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Workers World, 2/2/95 "MANAGED" MENTAL-HEALTH CARE A FIASCO By Nan Genger Boston The recent closing of large mental-health institutions, coupled with medical staff layoffs and a shortage of residential treatment centers, has put Massachusetts patients literally on the street.   This is the reality of Gov. William Weld’s managed mental health-care system. Heralded by some officials as "an example for the nation," the privatization of public health services is actually a fiasco for working and poor people. Mental illness and suicide are at epidemic levels as economic and social conditions and access to health care worsen. Budget cuts in Medicaid and Medicare proposed by the Contract with America will reduce services for the mentally ill even further. And right in the middle of all this is Weld, a major architect of right-wing welfare reforms and a leader in the assault on basic government programs. Meanwhile, thanks to corporate politicians like the Massachusetts governor, big business–particularly the pharmaceutical industry–reaps huge profits from federal tax breaks, drug patents and no regulation. WHAT IS MENTAL ILLNESS? Tens of millions of people in the United States are affected by mental diseases. Statistically the most common illnesses include depression, manic depression or bipolar disorder, schizophrenia, anxiety disorders, and dementias. Despite the prevalence of these illnesses, mentally ill people face cruelty and discrimination–unless these injustices are combated by public education and legal protection. Fear and guilt prevent many mentally ill people from seeking help, especially if they are penalized at work for admitting their illness or if they lack health insurance.   Dr. David Burns writes in "Feeling Good: The New Mood Therapy" that "depression has been called the world’s number one public health problem." An estimated 20 percent of the U.S. population will have some form of depression in their lifetime. More than 10 million people in the United States now suffer from depression. This illness causes changes in sleeping and eating, poor concentration, loss of confidence, isolation, hopelessness and despair, anxiety, and thoughts of death. Nancy Andreasen, M.D., writes in "The Broken Brain" that it is not fully known how depressions are triggered, but social stresses are a factor. Unemployment, homelessness, lack of education, poverty, as well as divorce, death of loved ones or physical ailments can influence depression.   A variety of research attempts to show how genetic, biological, and environmental forces all play a part in the illness.  Some of this research, especially the genetic studies, is controversial. Other research explores the role of neurotransmitters, key chemicals found between nerve cells in the brain. A second type of depression, called bipolar or manic depression, is indicated by extreme mood swings. Mania, or periods of high activity, excitement and loss of control, alternate with cycles of sadness, melancholy or suicidal urges. Symptoms of both unipolar and bipolar depressions may be relieved with medicine, psychotherapy or alternative treatments. Most people who receive treatment recover and are able to work. To obtain real relief people must have access to affordable health care, protection from job loss, and a range of support services. Millions of people suffer from chronic incapacitating mental illnesses requiring long-term care and disability payments. The term schizophrenia describes a variety of related illnesses ranging in severity. Hospitalization is often necessary when symptoms are acute and where careful monitoring of antipsychotic medication can relieve symptoms and improve functioning. If symptoms are controlled, outpatient day programs, rehabilitation centers and other support services can enable someone with the disease to work and live in the community. Post-traumatic stress disorder is a reaction to the severe stress of war, domestic abuse, incest or natural disasters. Vietnam veterans and battered women with this debilitating illness have fought for more outpatient services and shelters. Two percent to 8 percent of the U.S. population suffers from this or other anxiety disorders. Mental illness attacks every segment of the populace, but dementias generally effect those over the age of 40. One type of dementia, Alzheimer’s disease, occurs in 15 percent of those over 65.   There is no known cure for the mental and physical deterioration of Alzheimer’s. The high cost of nursing homes and lack of government services force many families and friends to shoulder the responsibility of constant care as the illness advances. MANAGED FOR PROFIT The chronic mentally ill survive on Social Security benefits, subsidized housing, food stamps, rehabilitation centers, and long-term care. That is why closing state facilities in Massachusetts alarmed advocacy groups like the Alliance for the Mentally Ill. Dr. Arnold Reif of Westborough State Hospital, comments, "They are laying off people and cutting beds at the state hospitals and they are not expanding funding in the community at the same level." Likewise, a local study found that mentally ill people on Medicaid were discharged into the street or shelters instead of proper medical facilities. Yet the Massachusetts Department of Mental Health plans to cut 84 more staff and 60 beds in the next several months.   The new managed-care system is in the hands of a private company, Mental Health Management of America. Last year this company made $2.1 million in profits from the state contract. Its management claims it saved the state over $12 million in mental-health and substance-abuse costs. But there is a $7.7 million deficit. Bed shortages in state and community facilities caused a revolving door of relapses, with the mentally ill showing up in emergency rooms or held in jails. The state had to spend millions of dollars to place the chronically ill in more expensive private hospitals. But a reporter discovered a $7.7-million deficit caused by placing the chronically ill in private hospitals.   Health-care activist Dr. Sidney Wolfe describes managed care as "managing to deliver as little or as poor quality of services as they can get away with." Here is how managed care works: The Boston Globe reported a case of parents waiting five hours in an emergency room while their manic 19-year-old son, hallucinating and paranoid, was refused admittance to a state program.   The father’s insurance benefits were exhausted. Mental Health Management of America would not take the son to a state facility unless the parents paid half the cost. After four weeks of psychiatric care his symptoms were managed. This family went into debt to help their sick son. But what is the choice of those without the money to pay for hospitalization and medicine? What happens to the 40 million who lack health insurance? [Next: The role of pharmaceutical companies]                                -30- (Copyright Workers World Service: Permission to reprint granted if source is cited. For more information contact Workers World,

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>Keywords: USA, health-care, mental illness, depression, anxiety, hospitals, >economics, insurance >Workers World, 2/2/95 >"MANAGED" MENTAL-HEALTH CARE A FIASCO >By Nan Genger >Boston

. But what is the choice of those without the money to pay for hospitalization >and medicine? What happens to the 40 million who lack health >insurance?

OK, Nan, babe,  I’m on the edge of my seat.What? What? This is riveting just like the nickel thrillers my dad told me about. But I doubt if this situation will be resolved by the fervant whining of the WWSRDG.

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