The Uninsured Mentally Ill

Photo courtesy of caregiving.com

Photo courtesy of caregiving.com

Here’s a scary fact: A single hospital admission for a mentally ill patient paid for by the taxpayer-financed state medical-assistance program costs more than a year of private outpatient care. It makes little financial sense, yet it happens every single day in America.

Everyday, a mentally ill person is admitted to an ER in the throes of a psychiatric emergency, desperately needing care and having nowhere else to go. No psychiatrist, no therapist, no case manager, no nothing. So they rely on ER doctors and nurses- and tax payers. But after the patient gets emergency care, they are back on their own. Until it happens again.

So why do these patients lack proper, long term psychiatric care that could provide regular treatment? Why do they end up in this endless cycle? The answer is simple, yet still disturbing- they have no health insurance.

Psychiatrist Christine Montross wrote an article,”The Woman Who Ate Cutlery,” about this quandary that many mentally ill people who lack health insurance face on a regular basis. The article was featured in the New York Times on August 3, 2013.

From NYTimes.com:

PROVIDENCE, R.I. — M is a 33-year old woman who swallowed silverware. Each time she ingested utensils, she went to the emergency room so that doctors could remove them from her esophagus and stomach.

Then the hospital transferred M to the psychiatric unit, where she was assigned to my care. When I met M she had already been hospitalized 72 times.

M’s case is dramatic. But she is one of countless psychiatric patients who have nowhere to turn for care, other than the E.R.

It is well known that millions of uninsured Americans, who can’t afford regular medical care, use the country’s emergency rooms for primary health care. The costs — to patients’ health, to their wallets, and to the health care system — are well documented. Less visible is the grievous effect this shift is having on psychiatric care and on the mentally ill.

How could this cycle of self-injury be disrupted? M and other psychiatric patients who turn to emergency rooms for care need regular outpatient appointments with a doctor they know and trust who can monitor their symptoms and assess the efficacy of their often complicated medication regimens.

Sadly, M’s history of recurrent hospital admissions is not uncommon. Recently I treated a 65-year-old man caught in a chronic cycle of homelessness and suicide attempts who had been in and out of the E.R. 246 times. If M had insurance, or enough money to pay out of pocket, she might see a therapist every week for an hour and a psychiatrist once or twice a month.

For full article, go to nytimes.com.

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4 thoughts on “The Uninsured Mentally Ill

  1. It gets worse. You can have perfectly good insurance that covers physical illnesses and broken bones etc. just fine, but puts severe limits on psychiatric coverage. Sometimes it’s just a matter of requiring the insured to choose an “in network” provider. The “in network” provider may be a horrible match with the insured, but that’s the only person insurance will cover. This situation was better 25 years ago than it is now.

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