After reading my last blog, “Mental Health Homes as Hospitals Without Walls …," a friend and colleague told me, “Nice analysis, but I kept waiting for the answers.” Since I received quite a few responses to that blog, it would appear that many other folks were also looking for answers. Obamacare, or the Affordable Care Act, which obliges all participating states to establish medical and mental health homes as a primary cost-saving measure, seems to be overwhelming providers with its complexities. Catnip, of course, for bureaucrats and social policy planners.
Here in New York State, the State Office of Mental Health recently published a list of providers that have submitted letters of intent to participate in setting up mental health homes, either as host or lead agencies or as network partners. The list, covering the six planning regions of the state, is ninety-one pages long and includes scores of applicants. It’s safe to say that not all the hundreds of agencies seeking a State contract will get one; but the sheer number of applicants is indicative of the imperative felt by providers to participate in the re-formed system or perish. It also portends a system of enormous size and complexity and, in all likelihood, as fragmented as the existing system. Consumers will need a case manager—or care manager, as they’re now referred to—to navigate this system and the care managers will need a map.
Unfortunately, this system, however novel, will not represent anything new. Its treatment system will remain rooted in the biomedical model and its principal treatment will be the psychoactive medications that have been documented to scramble brainwaves, cause diabetes and heart disease and shorten the lives of anyone who takes them. It will remain accountable not to the persons it will purport to serve but to its principal funders, the U.S. government, which will spend more on Medicaid than it ever has, particularly after 2014 when Obamacare is due to become fully operational; and the insurance industry, which, thanks to Obamacare and insurance parity, will have a greater investment in behavioral healthcare than it ever has.
Despite the promise of greater governmental cost control and regulation of access to and quality of care, we can reasonably predict that insurance companies will do what they do best—make money, raise premiums and degrade the quality of the services their policies cover. Finally, the new system’s mission will remain essentially that of social control. Rhetoric about consumer recovery will remain essentially that. As we’ve learned from Courtenay Harding and others, recovery by consumers, which I long ago defined as their reclamation of their citizenship in the larger community, is achieved only when they leave the mental health system.