Right now many Missouri and Kansas mental health centers repeatedly face huge budget cuts. In fact, this is true nationwide. We simply can’t afford as a society to keep spending as much money on useless mental health care costs. Right now the mental health system faces a choice that is also being faced in the energy, agriculture, freshwater supply, transportation, and education. In all of these areas there are market failures causing a re-allocation of resources away from science-based, effective, low-cost solutions. We are subsidizing unsustainability by pouring money into these systems in directions that make problems worse, not better.
Why policy analyts cut mental health care costs at random:
Looking at mental health care costs shows absolute nonsense like paying for nursing homes when it would be cheaper and more humane to help people stay in their own houses with a personal care attendant. Sam Brownback’s proposed Budget last year included eliminating the grant that would help community mental health centers pay to treat uninsured people. This means many people who are denied mental health services end up in jails or hospitals, where we have to pay $80 or $400 (respectively) a day to treat them. It also increases the amount of community police, ambulance, and crisis services we provide, some of the most expensive community services around. This is not a cost savings at all. Cost shifting is not a mental health care costs savings. It just lets government cutting advocates can claim a false victory.
Another problem in Kansas which is also true in many states is that we haven’t figured out what to do with sex offenders who have served their jail terms but are not politically OK to release. In Kansas, up to half of the state’s entire mental health care costs are spent on 330 pedofiles for what is mostly just incarceration.
Now that we no longer have the societal resources to keep paying for what isn’t working, we now have a simple choice. We can keep paying for what’s not working, only half as much of it. OR we can look to research and listen to voices of people who have recovered from the Kansas mental health system. We can listen to practitioners in the field and create a new system where people get better instead becoming permanently disabled by their illness. Recovery is, of course, the ultimate savings for mental health care costs.
An article last year in the Kansas City Star pointed out that the leading psychiatric medication prescribers can write scripts for up to $2 million a year in medications that are billed to Medicaid. It’s excellent that we are starting to investigate some of the costs of our current system of care. There are definitely some research based cost savings available to us.
10 Easy ways to reduce Mental Health Care Costs:
1. The biggest mental health care costs come from “atypical” or “second generation antipsychotics” Yet these are not neccessarily any more effective than the first generation antipsychotics. This was first shown in the CATIE trial, one of the biggest ever government funded studies of antipsychotics. Then the TEOSS study also showed no advantage for the new meds. Now recently a large trial in the UK just came to this same conclusion. The old meds cause Parkinson’s disease, the new ones cause diabetes. Pick your poison. The initial judgement that the new meds were better was heavily promoted by the pharmaceutical industry but now is becoming more and more controversial. However, not all doctors stay current with medical literature and many have used only the new meds for the last ten years so this is all they are familiar with. Most of the problem with the old meds is that they were used in really high doses. YET – See #2.
2. Each person has a unique response to medications. This is something cancer survivor and Tour de France winner Lance Armstrong has to repeatedly point out to fellow caner patients who ask him for medication advice. Eventually many people find one particular med that works significantly better, at least until people find honest information about the causes and solutions to emotional distress.
For instance most people have no idea that most psych meds have very severe withdrawal sypmtoms, so most people who come off them rapidly are addicted, not having a return of “illness.” In this case, limiting access to medications increases mental health care costs. All states that have implemented fail-first or restricted approval lists have actually increased mental health care costs.
3. Give people options besides medication. 40% of people do not respond to medications. So telling them that they just haven’t found the right medication yet isn’t true. Things like peer support centers, permanent supportive housing, employment supports, and crisis alternatives are extremely important. These are cost effective because people in recovery help others to recover. The current emphasis on medications is squeezing out this prevention based approach to treatment. I have myself recovered from schizophrenia and when people see the amount and kind of high quality work that I do, they have living proof that recovery is possible.
4. Acknowlege that not all people respond to medications. A reanalysis of the STAR-D trial, the biggest ever government funded study of anti-depressants, showed that only 7% of people in the study had remitted and were still on meds at the end of the year. The rest either quit taking their meds or did not get better. In the The New England Journal of medicine published an article saying that once you take into account the publication bias where only positive studies get published, then all of the antidepressants are no more effective than placebo. If we help people who don’t respond to meds to have a safe medication withdrawal, then we will save enough in medication expenditures to pay for people who truly DO need their medications. And some of us truly DO need our meds, just not all of us. If we created programs at mental health centers to help people come off medications when they are ready, these programs could pay for themselves overnight.
5. Closely examine prescribing patterns to foster children. These children are being prescribed medications at 9 times the rate of other Medicaid users according to PBS documentary. Texas cut their juvenile psychiatric medication expenditures in half by simply saying that kids shouldn’t be on more than two drugs of the same class or five psych meds total. That’s not a very conservative restriction.
6. Put pedofiles in jail for life or release them to a program like Darkness to Light, where we work on prevention instead of the 1% of sex offenders that are caught. Leaving that 1% in limbo does nothing to solve the problem but is a huge drain on mental health care costs.
7. Call personal care attendants by a name that sounds less luxurious and more like the huge mental health costs reducers that they are. Call them “nursing home prevention specialists,” and make this a well paid and honorable trade.
8. Fund permanent supportive housing that solves the homeless problem, not homeless shelters and jails that cost the same amount but don’t solve anything.
9. Let kids be kids, let emotional difficulties be transient, let abnormalities amuse you. You don’t have to label or diagnose every single variation on humanity.
10. Enjoy your life. Take good care of the people around you. Be active in your community. Exercise, get outside, eat fermented foods, eat fruits and veggies, pet a dog. Go blow bubbles.
How do you think mental health care costs can change?