By Dina Sokal, MD
[Spring 2006; Vol. 32, No. 3; Pg 1, 2, 4]
The
MPS does not endorse any candidate running for political office. However, we
believe it’s important to alert our members to their views on issues important
to psychiatrists and our patients.
The
following questions were sent to each candidate for governor for their
responses.
Douglas Duncan was
the first to respond.
What
are your views on the best ways to meet the rising costs of health care in the
state? How might this
impact on mental health care costs and treatment?
The
federal government should be taking the lead on healthcare reform, but in the
continuing environment of rising healthcare costs, and the lack of adequate
federal action, in Maryland there are a variety of steps that can be taken.
For
example, we can ensure that health care expenditures can be spent on treatment.
Too large a proportion of the health care dollar is spent on
administrative costs, marketing, and other non-treatment costs.
Also,
we can develop ways to ensure that illnesses do not become severe and chronic.
The vast majority of health care dollars are spent at this stage of
illness. People
should have full access to psychiatric providers early on, so they can achieve
recovery before their illness becomes too severe or chronic and is more
difficult to treat. In
addition, as we have demonstrated in Montgomery County, access to housing, jobs,
transportation, and appropriate medications reduces both the cost and severity
of illness and complements the therapeutic services.
Maryland
has a state mental health parity law (section 15-802 of the Insurance Article
and section 19-703.1 of the Health-General Article).
In light of the rising costs of health care, do you envision making any
changes in this law?
In consultation with
many different sectors, I would make changes in the law.
It would not be only because of rising health care cost, however, but
because any difference between somatic and mental health care is a difference
that cannot be justified. People
afflicted with a mental illness suffer just as much as people facing a somatic
illness.
Maryland
also has Small Group Market Coverage separate from the above parity law.
There are mandated mental health benefits in this law.
Recently, the legislature reviewed this law due to concerns of rising
insurance premiums for small businesses.
What is your position on the mental health benefits in this current law?
(COMAR 31.11.06 sets forth these benefits).
It
is tough for small businesses to pay health insurance costs, as well as other
costs associated with operating a business.
At the same time, I do not think the answer lies in making an unjustified
distinction among various illnesses, based on how “popular” they are.
Policies and laws that result in any discrimination against people with
mental illness contribute to the prejudice that they do not suffer a “real”
illness.
Currently,
mental health services through private insurers are not always easily accessible
due to a lack of psychiatrists on panels, delays in payments, and utilization
review criteria shortening inpatient stays and creating a burden of paperwork
for providers and consumers.
In December of 2004, the Task Force to Study Access to Mental Health
Services completed their report to the Legislature on these issues (Senate Bill
252 passed in 2003). What
are your views on how accessible mental health care is through private insurers
and what initiatives, if any, would you consider to make care more accessible.
I
do not believe that mental health services are adequately available to people
who are privately insured, which is one of the reasons so many people with a
mental illness end up eventually becoming part of the public mental health
system. In addition,
because private insurers have often inadequately served people suffering from a
mental illness, those very people often end up becoming far sicker than modern
medicine can reasonably justify.
As
I stated above, there is no justification for treating people with a mental
illness differently than someone with a somatic illness.
What follows from that premise is that there needs to be the same
attention to quality and outcomes in both parts of the health care system –
somatic and mental health.
For
quality, that means, at minimum, that there needs to be an adequate number of
psychiatrists on panels, that the panels must be current, and that the panels
must include psychiatrists with all needed skills, including child and
adolescent psychiatrists. It
also means that there must be a clear and sustainable definition of what
constitutes an “adequate” panel, mechanisms for prompt payment and
utilization review criteria related to good outcomes rather than serving solely
as a cost savings measure.
To
the extent that care is managed, as it often is in today’s health care
delivery system, care provided to the psychiatrically ill must be consistent
with best and prevailing practices and it must be measured according to its
effectiveness and propensity to further good client outcomes.
Otherwise, “managed care” can quickly become another way of saying
“substandard care.”
Recently,
the Department of Juvenile Services closed the Hickey Detention Center and is
reviewing treatment options for juvenile delinquents.
What are your views on the best placements for these children and
teenagers?
Children
should be in their home communities, they should be provided treatment options
appropriate for their needs, they should receive state-of-the–art wraparound
services which involve their families, are strength based and constantly
measured for their effectiveness.
If a secure facility is indicated, it should nevertheless be in the home
community, and it should be small and therapeutic.
All interventions should be based on best or prevailing practices,
monitored constantly for effectiveness and adjusted when needed to ensure the
best possible outcomes.
In
Baltimore city, the Department of Social Services is having difficulty placing
foster children in homes, sometimes having them waiting in temporary settings
before a placement is found.
What are your ideas for possible solutions to this situation?
This is not an
acceptable situation for our children under any circumstances.
Placing children in public buildings, often without even the availability
of beds or showers, should not be an option.
I
would attack this problem two ways:
First,
I would plan for emergencies like this, and design and fund appropriate
alternative facilities for children who do not have an immediate placement
available. The
facilities should be designed to be safe, clean and adequate as a place of rest
for children who are already in crisis as they are removed from their home.
Second,
and more important, I would design and fund a foster care system that has
sufficient capacity to care for all of the children placed in its care.
This is one of the most fundamental roles of government – protection of
the vulnerable children in our society.
In
addition to the basics – ensuring protection of children in the care of the
state – I would also design and fund wraparound mental health services for
children in foster care so that when they leave foster care, they leave with the
best possible chance of success.
Under the system in place today, approximately 70% of all children in
residential treatments centers were once in either foster care or juvenile
services. My goal
would be to reverse that trend through the provision of quality mental health
services in both the juvenile services and foster care systems,
and to ensure the services are adequately funded.