Mental health advocates applaud a new rule requiring health insurers to cover mental health and substance abuse care. Still, Blacks are expected to lag behind in getting services.
BY JENISE GRIFFIN MORGAN
FLORIDA COURIER – This story originally appeared in the Florida Courier on Nov. 15, 2013.
A landmark “final rule” decision was issued in November 2013 by the U.S. Department of Health and Human Services stating that health insurance companies must cover mental illness and substance abuse just as they cover physical diseases.
While she applauds the decision, Central Florida mental health advocate Muriel Jones is among those who say it’s still not enough to help the many people living with mental illness.
“It’s a shame it has to be a rule. That should be something already in place. Everyone knows mental illness is on the same level as physical illness,” remarked Jones, executive director of Federation of Families of Central Florida and vice president of the National Alliance on Mental Illness (NAMI) in Orlando.
Lack of Services
She cites a myriad of problems: Lack of community services in Florida. The state’s hard line on extending Medicaid to more low-income residents in the state. And for African-Americans, their refusal to seek care. “The demand will be there, but the supply won’t be there…Some of these service delivery gaps could be established and implemented if there were the Medicaid dollars,’’ she told the Florida Courier.
Florida ranks 49th in the nation in per capita mental health funding, at $39 per resident.
Jones, who also serves on a variety of other boards advocating for mental health, said there are just not enough community services in Florida. She was part of a group of mental health professionals invited to the White House in August for a briefing on the Affordable Care Act.
Health care in the United States has been at the forefront of national news since Congress passed President Barack Obama’s Patient Protection and Affordable Care Act in 2010. Informally known as “Obamacare,” scores of registered Americans will profit from the law’s benefits and avoid penalty for pre-existing conditions.
Blacks And Stigma
Unfortunately, scores of others who endure mental health illnesses will continue to suffer in silence due to the associated stigma. Among the most underserved, undiagnosed and misdiagnosed are African-Americans of all ages and gender.
More than 45 million U.S. adults suffered from a mental illness in 2011, but just over 17 million of them received treatment, according to a 2012 report by the U.S. Substance Abuse and Mental Health Services Administration.
Studies show that less than half of African-American adults with mental illnesses seek treatment for mental health problems. And less than one third of their children receive treatment even though suicide is the third cause of death among African-American males between ages 15 and 24.
Jones believes Blacks won’t seek help, even if their insurers cover it.
“I don’t think it will make a difference. I still think it’s a part of the culture, that it’s a badge of shame,’’ she noted.
She said it’s time for Blacks to get over it.
“Your child is being suspend in school twice a month (for behavioral issues). At that point, you have to say, ‘It’s time I put aside my pride and get the kid some help.’
Crowning Achievement
U.S. Secretary of Health and Human Services Kathleen Sebelius called the Nov. 8 rule the “largest expansion of behavioral health coverage in a generation.” She made the announcement at the 29th annual Rosalynn Carter Symposium on Mental Health Policy held at the Carter Center in Atlanta.
“This final rule breaks down barriers that stand in the way of treatment and recovery services for millions of Americans. Building on these rules, the Affordable Care Act is expanding mental health and substance use disorder benefits and parity protections to 62 million Americans. This historic expansion will help make treatment more affordable and accessible,” Sebelius said.
NAMI’s campaign to end unfair discrimination led to the Mental Health Parity and Addiction Equity Act in 2008. The organization called the parity regulations “the crowning achievement” of a 20-year campaign, but as Jones noted, the regulations don’t cover managed care plans through Medicaid or the state Children’s Health Insurance Program. That excludes about 15 percent of Americans covered by health insurance.
“Some of our most vulnerable people are still being left behind,” said Michael Fitzpatrick, NAMI’s executive director.
Don’t Call Her Crazy
That’s also a concern of Swiyyah Muhammad, a 37-year-old in St. Petersburg, who was diagnosed in 2003 with paranoid schizophrenia and has been hospitalized six times.
“I think this is really great. It will open the doors for more people to get help,’’ told the Florida Courier.
“Organizations like NAMI are trying to end the stigma,” said Muhammad, who wrote a novel that features a female character diagnosed with schizophrenia titled, “Don’t Call Me Crazy: I’m Just in Love.’’
Muhammad, who has a degree in psychology, also is an advocate and speaks in Tampa Bay about mental health and mental illness. But she also worries about those who can’t get the best care.
Muhammad said she has had to skip taking her medication because of the cost and has a hard time getting a good therapist. She calls the lack of services a “really big bump in the road” for so many who need mental health treatment.
Some Concerns
Dr. Charles English, a Black psychologist in Orlando, also was pleased to hear about the rule but has his concerns too.
“From a psychological perspective, it will make a difference just in knowing that if they need this kind of assistance, insurance will pay for it,’’ he told the Courier.
About half of his clients at his Multicultural Counseling Centers in Central Florida are Black.
Mixture Of Emotion And Conduct
“The question is: Will African-Americans take advantage of the mental health coverage?” he asked. English noted that the majority of his clients are diagnosed with “some sort of adjustment disorder – depression or anxiety.’’ Like Jones, he’s also concerned about kids, especially Black children, falling through the cracks. He sees a lot of children from broken homes.
“Some are children of mothers who were abused by their significant others. They lived in poor neighborhoods, witnessed a crime or have been the victims of crimes.
Their behavior is oftentimes a reaction that happens out of their excessive anxiety – a mixture of emotion and conduct.”
English said many of the Black kids are quickly diagnosed with attention deficit disorder. He’s careful not to rush to that label.
“I give them a minimal diagnosis to continue to work with them under their insurance coverage,” which he said has been effective with children and adults.
‘Let’s Do It Here’
While an estimated 62 million Americans are estimated to gain by the expansion of the mental health and substance use disorder benefits and parity protections, a fraction of African-Americans will still fall by the wayside.
“Money should never be a reason why you stop serving people with mental illness and children,’’ stated Jones, whose grown son lives with schizophrenia. He lives in a facility in New Jersey because services are better there than in Florida.
Jones wants Florida to look at other states that are successful in providing mental health services.
“We don’t have to reinvent the wheel,’’ she said. “Let’s do it here. Let’s bring these services up a notch.’’
Jenise Griffin Morgan, senior editor of the Florida Courier, is a 2013-14 fellow of the Rosalynn Carter Fellowships for Mental Health Journalism. She can be reached at Jmorgan@flcourier.com.