To The Daily Sun,
Presidential candidate Hillary Clinton recently expressed that she found "somewhat surprising" the concern of New Hampshire and Iowa voters about mental illness and substance misuse disorders. For Granite Staters whose lives affected by such disorders, it comes as no surprise. For those of us who live with mental health and/or substance use disorders, or love someone who struggles with such challenges, we know all too well that we are facing a crisis.
The "treatment" or, more accurately stated, lack of available and effective treatment for people with mental illness as well as for people with addictive disorders is a state and national disgrace. A prime example of this disgrace is the day Clinton made the comment there were 20 adults and four children in emergency departments throughout New Hampshire waiting for an inpatient psychiatric bed. Many of these adults and children will spend days "boarding" in the emergency department, waiting for a bed.
Can you imagine leaving someone having a heart attack, a diabetic coma, cancer or other medical crisis on a gurney in a hallway waiting for a bed or treatment? This is abominable and, sadly, not isolated to New Hampshire. Ironically, it is happening at a time when research over the past several decades has overwhelmingly determined that mental illness and addiction, like other medical conditions, are biological diseases. It is also important to note that research dollars for mental illness have lagged far behind other medical conditions.
The reasons for the shortcomings of mental health treatment are many but largely are the result of stigma and discrimination. For years health insurance failed to provide parity — reimbursement for mental health and addiction treatment at the same level as physical health care. This led to the closure of many hospital inpatient psychiatric treatment units and, more importantly, low or no reimbursement for community-based treatment. Despite parity now being the law of the land, a recent national report by NAMI, as well as national news reports, indicates that discriminatory practices toward people with mental illness and those with addictive disorders continue to be commonplace.
Examples include denials for prior authorization for treatment and for prescribed medications, as well as higher co-pays, deductibles and other self-pay mechanisms.
Not only is treatment for psychiatric conditions lacking, but studies cited by the National Institute of Mental Health indicate people with mental illness die 14 to 32 years earlier than their peers in the general population. Reasons for this disparity in life expectancy include high co-occurrence between mental illness and other medical conditions, complications due to weight gain from psychiatric medications, and general lack of access to effective medical care.
There are other significant ramifications of not effectively treating mental illness. In December 2012, the Portland Press Herald reported that half of the fatal law enforcement shootings in the U.S. are of people with mental illness and in most of those cases the responding officer was aware the subject was unstable. The article further concludes "that Maine and rest of the country have failed to employ methods or invest in training that could defuse life-threatening situations with mentally impaired people."
Criminalization of people with mental illness as well as people with addictive disorders is widespread. Our jails and prisons are full beyond capacity and have replaced hospitals as the largest "treatment" facilities for people with mental illness. But little treatment actually occurs for individuals who are incarcerated and recidivism rates and poor outcomes are much higher for prisoners with a mental illness or addiction. Study after study shows the economic benefits of providing treatment rather than incarceration, yet we continue to build more prisons and unnecessarily lock up people with behavioral health issues.
Many of our veterans suffer from mental health conditions. Though the factors which triggered or exacerbated these illnesses may be different than the civilian population, the underlying biological symptoms for depression, post-traumatic stress, suicidality, traumatic brain injury, or addiction are all the same. That our warriors, our strongest men and women, struggle with these illnesses highlights the fact that such disorders are not due to personal weakness or character flaws.
The lack of treatment access has far-reaching impact upon individuals, families and communities. Far too many people are homeless as a result of mental illness and/or drug addiction. The suicide rate creeps upward each year and will likely continue to do so until we make a commitment to improve mental health services. And, tragically, more than 300 New Hampshire residents died of drug overdoses last year – more than the number of suicide deaths or traffic fatalities.
The sad truth is that, like other diseases, if left untreated, mental illness and addiction can be fatal — and the impact of those deaths on families and communities is devastating.
Granite Staters are fortunate that many of our political leaders understand voters' concerns about these issues. Congressman Frank Guinta called mental illness the biggest problem facing New Hampshire during his campaign. He has reached across the aisle, and together with Congresswoman Kuster will be holding a bipartisan Mental Health Summit during May which is Mental Health Month. Senators Shaheen and Ayotte have also both been strong supporters of treatment for mental illness and addiction. Governor Hassan has been steadfast in her commitment to improving access to treatment and services for mental health and addiction. And much of our state Senate leadership has been supportive as well.
Sadly, the New Hampshire House of Representatives still doesn't get it and removed funding for key treatment components for both mental health and addiction which the governor had included in her budget.
On Tuesday, May 5, the Senate Finance Committee will hold its public hearing on the budget. Please come out and express your support for mental health and addiction services. Ask the Senate Finance Committee to fully fund the settlement agreement for the mental health lawsuit, to continue funding for the New Hampshire Health Protection Program provides 38,000 residents with access to mental health and substance use disorder treatment, and to include funding to allow current Medicaid recipients access to treatment for substance use disorders.
Thank you, New Hampshire and Iowa voters, for raising your voices about mental health and addiction. Hillary Clinton clearly heard you and we need to keep raising our voices to make sure all the other presidential candidates and political leaders do so as well.
Executive Director of NAMI New Hampshire
The National Alliance on Mental Illness