Flickr: Elja Vellekoop

By  Eric Bitet, LMHC, MA, MPH

Did you ever stop and consider the cost of talking to a professional about your problems?  Have you been feeling increasingly depressed or anxious recently, overly stressed or worried about your job, finances, or your shrinking property value?  Have you been overcome by malaise or sadness as you remember a lost loved one during this holiday season and wanted to speak to a therapist but were scared of what your out-of-pocket expense would be?  If your answer is “Yes,” you are not alone and many people struggle with problems like these.  These are a few examples of stressors that affect millions of people in the United States and around the globe every year.  The American Psychology Association (APA) reports that in any given year, 1 in 10 Americans overall suffer some disability from mental illness.  Of these millions of American, many have insurance that offers limited benefits for mental health while others are uninsured and must qualify for their state Medicaid programs to have access to treatment.

When these kinds of mental health related problems arise, where do these people go for help?  Well, the first step can be to contact your primary care physician and request a referral to talk to a mental health professional whether it be a psychiatrist, psychologist, or a psychotherapist.  But how will it be paid for?  Do health insurance plans cover mental health care?  Most insurance companies do provide some level of coverage but the pressing issue here is how much?  The answer in most cases is not enough!  The readers will be the judge on whether mental health treatment coverage should be equivalent to coverage provided by insurance companies for physical illnesses but how many of us have thought critically about this issue?  Do you believe that schizophrenia and bipolar (manic-depressive) disorder should be treated the same as physical illnesses in health insurance plans by providing the same amount of cost coverage and inpatient and outpatient treatment visits?

While you ponder this question lets briefly explore the facts.  History shows that physical and mental health has long been treated with great inequality and has only begun to make strides towards parity within the last decade. The struggle of mental health advocates against cost-containment policies that restrict mental health benefits has raged on since the 1980s.  The Mental Health Parity Act of 1996 was a significant first step towards parity as it addressed “catastrophic” benefits and put the issue on the map for policymakers.  The new act prohibited lifetime and annual limits on coverage that were different for mental and physical illnesses.  This was a positive first step for mental health advocacy but barely scratched the surface of the issue as many areas were not addressed.  A report by the Surgeon General indicates that the Mental Health Parity Act did not address other forms of benefit limits such as per episode limits, visit limits, co-payments or deductibles, and substance abuse treatment.

A decade after the Mental Health Parity Act was implemented, mental health advocacy groups have continued their mission to bring parity to mental health insurance coverage and the arguments have been heard by policy and law makers in state governments and on Capitol Hill.  There are 42 states that have followed suit and since enacted their own parity laws requiring mental health coverage to be par with physical health coverage.  In 2008, after a long 10 year battle for equality, President George W. Bush passed a “Mental Health Parity” law that will mandate the equal coverage for depression, bipolar disorder and all other diagnosable mental illnesses with physical illnesses like heart disease and cancer.  As of January 2010, health insurance companies and group health plans will no longer be allowed to impose different limitations on mental health and substance abuse treatment coverage than they do for medical treatment.  At this time, the new law will only exclude those people who are employees of companies with 50 or fewer workers and those who purchase their own insurance.  So there are still some loopholes and speed bumps along the road for mental health parity, but this new law is a monumental victory for mental health advocates who have fought hard to bring mental illness to the mainstream of our society as something that is very important and to be treated seriously!

Up to this point, research indicates that cost is one of the biggest deterrents that prevent people from seeking treatment for mental health related issues.  Well now help is on the way and mental health care should come cheaper and easier for most Americans.  So where do you begin on your journey to access treatment if your experiencing some type of mental health related problem?

Here are some tips that might be helpful:

• Contact your Primary Care Physician (PCP) and make an appointment to discuss issue and request a referral to speak to a mental health specialist.
• Contact your insurance companies who have clinically trained case managers ready to take your call and refer you to the proper level of treatment.
• Many employers have Employee Assistance Programs (EAP) that are staffed with counselors that are prepared to help employees manage and cope with any type of stressful situations whether it is personally or professionally related.
• In the most severe situations, if you are having any thoughts of harming yourself or anyone else, you must call 911 or visit your nearest emergency room right away!

So as we conclude this article, I challenge you to think about what mental illness means to you and think about all the stigma associated with having a mental illness.  Have these stereotypes had an effect on how the American health care system and more importantly insurance companies viewed mental illness and why they didn’t cover its care to the same extent as medical?  Is it possible that something so serious can be taken this lightly and left in the dark for this long?  Whether the answer be yes or no will be left for you to decide!  I will leave you with one reality though; the dark ages of ignorance and prejudices against mental illness are behind us and a new age of public awareness is now here. This is depicted by these mental health parity laws and the conformity of insurance companies!  So where do you stand on this issue and so you think we are there yet?

By: Erin Lieber

This week some very surprising new breast cancer guidelines were released, through the U.S. Preventive Services Task Force. The group, made up of independent clinical experts , has amended their 2002 recommendation and gone against the early prevention guidance of the American Cancer society, which previously advised that woman should receive routine mammograms every 1-2 years after the age of 40. The new guidelines assert that women no longer need to begin the proactive mammograms at 40, but rather 10 years later, at the age of 50. What is even more surprising is that the Task Force disputes the effectiveness of self-examinations as well.

