AACP
Newsletter, Volume 7, Number 2, Spring 1993
Editor's Column: A Window of Opportunity:
Mental Health and Health Care Reform
This is obviously not a time for us to be wasteful, and clearly not a time in which we can throw money at problems hoping they will disappear. As our government ponders how to apportion limited resources, it is imperative that solutions must not only be effective, but economic; that they must address not only the needs of today, but anticipate those of tomorrow.
One of the most significant failings of our system, has been its focus on short term solutions that may save money immediately but which often create expensive problems in the future. It is a system that has seldom been willing to challenge the status quo and it has too often been controlled by groups with vested interests. We have been victims of conservatism and complacency - afraid of change, avoiding risk and sometimes ignoring the obvious.
As we face these grim facts, it is not time to be timid. It should be clear that we must all work hard and be prepared for sacrifice. There will be temptations to repeat past failures, however, and it is of this that we should be most wary. The crucial role that proper and affordable healthcare for all our citizens plays in the overall health of our nation is not a matter of debate. What has been less certain is how we define “proper” or “adequate” healthcare and how we can provide it in an economic manner. If we define it too narrowly in the interest of saving money in the short term, under the weight of the other tremendous economic burdens we carry, we will most likely flounder and eventually be confronted with our failure of foresight and the even larger difficulties that would be created. Mental health has long been a stepchild in the family of health care services. We have become accustomed to the inferior value and attention that are often given to the services we provide. It is most critical at this time that we not become submissive to those expectations. This is the time to press the case that any definition of “adequate” healthcare must include mental health services, provided on the same basis as other healthcare. It must be recognized by policy makers that this is an economic solution, not simply an idealistic or self-serving one. We must clearly demonstrate the costs our society has paid for past neglect of mental health care.
In the later part of 1992, The Mental Health Liaison Group, a consortium of national organizations involved in mental health and representing consumers, family members, advocates and providers, met in Washington to prepare a transition briefing on mental health for the new administration. The report identifies seven principles upon which mental health services must be integrated in to a new nation al healthcare system:
- Nondiscrimination - mental health needs must be met on the
same basis as other healthcare need for all citizens;
- Comprehensiveness - must include a broad array of mental health
and rehabilitation services;
- Service Equity - provision of mental healthcare must be
determined by necessity - not arbitrary limits;
- Choice - consumer selection of services and participation in planning;
- Cost Equity - adequate services must be available to all persons
with mental healthcare needs so that they do not need to spend a
disproportionate share of their personal resources to obtain them;
- Efficiency - services must be delivered with efficient use of resources;
- Managed Care - the system must control the use of resources while insuring the quality of care.
The principles this report enumerated are shared by the Board of Directors of the AACP and are consistent with the position statement developed by the Board at the Winter Meeting.
In this issue of Community Psychiatrist we have included this policy statement (See Board of Director’s Report, page 7) and have modified that statement to take the form of a letter. The Board has sent the letter to the President’s Task Force on Health Care Reform, chaired by Hillary Rodham Clinton and to the Subcommittee on Mental Health with in the Task Force, chaired by Tipper Gore. We strongly encourage our members and allies to take advantage of this window of opportunity for change. Take the time to send letters to policy makers and your representatives in Congress so that the message will be clear: it will ultimately cost more to exclude necessary mental health services from healthcare reform than to integrate them in a logical manner.
We believe that the principles we have set out provide a rational basis for designing a new healthcare system. We have included a copy of the letter we sent to policy makers and legislators on page 11. Please take the time to read the letter and, if you agree, clip it out, copy it, and encourage friends and co-workers to join us in sending this message. Add your own personal comments if you wish, and send them to the addresses provided. If we do not act now, our opportunity may be lost, to be revisited only after a great deal of suffering and pain.
Wesley Sowers, MD
Editor
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