The economics of mental illness
If it bleeds, it leads. CNN has a piece about Ramon Rivera, who randomly stabbed three people in NYC. He was mentally ill, in and out of Rikers and mental health facilities. He’s like a drunk driver who has a history of alcoholism.
“New York City Mayor Eric Adams described Rivera as a homeless man with a criminal history and “severe mental health issues,” an example of failures of the criminal justice and mental health systems.
“The seemingly random killings highlight the challenges confronting New York City and other municipalities across the country as they maneuver a delicate balancing act – how to deal with soaring homelessness and mental illness and its perceived – and actual – impact on public safety.
“We always hear something is being done but nothing changes, and every six months something unthinkable happens,” said Mary Brosnahan, who for three decades led the Coalition for the Homeless, an advocacy and service organization. “
Not unthinkable, but predictable. We do a poor job of dealing with mental health in America. Insurance companies hate to pay for it. The result is that the rest of us pay—as victims or as taxpayers for the criminal justice system.
We need to *invest* in mental health research and treatment that identifies and prevents the insane from killing more innocent people. That costs money. How much is your life worth, or the life of a loved one?
Mental illness and crime prevention
“New York City Mayor Eric Adams described Rivera as a homeless man with a criminal history and “severe mental health issues,” an example of failures of the criminal justice and mental health systems.
“The seemingly random killings highlight the challenges confronting New York City and other municipalities across the country as they maneuver a delicate balancing act – how to deal with soaring homelessness and mental illness and its perceived – and actual – impact on public safety.
“We always hear something is being done but nothing changes, and every six months something unthinkable happens,” said Mary Brosnahan, who for three decades led the Coalition for the Homeless, an advocacy and service organization. “
Not unthinkable, but predictable. We do a poor job of dealing with mental health in America. Insurance companies hate to pay for it. The result is that the rest of us pay—as victims or as taxpayers for the criminal justice system.
We need to *invest* in mental health research and treatment that identifies and prevents the insane from killing more innocent people. That costs money. How much is your life worth, or the life of a loved one?
Mental illness and crime prevention
I sort of dispute that insurers hate paying for mental illnesses. They don’t like paying any claims. Mental health claims aren’t particularly hated. Pre-ACA, mental health was a relatively attractive coverage carveout, which is not the same as hating it. One issue with mental health was that it did not feel random enough to enough folks that they wouldn’t risk dropping coverage. The 35 year-old with no history of cancer never dropped cancer coverage. Same person with no prior indication of schizophrenia might easily drop that coverage if possible.
@Eric,
“A recent survey of nearly 2,800 US patients found that 40 percent of patients who had sought in-network mental health care had to make four or more calls to find a provider who would see them — compared to just 14 percent for physical health care. More than half of patients said they had had a claim for mental health care denied three or more times, compared to about one-third who had the same experience with physical services.”
https://www.vox.com/2023/8/4/23815827/mental-health-therapy-services-health-insurance
“Accessing mental health care can be a harrowing ordeal. Even if a patient finds a therapist in their network, their insurance company can overrule that therapist and decide the prescribed treatment isn’t medically necessary.
“This kind of interference is driving mental health professionals to flee networks, which makes treatment hard to find and puts patients in harm’s way.”
https://www.npr.org/sections/shots-health-news/2024/08/23/nx-s1-5084256/insurance-mental-health-care-coverage-legal-protection
Thanks for the info. Even though it is “green” in neither of the two areas of insurance law per the second link, I don’t think mental illness coverage is much different than other areas here in Wisconsin. But that is coming from just a few patients that I know well. Two are being treated for schizophrenia and one for autism. The autism one kind of baffles me as it isn’t a mental illness at all (my view) but diagnosis code puts it there. The schizophrenics have had no insurance problems at all for years. This might be because the by now well accepted drug protocols save the insurers a ton of money versus hospitalization. Possibly the more “organic” that your diagnosis seems, the less insurance issues you’ll have.
@Eric,
“Possibly the more “organic” that your diagnosis seems, the less insurance issues you’ll have.”
Exactly. That’s why insurance companies hate to insure for mental illness (which is a whole lot more than just autism and schizophrenia). Anxiety disorder, depression, bipolar disorder and PTSD don’t have any obvious physical stigmata that can be bandaged or treated with surgery, radiation, antibiotics or anti-tumor drugs. They don’t show up on imaging. When will the patient be “cured?”
I lived in the United States for 25 years, being originally from Europe. What Americans often fail to realize is that their “mental illness” epidemic has a cultural origin, not a business (or a medical one) one they can fix with “investments”, insurance regulations or even “drugs” (although many pharma companies would and do market their products as coming to the rescue).
It anchors deeply into American society, family structures, values, pressures, lifestyle, relationships and societal support system (or lack of thereof in their case) that brings human beings living in that context to extremes circumstances and desperation. I lived there, I have felt it, I have seen it. Eventually I have left it behind me.
America (or the USA for that sake) often claim to be “the best country” in the world, which makes any criticism of their society difficult to construct (because it goes against a very strong sets of beliefs that have been “marketed” to people for decades now, often leveraging the mass ignorance of the audience they are targeted to), but that is also a product of heavy marketing that we are seeing evidence it is being torn down and deconstructed as more and more people around the world are questioning it and putting it under scrutiny.
My point being: mental illness in my opinion, as far as the US are concerned, is going to get worse before it gets better, and will only improve if America will be ready to open up and transform itself around healthier human values and priorities.
Mauro:
There are definitely differences between the US and Europe, Mexico, and Canada. People in all three countries live quite different the American citizens. We believe we are entitled to do many things which would not exist in the other places. The individualism comes at the expense of others around us. I stayed in Germany, etc. for about 6 weeks. Traveled through Asia from plant to plant for a month at a time. The differences are very pronounced.
The US is not the best place to live and we have proved it with the past election. Hopefully, he fails and there are enough politicians who would stand in his way.