Winning work: Swine flu, costs and mental health
In the SPJ’s 2010 Sunshine State Awards, AHCJ members made their presence felt in the “Medical/Health Care/Science Reporting” category, where they snagged two of the three spots.
The Miami Herald; John Dorschner; Healthcare costs
“Thanks to Dorschner’s detail-oriented reporting, readers of The Miami Herald learned just how much a 45-hour hospital stay for thyroid treatment might cost. Dorschner did not stop there either, confronting the hospital with the charges and asking them to justify the expenses – which they declined to do.”
The Palm Beach Post; Stacey Singer; Swine flu
“So many stories were written about swine flu in 2009 but few of them provided the human details and intimate touches of Stacey Singer’s reports. She introduces us to the people who were deeply affected by the flu, especially the expectant mothers and their children who were most vulnerable to it. She tells their stories with vivid, insightful details.”
In Mental Health America’s Awards for Excellence in Coverage, Portrayals of Mental Health Issues David Jackson pulled in the investigative reporting award for the Compromised Care series he did with Gary Marx. Read The Chicago Tribune’s full package here. AHCJ members can read an article about how they reported the story.
Mental health parity law implementation evolves
Filed under: Government, Health care reform, Hot Health Headline
Writing for Kaiser Health News and The Washington Post, Sandra Boodman considers the effect that the American mental health parity law has had since it went into effect on Jan. 1.
The law applies to about 140 million Americans, Boodman writes, most of whom are insured by employers with more than 50 employees. For qualifying groups, “Higher deductibles, steeper co-pays and other restrictions are no longer allowed for mental health and substance abuse treatment.” It doesn’t apply to individual policies and doesn’t require employers to offer mental health coverage of any kind.
There are still questions about the implementation of the law, many of which are addressed in the Obama administration’s implementation plan (PDF), which should take effect on July 1.
Officials of key business and insurance industry groups said they were displeased that the regulations were “more expansive” than they believe lawmakers intended. Mental health advocates applauded the rules, which they said would help ensure that Americans battling schizophrenia, for example, receive the same level of care provided to those facing leukemia.
Federal officials estimate that complying with the law will increase premiums nationwide by four-tenths of 1 percent, or about $25.6 billion over 10 years. Employers are free to drop mental health and substance abuse coverage and are allowed to manage claims to determine if treatment is medically necessary, just as they do now for physical ailments, but the standards can no longer be more stringent. Plans are also allowed to exclude treatment for certain illnesses, such as eating disorders, as long as state law does not mandate coverage. There is also an escape hatch: Plans that can prove that their costs increased by more than 2 percent in the first year can file for an exemption.
Fortunately, it looks like that sort of cost increase will be rare, based on research that shows similar rules improved access without increasing cost.
For some background on the mental health parity law, check out MIWatch.org.
Comments invited on latest draft of DSM
A new version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders has come out every decade or so (it varies widely) since 1952. 
It hasn’t substantially changed since 1994, but the next revision is slated to come out in 2013. It’s a pretty big event, as the book’s diagnostic criteria are used around the world to determine who is diagnosed with mental disorders.
With the release of the new version, lines may shift and folks who were diagnosed with mental disorders may find themselves “undiagnosed.” Others will have labels changed and gain labels they didn’t have before.
The latest draft proposal of the May 2013 revisions, upon which public comment will be accepted until April 20, 2010, was posted on Feb. 9. APA workgroups will review the comments and begin trials soon after. Benedict Carey rounded up and evaluated some of the biggest proposed changes for The New York Times. In addition to bipolar disorders in children and autism spectrum disorders, Carey discusses the sheer significance of the changes.
“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.
“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”
More vets come home as result of psychiatric issues
On Shots, NPR’s Health Blog, Nadja Popovich reports on a recent Johns Hopkins study that found, more troops were evacuated from Iraq and Afghanistan in 2007 for mental health problems than for combat injuries.
The increase comes despite the military’s increased focus on combating mental health problems among American soldiers. The largest number of evacuated soldiers are still those diagnosed with “noncombat-related injuries, such as muscle and joint problems that come from carrying equipment,” but psychiatric evacuations are a growing and complex problem.
American paratroopers in Afghanistan. Photo by U.S. Army Spc. William E. Henry via Flickr… those suffering from mental health issues had a remarkably low rate of returning to full duty. “Psychiatric conditions have the lowest return to duty rates among any diagnostic group aside from combat injuries,” (study leader Steven P. Cohen, an associate professor of anesthesiology at the Johns Hopkins School of Medicine and a colonel in the U.S. Army Reserve) wrote. “But the effects are much worse, because psychiatric conditions worsen the prognosis for all other conditions.”
“Patients with PTSD — as a rule — have multiple other complaints,” he continued. “Studies have shown that most people with persistent PTSD have ongoing musculoskeletal, neurological and constitutional complaints that are unlikely to respond to treatment.”
