Mental Health Care

Providing mental health care and substance abuse treatment for workers and their families is likely to be a growing expense for U.S. employers in the 1990s. And the cost is rising even faster than the cost of other types of health care. In the 1980s, the total workplace cost of mental illness and substance abuse--factoring in treatment, lost productivity, and damaged property--was estimated to be as high as $237 billion a year.

"I sleep in trash cans. " It is a minute and 45 seconds into the security camera video. Kelly Thomas, 37, jaws with police officers at a Fullerton bus depot, his arms crossed over his bare chest, his backpack double-strapped. It is the night of July 5, 2011, about 8:30. It's still 80 degrees outside. A few pedestrians wander by. A car passes. There is no indication that the lives of every person on the tape are about to change. "You planning on going to sleep pretty soon?"

It wasn't so much that President Clinton said mental-health services would be included as a basic benefit in his health-care reform plan. It was Congress' reaction. On both sides of the aisle, lawmakers rose and cheered the concept of equating illnesses of the brain with illnesses that occur elsewhere in the body.

After it happened, Megan Beza was consumed with figuring out why. Did her husband's struggle with painkillers play a role? His months of fruitless job-hunting? But with suicide, there are rarely tidy answers. What is known is that southern Nevada's unusually high suicide rate spiked with the recession, and Megan thinks that must explain, at least in part, what happened the morning of Oct. 25, 2010. John Beza had just returned from dropping off their 4-year-old son, Jacob, at preschool.

Sandra had been diagnosed with manic depression in 1973 at age 19. But, with lithium and psychiatric counseling, she coped well. She even held down a low-paying job. Then, in 1986, she moved to Southern California. Her woes were about to begin. Because her income was meager, she found psychiatric care through a San Fernando-based public clinic that charged her on a sliding-scale fee. However, in 1990, state budget cutbacks left her with just the health insurance provided by her employer.

Consumers who see their mental health benefits expanded in the future will also discover that insurers will be intimately involved in the process. In managed care plans, employers and the insurance companies they hire monitor, evaluate and control how benefits are doled out. Experts predict it is only through managed care that some states and private companies are taking timid steps to expand benefits.

A Northrop worker ordered by his boss to seek treatment for alcoholism was told by the physician provided through the firm's health maintenance organization simply to "go home and quit drinking."

Just under 2 million Californians have mental-health problems or illnesses that require treatment, but only a fraction of them receive care, according to a report released Wednesday by the UCLA Center for Health Policy Research. The study found that one in 12 of the state's adults have symptoms that are consistent with serious psychological distress and cause them difficulty functioning at home or work. About half said they are not receiving treatment for their symptoms and about 25% receive "inadequate treatment," according to the authors of the report.

"I sleep in trash cans. " It is a minute and 45 seconds into the security camera video. Kelly Thomas, 37, jaws with police officers at a Fullerton bus depot, his arms crossed over his bare chest, his backpack double-strapped. It is the night of July 5, 2011, about 8:30. It's still 80 degrees outside. A few pedestrians wander by. A car passes. There is no indication that the lives of every person on the tape are about to change. "You planning on going to sleep pretty soon?"

Re Ventura County's system of mental health care. If anything is to be learned from the turmoil of the past two years, it is the value of an open process, nondefensiveness and the reporting of honest facts. From its inception, legislation for the Ventura Model promised more than the system delivered. Yet it was characterized and promoted as highly successful. The money attached to it made it sacrosanct. Critics were maligned as "adversarial" or "rabble-rousers." Yet they were the heartbeat of the system, taking distress calls from other families.

Just under 2 million Californians have mental-health problems or illnesses that require treatment, but only a fraction of them receive care, according to a report released Wednesday by the UCLA Center for Health Policy Research. The study found that one in 12 of the state's adults have symptoms that are consistent with serious psychological distress and cause them difficulty functioning at home or work. About half said they are not receiving treatment for their symptoms and about 25% receive "inadequate treatment," according to the authors of the report.

Antidepressants, now the third-most commonly prescribed class of drugs in the United States, are routinely offered to patients with vague complaints of fatigue, pain and malaise but who are not classified as suffering from a mental disorder by the physician who recommends the treatment, says a new study. And among primary care provider as well as specialists who are not psychiatrists, the practice of prescribing these medications without diagnosing depression is rising steeply, the study finds.

In any given year, more than a quarter of U.S. adults have a diagnosable mental health problem -- from depression to bipolar disorder -- yet fewer than half get any kind of treatment for it. The figures are similar for children. Many who do receive care get it through their primary-care physician rather than a mental health professional like a psychiatrist or psychologist. That's partly by choice: People prefer to talk to someone they know and trust about medical problems, and for many, there's still a stigma in seeing a "shrink.

New rules The California Department of Managed Health Care has issued regulations for HMOs requiring timely access to medical care. Plans have one year to comply. Consumers can complain to the department at (888) 466-2219 or www.healthhelp.ca.gov. Among the rules for HMOs: Patients with urgent matters that require "prompt attention" must be seen by a physician or other healthcare professional within 48 hours of requesting an appointment. Urgent care with specialists must be provided within 96 hours.

To bring more science to psychotherapy, some psychologists endorse a new accreditation system that would effectively call "Time's up!" on clinical programs it feels devalue science. To enter practice, aspiring clinical psychologists must first attain a doctoral-level degree from an accredited institution. The accrediting body governed by the American Psychological Assn. is widely considered the field's standard, though state licensing boards vary in terms of which accreditation system they recognize.

Suicides among veterans average 18 a day, by the government's estimation, and a backlog of disability claims for post-traumatic stress disorder and other untreated ailments approaches 1 million. With a massive military drawdown from Iraq and Afghanistan potentially on the horizon, lawyers for the veterans want a federal appeals court to order the Department of Veterans Affairs to make good on the nation's commitment to take care of those wounded in mind as well as body. It is an onerous task that a lower court has already deemed beyond the power of the judiciary to correct.