The reasons cited for the changes? Women in their 40’s are more likely to get false positive results leading to biopsies and stress. According to the Task Force, the benefits of early detection, in this age group, outweigh the risks of incorrect test results and the damage and cost of biopsies that are not necessary.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chairwoman of the panel.

I have many concerns about the new guidelines. The first being, the precedent of ambiguity that is being set here. Whether or not it is their intention, these new guidelines contradict what so many have worked to instill in women: “Early Detection Saves Lives”. According to the U.S. Cancer Society, approximately 65% of women in their 40’s currently get a preventive mammogram every 1-2 years. Even with the old guidelines, only three quarters of woman followed the advice. Can we afford to have less than 65% of women seeing their doctors about breast cancer and getting the appropriate tests because of this new messaging? Doesn’t this go against all of the progress made by breast cancer survivors and cancer groups who have worked so hard to educate women on prevention and awareness? These new guidelines certainly don’t apply to those women who are high risk for breast cancer and have a family history of the disease, however, all woman are at risk for breast cancer. My fear is that these guidelines are inconsistent with the message that needs to be conveyed to woman on the importance of early detection, and I’m not the only one who sees this as an issue:

“Our concern is that as a result of that confusion, women may elect not to get screened at all. And that, to me, would be a serious problem,” said Dr. Len Lichtenfeld, the Cancer Society’s deputy chief medical officer.

Furthermore, what will these kinds of recommendations due for coverage of mammograms assuming that women within this age bracket still want to practice early detection? Will insurance companies change their policies and reimburse less or not at all for preventive mammograms within this age group?

Susan G. Komen for the Cure, the Dallas-based breast cancer advocacy group, said it won’t change its recommendation that women ages 40 to 49 get annual mammograms. “We would not want to see a change in policy or reimbursement for screening mammography at this time,” said Eric Winer, the group’s chief scientific adviser, in a statement.

What is motivating these changes? Is it more than just policy review and data extrapolated from studies over the last few years? Could this be the start of health care rationing as we see Congress and their constituents struggle with the cost of the new health care bill and insuring almost 40 million new members without a significant increase in health care workers and supplies? Will we see more of these kinds of guidelines ahead and efforts to decrease prevention as a government option unfolds in health care reform? The latest bill passed by the House included billions in tax increases without measures to control costs. Will we have to pay for health care reform at the expense of the very thing we should be trying to improve…will reform be at the cost of our health?

Flickr: Optical illusion -The University of Groningen's Medical Facility

By J.D’Abbraccio RN, MSN

The “Green” movement in hospitals has taken finally taken momentum in the United States. More and more hospitals are starting to understand the long term impact of going green. Why is that important? Did you know that the U.S. health care sector accounts for almost one tenth of the country’s carbon-dioxide emissions? A report by University of Chicago researchers published in the Journal of the American Medical Association (JAMA) showed that the health care sector accounted for 16% of U.S. gross domestic product. What was most disturbing was that health care contributed to 8 percent of the United States’ total carbon-dioxide output. The analysis found that hospitals were by far the largest contributor of carbon emission. The researchers attributed this to the high energy demands needed for temperature control, ventilation and lighting in large hospital buildings.

What does it mean to for a hospital to be “Green?”  It means a hospital is trying to be environmentally friendly and proactive about leaving a smaller carbon footprint on the planet. It means they are more efficient with energy by utilizing green technology, such as smart efficient heating and cooling systems, high-efficiency glass, solar panels, LED lights, digital thermostats, low-flow faucets, automatic on/off light switches, recycled products and material to name a few. Also, hospitals are focusing their attention on new ways to be more inventive with waste management and recycling. What kind of impact does a green hospital have on its patients?  Green health care design does promote a more healing environment through more natural daylight, outdoor views, landscaping, improved ventilation, better indoor air quality, efficient lighting, low-impact materials and furnishings, and a more relaxed atmosphere.

Why now? Many health care organizations are starting to really understand the long term financial impact of going green. Besides the numerous environmental and health benefits, the combination of affordable new green products, green grants and tax credits, and potential for huge financial savings are really driving this change. Companies like AMSOLAR (www.amsolarcorp.com ) work on innovative models for educational and medical institutions thinking of best practices and solutions on how to maximize investments made by hospitals who decide to go green. Hospitals can spend millions of dollars monthly just for energy. Why wouldn’t a hospital want to save millions by being more efficient? Hospitals are analyzing up-front costs of green technology and are determining that is will usually balance out against long-term savings. Going green may save millions of dollars over the years. Also, the competition for attracting patients plays a big role too. Many patients are looking for clean, efficient, and up to date rooms while recovering from illness. Being green gives the public an enhanced perception that a health care provider is environmental sensitive and cares about the community.

More and more hospitals are going green. It seems like the green message to save the planet is becoming clearer and clearer everyday. Reduce waste and your carbon footprints wherever you can. As a potential patient/customer, will the green movement affect where you will go for your healthcare? Do you think this will improve the quality of care being delivered? Have you been in a “green” hospital? If so, please share your experience and thoughts.