By Howard Gochberg
Medicare Justice Coalition co-chair

How much longer must we wait for seniors with mental health problems to be treated on par with those with physical ailments? The increased growth of seniors in our population, their high suicide rate, compelling evidence of high potential for recovery with appropriate treatment, and the low rate of treatment utilization due in part to factors like unfounded stigma, access barriers and specialized provider scarcity must be recognized. This is a glaring indication of a lack of parity for those with mental health problems and must be addressed by all levels of government as well as emergency rooms, other health providers and insurance companies.

With a documented prevalence of mental health problems in the elder population, preventive treatment for mental illness could save money in the longer term. Many seniors cannot afford to pay the higher costs of mental health visits to psychiatrists, psychologists and other mental health professionals. By delaying treatment early on, complications from untreated mental health problems are more likely to result in a cumulative increase in cost, efforts and energy that will increasingly burden the community, families and friends, and seniors themselves.

Unfortunately, our legislators, particularly at the federal level, have been ignoring the need for correcting inequities in mental health treatment. The late Sen. Paul Wellstone authored and introduced legislation in 2001 that has never made its way to the floors of Congress despite overwhelming support of both political parties. This glaring inequity is not being seriously addressed by our political leadership due to fear of high costs of such legislation.

Such projections are not accurate since cost increases would be minimal and more than offset by the benefits of earlier and more effective treatment. This position has been confirmed by a recent study of the Federal Employees Health and Benefits Program (FEHBP) which implemented mental health parity in 2001. The article, which appeared in a recent issue of the New England Journal of Medicine, indicated that implementing and eliminating discriminatory limits on mental health coverage is definitely affordable.

There is pending legislation that would rectify inequities in both public and private sectors on both federal and state levels. Senate bill S1152, titled the Mental Health Co-payment Equity Act, introduced by Senators Olympia Snowe (R-ME) and John Kerry (D-MA). A companion bill, H1125, has been introduced in the House by Representatives by Ted Strickland (D-OH) and Tim Murphy (R-PA). These bills would reduce the co-insurance requirement amount for Medicare mental health visits from the current 50 percent to the 20 percent level required for all other Medicare visits and would eliminate discriminatory co-payment rates for outpatient psychiatric services under the Medicare program.

Another bill, H1402, introduced by Representatives Jim Ramstad (R-MN) and Patrick Kennedy (R-RI), is commonly known as the Paul Wellstone Mental Health Equitable Treatment Act. This piece of legislation would expand the Mental Health Parity Act of 1996 by prohibiting private health plans from imposing treatment of financial limitations on mental health benefits that are different from those applied to other physical health services. Senators Ted Kennedy (D-MA) and Pete Domenici (R-NM) plan to reintroduce the Senate version of this legislation.

This inequity issue already has been addressed legislatively by 36 states with a number of others considering similar parity measures. In Minnesota, NAMI Minnesota (National Alliance on Mental Illness), VOA Minnesota (Volunteers of America) the Minnesota Board on Aging and other interested groups and individuals came together in the fall of 2003 under the umbrella of the Minnesota Mental Health Action Group (MMHAG), a public-private partnership led by the Commissioner of Minnesota Department of Human Services and the Chair of the Citizen's League of Minnesota to study relevant mental heath issues. One of the sub-groups of MMHAG, which focused on the issues relevant to older adults, made the following recommendations:

• Require mental health plans in Minnesota, including Medigap and Medicare Supplemental plans, to abide by the state parity act in covering services on par with other illnesses.
• Increase availability of specialized service providers (who are dually trained in mental health and geriatrics) to serve seniors.
• Integrate mental health care for seniors with aging services (social services).
• Ensure that services proposed under the model benefit set are applicable for older adults.
• Include intensive outpatient treatment under ARMHS (Adult Rehabilitative Mental Heath Services) in the model set to provide senior specific adult day treatment.
• Expand the definition of SPMI (Serious and Persistent Mental Illness) to include anxiety, mood and cognitive disorders not presently covered.

Recommendations of all MMHAG sub-groups have been incorporated into Gov. Tim Pawlenty's $109 million Mental Health Initiative that is currently before our state lawmakers. If adopted, changes including integrated funding for mental and physical health and social services, formulation of a model benefit set, and other innovations we hope will lead to improved availability and delivery of comprehensive mental health services for all, including older adults. This is a start in the right direction. Mental illness is not part of normal aging and can be successfully treated if the process and providers are sensitive to the special issues critical to the senior population.

Our seniors with mental health problems need more attention and respect from legislators. The most recently announced cuts in Medicare and Medicaid carry the message that health care coverage is not as important (or politically correct) as tax cuts and some other federally funded programs. It's about time for our government to act more responsibly and address the mental health challenges facing our senior citizens.

It is vitally important that you communicate with your legislators via telephone, e-mail, fax or letter regarding this escalating problem for all seniors. It's never too late for the state and federal legislative bodies to act positively to support and move forward bills and recommendations already introduced that recognize ongoing needs of senior citizens with mental health problems.