Mental Illness Funding, Healthcare Coverage and Bureaucracies: What a Headache!

Being Canadian, having a mother who worked for Toronto Public Health and having a father who worked for Ontario Power Generation, I have never had to worry about whether or not I could 'afford ' to get sick. If I were to notice a painful bump on my wrist, I'd see my doctor and be told - for free - that it was a benign ganglion cyst. If I were ever to need antibiotics, I'd get a prescription, pay 6 bucks and pick up some erythromycin. If I fell off my bike and heard a big crunch in my elbow... Well, you get the point. So when I read about people not being able to afford healthcare services, I'm a little bit baffled and a lot freaked out. What would happen if a private system usurped our own universal healthcare policies? What would happen to me if I were ill and lived in a country where I could not afford to get healthy?

This is the case for an 8-year old boy named Carlos in LA, whose story is told in a CNN broadcast. This little guy suffers from severe anxiety and ADHD, both of which can be crippling for any kid, socially and academically. Carlos's family is very poor and must rely on state-sponsored insurance for healthcare coverage. Because such coverage limits the types of clinics at which one can apply for service, Carlos's family had a great deal of trouble finding a place to get him help. The family sought for some place to help him for close to a year and was turned away by 4 different clinics, since he was not seen as an emergency. Carlos was finally accepted at a free clinic where he receives ongoing counselling, including art therapy sessions.

It really amazes me that such a case as Carlos's would be turned away by so many places because he is not an emergency, i.e. he is not violent or suicidal. The obvious problem with the "emergency" criterion is that there may not be a large enough interval for the child's family to seek help between the time a child displays such behaviour and the point at which something really serious happens. For example, what if Carlos were a bit older - his teens, let's assume - and did not display any violent behaviour... until one day when he beats up another kid and puts him in the hospital? Wouldn't the damage already be done at this point? And perhaps it could have been totally avoided altogether had Carlos been able to get help earlier.

Now, I'm not blaming the clinics here because, as the video explains, so many of the public clinics in the States are overworked and underfunded. This no doubt goes for Canada's healthcare system also, which is horrendously burdened as it is. On top of that, it's quite possible that a troubled kid like Carlos would not be able to access the kinds of services he needs for free here, since - although I love our system - many such services are not covered by provincial health plans. For example, you are only covered for most types of counselling services if you have additional coverage to what's provincially funded, e.g. from the workplace. So if you experienced an emotionally traumatic event in your life and felt the need to speak to a therapist, chances are you'd have to pay out of your pocket unless you have additional coverage; OHIP's not covering your back, that is. In terms of Canada, I can't imagine that more comprehensive coverage will be funded by the province any time soon, but with Obama's recent proposals towards a more universal healthcare system, I have some hope that the States may be moving towards a more Medicare-ish system... I don't imagine, however, that the US will be covering MOST psychiatric services within the near future.

That's another thing: why are mental illnesses still treated as outside the medical sphere in so many cases? Why isn't psychiatric care taken more seriously, even with the vast body of medical knowledge we've amassed over the past several decades? We know that people with severe mental illness can be at great risk for future problems, and yet still psychiatry receives a fairly low proportion of healthcare funding. For example, persistent depression early in life has been strongly linked to the development of Alzheimer's later in life. And, of course, people with debilitating mental illness - including severe depression - no doubt can become a "burden" on the welfare system in the long run if they are unable to work or to function independently. (For those of you interested, Pat Capponi's work speaks to the plight of the impoverished mentally ill from a first-hand perspective.) Thus, I think that, from my very callow economic perspective, we'd be saving money in certain sectors (such as welfare programs and even law enforcement) if we were to shift some of the healthcare dollars towards programs for the mentally ill. Not to mention the fact that people are suffering just because of a condition they cannot help.

But, just as the Ministry of Health Promotion and the Ministry of Health and Long-term Care have so far found great difficulty in functioning interdependently and still efficiently (as discussed in class - think back to the elephantine organization charts for these two departments), healthcare funding and social programs like welfare don't seem to talk, don't seem to see their interrelatedness. This is, quite simply put, the nature of a monstrous bureaucracy. In addition, as we also discussed in lecture, there seems to be a very lengthy praxis cycle for much research; thus, even when we have solid evidence for a connection between two issues - taking for example the aforementioned link between Alzheimer's and depression - there seem to be great inefficiency and delay in applying such knowledge to policy and to practice. This could not be more true than in a lot of nutrition research, in spite of the fact that our own degree is called a Bachelor of Applied Science!

Anyway, I don't have all the answers, nor do I claim to. The inefficiencies of large bureaucracies, the plight of the uninsured and the persisting neglect of psychiatric care are issues that have been problematic for decades and won't change with a simple tax hike or a critical thinker in power. In any case, as academics, we can keep supporting research in these areas and as future practitioners, hopefully we will one day fight for change.