Related AHCJ articles
Interviewing ‘profoundly affected’ soldiers
Tips for interviewing service members returning from Iraq, the Middle East or Afghanistan
Learning from Calif.’s mental health parity law
On the Los Angeles Times Booster Shots blog, Shari Roan writes about a recent scholarly review of California’s mental health parity law that illuminates lessons that will be key to the success of the upcoming national mental health parity law. The California law has been in place for five years.
Roan summarizes the most important of these lessons, including the accuracy of price estimates and the lack of public awareness about the program. The study considers the views of consumers, insurers and providers as well as the public at large.
The national mental health parity law, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (HR 6983), is intended to prevent discrimination against patients seeking treatment for mental illness by prohibiting “insurers and group health plans from imposing treatment or financial limitations when they offer mental health benefits that are more restrictive from those applied to medical and surgical services.”
However, as MIWatch.org reports, the three federal agencies that are supposed to write the regulations to implement the act missed an Oct. 3 deadline. The law will go into effect in January.
Resources to cover mental health and the military
AHCJ offers resources to help journalists cover the wide range of health topics, including those surrounding the military, veterans and post-traumatic stress disorder. Members and other journalists write articles and tip sheets specifically for AHCJ about how they have reported a story, issues that our members are likely to cover and other important topics.
We have compiled a selection of tip sheets, articles, Web sites and reports that we feel could be helpful as journalists cover the aftermath of the Fort Hood shootings.
Some of these resources are normally available only to AHCJ members but we are opening them up to nonmembers for one week to help journalists cover this important topic.
Equal treatment for mental health in peril
Phyllis Vine of MIWatch.org, a site about mental illness, writes that last year’s mental health parity legislation has run into problems. According to Vine, if federal rules for implementing the Wellstone-Domenici Mental Health Parity and Addiction Equity Act are not in place by the Oct. 3 deadline, treatment for many could be delayed or stopped.
The act requires insurers to treat mental illness the same way they do physical ailments, eliminating higher co-pays, deductibles and limits on hospital stays. Vine provides some background:
We should recall that parity was hotly debated before two bills (HR 1424 in the House, S 558 in the Senate) were folded into last year’s stimulus package. It was an initiative supported by a unique collaboration between advocates in the mental health community and those in the addiction community, with coverage extending to the self-insured and to those in Medicaid managed care. The House initiative, led by Reps. Patrick Kennedy and Jim Ramstad, wanted to base treatment criteria on the American Psychiatric Association’s Diagnostic and Statistical Manual. Insurance and business were able to determine that the Senate’s bill allow them to define “medical need.”
Vine writes that insurance companies are now trying to sabotage the law in an attempt to preserve profits. Letters from the American Benefits Council and Wellpoint Inc., sent during the public comment period, ask for exclusions of some conditions, treatments, providers and limits on the number of visits patients can make.
Tompkins: Juvenile jails taking on mentally ill youth
Al Tompkins, the reliable story-spotter at the Poynter Institute, jumped at the potential to localize a New York Times story on how cash-strapped mental health systems are allowing young offenders with psychiatric disorders to be handled by the juvenile justice system instead of by mental health specialists.
According to The New York Times, which refers to the current situation as a “crisis,” two-thirds of the nation’s approximately 92,000 juvenile inmates suffer from at least one mental illness while at least 32 states are slashing the budgets of their mental health programs.
DoD campaigns against stigma of depression, PTSD
The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury’s new Real Warriors campaign is designed to aid soldiers with what they seem to see as the three r’s of military mental health: resilience, recovery and re-integration.
The RealWarriors.net site not only directs soldiers to additional resources, but also shares anecdotes from their peers and provides them with guidelines for good mental health, both in combat and out of it.
The effort, launched in May, even has a Twitter account.
(Hat tip to Arline Kaplan of the Psychiatric Times)
Related:
Bay Area panel on veterans’ health highlights untold stories
A painful picture of rare childhood mental illness
The Los Angeles Times’ Shari Roan tells the story of a 6-year-old girl suffering from a rare – perhaps even unique – case of early childhood schizophrenia. For months, even the most powerful medications her young body can handle don’t seem to phase her imaginary animal friends and almost-constant hallucinations. The mental illness is a serious threat to her health and that of those around her. In January she had to be moved from home to UCLA’s pysch ward. Roan uses the story, told with intense, wrenching detail and ending with a note of hope for the future, to illuminate the plight of America’s tiny population of mentally ill children.
About 1% of adults have schizophrenia; most become ill in their late teens or 20s. Approximately one in 10 will commit suicide.
Doctors and other mental health experts don’t fully understand the disease, which has no cure. Jani’s extreme early onset has left them almost helpless. The rate of onset in children 13 and under is about one in 30,000 to 50,000. In a national study of 110 children, only one was diagnosed as young as age 6.
“Child-onset schizophrenia is 20 to 30 times more severe than adult-onset schizophrenia,” says Dr. Nitin Gogtay, a neurologist at the National Institute of Mental Health who helps direct the children’s study, the largest such study in the world on the illness.
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