Drugs and County Mental Health Programs

Posted on October 7, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

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On Medication and Pharmaceutical Direction

[By Carol S. Miller BSN, MBA, PMP]

Two issues related to medication have an impact on county mental health programs. The first is the new emphasis on drug therapy and the second is targeted marketing by pharmaceutical companies of newer, more costly drugs.

First

In the past, psychiatrists focused on identifying the “cause of the problem” and developing associated treatment plans to treat the cause. With the increasing number of mental health patients, especially those with chronic mental illness conditions, psychiatrists do not have the time to focus solely on the treatment plan and the underlying cause of the mental illness. Instead, their focus has had to become intake evaluations, case coordination, and medication checks. Use of medication has replaced the treatment plan, and continues to play a much larger and more primary role in the treatment of most, if not all, patients.

Second

The second major issue is advertising. The Food and Drug Administration (FDA) lifted restrictions against direct pharmaceutical advertising several years ago, enabling the representatives of these firms to market and advertise their drugs. Advertisers target both medical and mental-related problems, including everything from depression, anxiety, attention deficit disorder, acid reflux disease, high cholesterol, erectile dysfunction, arthritis, allergies, over-active bladder, to asthma. With the advent of marketing, many drugs are now being over-prescribed and are becoming a component of spiraling healthcare costs.

Assessment

In summary, both of these pharmaceutical issues are having an impact on county mental health centers — first, as a cost issue, second because of the change-in-direction treatment modality, and third from the perspective of potential ethical issues involved in provider/pharmaceutical company ties and relationships.

Conclusion

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Health Insurance versus Mental Health Parity

Posted on February 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Understanding Physical Health and Mental Health Insurance

By Carol Miller; RN, MBA

Carol S. Miller

There is a difference between the benefits covered under medical insurance compared to those covered under mental health benefits.

Mental Health Parity Act

There has always been a disparity resulting in caps on the annual number of visits allowed, higher co-pays, higher deductibles, and reduction of covered benefits such as partial hospitalization and number-of-treatment limits for mental health. Congress touched on this issue in 1996 with the Mental Health Parity Act. This federal law prevented group health plans from placing annual or lifetime dollar limits on mental health benefits that are lower¾less favorable¾than annual or lifetime dollar limits for medical and surgical benefits.

Group Health Plan Exclusions

However, the law did not require group health plans and their health insurance issuers to include mental health coverage in their benefits package¾it only applied to group health plan insurances that already did include mental health benefits in their benefit package.

MHETA Attempts at Correction

In 2003, Senators Pete Domenici, Edward Kennedy, and Representatives Patrick Kennedy and Jim Ramstad introduced S. 486 and H.R. 953, called the Mental Health Equitable Treatment Act. In March 2005, the Mental Health Equitable Treatment Act [MHETA] was passed and with the passage of this bill a loophole – insurers may no longer arbitrarily limit the number of hospital days or outpatient treatment sessions for people in need of mental health care – was closed.

Assessment

Nevertheless, even though states are encouraged by the government with this new bill to enact stronger parity laws, the final decision of parity still rests with the states.  Many states have not enforced the law and therefore, insurers may still be inclined to limit

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Why the mental versus medical health care insurance disparities?

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