Fair Deals for Mentally Ill

Investigators from the Justice Department visited Metropolitan State Hospital in Norwalk last week to check out allegations that staff at the institution for the mentally ill had excessively restrained and medicated patients. Whether federal charges result or not, the investigation illuminates a deeper problem: a steady decline in funding for inpatient care of the seriously mentally ill.

To his credit, President Bush has acknowledged a piece of the problem: that health insurance often discriminates by paying for serious physical illnesses like cancer but not for equally debilitating mental illnesses like autism and schizophrenia. Bush should go beyond sympathy to action.

Specifically, he should pressure GOP leaders in the House to schedule a vote on HR 4066, a measure by Reps. Marge Roukema (R-N.J.) and Patrick J. Kennedy (D-R.I.) and co-sponsored by a majority of House legislators that would end disparities in coverage of mental and physical illness. Since the bill is a mirror image of legislation that has already passed the Senate, it would quickly become law if Bush supported it.

Employers and health insurers want the legislation to exempt them if they can show that it would increase premiums by more than 1%. This issue is ripe for compromise, as the sponsors of the Senate measure have already agreed to a 2.5% exemption trigger.

The bills also need work on their unclear definitions of qualifying mental illnesses. A final bill should limit the mandate to diseases that psychiatrists agree cause significant “functional impairment.” This would clearly cover severe schizophrenia, but not moderate anxiety. There is room to fight in the middle, but at least “impairment” draws a line.

State leaders also can help correct discrimination in care of the mentally ill. By all accounts, conditions at state hospitals like Metropolitan nose-dived after the state, to cut costs, shuttered Camarillo State Hospital in 1997. Camarillo was a national model of inpatient care for mentally ill children. Metropolitan--now the last state hospital to accept such children--is overcrowded and no one’s ideal.

Its 101 children ages 11 to 18 have been rejected from an average of 15 prior placements in group or foster homes. They look out not to the green agricultural fields that surrounded Camarillo but to charcoal gray razor-wire fences and guard towers that separate them from the 803 adult patients, including 370 prison inmates, also housed in the facility.

The state doesn’t have the money to reopen Camarillo, but legislators could help by rethinking the current policy of sending sexually violent predators to state mental hospitals rather than prisons. That would make room at other state hospitals for the inmates housed at Metropolitan. And the children who are at the end of the line at Metropolitan might at least feel like they’re in a hospital, not a prison.