mental health services they may need.  In addition, some psychiatrists may want to consider the importance of having a few more patients in the mix who have insurance and to treat these same people with the same level of care as the rich and famous.

Private vs government-run agencies: Either can fail in service delivery

[caption id="attachment_22101" align="alignleft" width="391"] United Parcel Service[/caption]

Gordon Matilla----While many people complained about the rollout of the Affordable Care Act's health care options and fault President Barack Obama and the Democrats for the inefficiency and errors that were dramatically displayed in the government website, the United Parcel Service is presently criticized for its delays in shipping Christmas gifts. One is a government program; the other privately managed.  It simply might mean that corporations and agencies must be individually evaluated for efficiency as opposed to criticizing one or the other as faulty or favored.

Many people complain about too much government and maintain that privately-run corporations can do a far better job at managing the affairs of business, and even social service and mental health programs.  On the other hand, across the board there have been examples of private companies failing in their attempts to provide services, just as government agencies sometimes fail as well.  The difference, however, is many in the private sector have had less oversight and therefore more likelihood of failure.

An example are the privately-run prisons.  Experts contend prisons managed by private corporations not only aren't necessarily more efficient in delivering services, often they exhibit poor management and poor outcomes related to treatment and recidivism.  In addition, many times the prisons themselves exhibit poor conditions and sometimes less qualified staff than those that are state or federally managed.  In fact some say that the promises made by private corporations seem to be like so much "fairy dust."

Criticisms should be given those who fail regardless of whether they are corporation or government managed, as experience has shown it is the individual situation or event that should be assessed as opposed to making generalizations about whether one way is right or not.  The post office may have its problems, but perhaps they did just as well delivering merchandise as UPS, or at least tried just as hard to get those gifts to the recipients as early as possible.

Affordable Care Act undermined by false beliefs that undermine humanitarian values

[caption id="attachment_17150" align="alignleft" width="300"] Learning about health care options[/caption]

Carol Forsloff---After living in Hawaii 28 years, a journalist has perspective on health coverage, given the way the State has functioned with its insurance programs and coverage. There are good reasons why Hawaii ranks #1 in health factors, much of it having to do with the availability of health care.

In Hawaii every employer must provide health coverage for employees who work 20 hours weekly or more. The State also has a program for the poor, so that they too have coverage when they are unable to work or are otherwise in need of health care maintenance.

For 28 years, unless there was a job specifically with insurance coverage, I was unable to leave the State. That's because of preexisting health conditions from a long-term and life-threatening illness that occurred when I was 35. Individual insurance was either not available, and I was declined, or so expensive that it would have meant a choice between food or health care.

In Louisiana every presentation from a politician around the State focused on the negatives of the Affordable Care Act when it was first proposed and watching and listening to “plants” in audiences and vetted questions so that no one was allowed to question speakers, all offering those negatives, brought information to this journalist that there were planned techniques to undermine almost any decision made by President Barack Obama.

Much of the continuing spread of those negatives has to do with the psychology of all of us. When we hear criticism constantly about anyone, even if the individual being criticized is a close friend or relative, we begin to question our beliefs. After all, how can so many people who differ with us be wrong? In addition there is also the dictum that it's harder to believe the truth when it's told after a falsehood has spread,

The statement from Republicans that focused on undermining any decision made by Obama has made not just a difficult environment within the political party but a toxicity of belief that has permeated almost every social issue in America. That includes guns, women's rights, immigration and health care. Those who oppose the loudest voice are shouted down indeed. That means truth is never read or heard by the larger number of people.

Indeed as some of the media has declared, the mainstream television, radio and newspaper stories seldom, if ever, offer an positive information about the Affordable Care Act, even when there are many stories of people receiving health insurance who were denied health insurance when they desperately needed it most.

Surely the Affordable Care Act has snags, but so did Medicare and Social Security when these programs were first unveiled. And those programs met with many of the same criticisms---primarily by those who used the words “Socialist” or even “Communist” in relationship to them. But there was not the concerted effort, vocalized by leaders of the opposition, to undermine completely any of the President's ideas at the time. Targeting an individual repeatedly will eventually wear down the public good will, as it has in the case of Barack Obama. And this means from both left and right, especially in the more extreme areas of the spectrum of each party but reaching into the moderate groups as well, because those who scream the loudest and the longest become the message most heard and believed.

If young people do not join the program, and others don't who believe the worst about it, then the program will fail for sure. And those who had hoped that everything Obama did would fail would have met their objectives, stated objectives as they were. That will inevitably lead to folks looking for an alternative, and where else will they look but among those who will say, “I told you so” when the program fails entirely.

Indeed a recent letter from Rush Limbaugh to his public says this, “If you believe in government, you should be furious about Obamacare’s incompetent rollout: A fiasco that could haunt progressives for years to come.” – Headline, “The New Republic,” Nov. 14, 2013

“If this goes down, if health care, the Affordable Care Act, is deemed a failure, this is the end – I really mean it – of liberal government, in the sense of any sense that government as an instrument of social justice, an engine of economic progress, which is what divides Democrats from Republicans – that’s what Democrats believe.” – Mark Shields, “PBS News Hour,” Nov. 15,

28 years in Hawaii was not a negative experience, but the lack of health care opportunities prevented me from moving on to independent work, a full-time private practice in counseling and a strong area of journalism opportunities as well. It is the choice many people must make when they can't lose their jobs for fear of losing health coverage they couldn't otherwise get. And the lack of the option will cause needless suffering and death, all arising from the false notions that Obama be defeated at all cost, thus undermining the humanitarian value of good health for everyone.