Federal Assistance for the Mentally Ill

The Times is right in saying the federal government must step up to the plate and stop discriminating against people with mental illness (“A Deadly Group Home,” editorial, Oct. 21). The discrimination comes from a little-known restriction in Medicaid known as the Institutions for Mental Diseases exclusion. While the federal insurance plan will pay for hospital care beyond 30 days for people with other medical disorders (strokes and Parkinson’s are examples), it excludes payment for long-term care of people with brain disorders such as schizophrenia.

There is a disastrous trickle-down effect of neglect that results from this exclusion as states and counties try to utilize the allowed federal benefits. People with mental illnesses who need extended hospitalization frequently do not receive it. They are instead placed in facilities that are not up to their needs for care and treatment. And county funds that could be used in the community to shore up out-of-hospital services are diverted to the long-term care for the few who do receive it. It’s time to stop the discrimination. The president’s New Freedom Mental Health Commission should look carefully at your suggestion.

Carla Jacobs

National Alliance

for the Mentally Ill

Tustin

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Homelessness is a tragedy, but allowing our nation’s veterans to live on the streets is a national disgrace. Many of our veterans have suffered the trauma and stresses of war.

This year, New Directions opened a model 43-bed treatment facility. The program was developed in collaboration with the Veterans Affairs Department to address the multiple needs of veterans who are diagnosed with a major mental illness and a substance abuse disorder (dual diagnosis). Many also suffer from hepatitis C and other health issues. The funding, foundation grants and donations are no longer available for this project.

The city of Los Angeles has no mental health funding, and L.A. County’s Department of Mental Health has had dramatic cuts and refuses to fund programs that serve veterans because it feels that the VA ought to be providing this service. The VA continues to cut mental health funding, and the state Department of Mental Health does not provide direct funding and has no dual-diagnosis grants.

It is critical for Bush’s New Freedom Mental Health Commission to make funding for programs that are finding solutions for individuals with co-occurring disorders (especially veterans) a priority. Americans cannot go to war and expect our soldiers to return unscathed. Homelessness is not an answer to mental illness; it is a symptom of political priorities.

Toni Reinis

Executive Director

New Directions, L.A.

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The mechanism for accomplishing what you term “clean, well-staffed, independence-oriented alternatives” financed through the Medicaid system is already in place and requires no new legislation. Medicaid funding (called Medi-Cal in California) for adult residential treatment programs, group homes and the like for people with severe and persistent mental illness has been recognized since 1993 in California for programs with relatively small, homelike environments, 16 beds and under, through a waiver granted by the federal government in connection with the state’s adoption of the so-called “rehab option.” The federal government picks up 50% of the cost for those who are Medi-Cal eligible. Ours was the first of these programs locally to be so funded in 1993.

Unfortunately, there has not been either the will or the funding available by the state for the federal government to match on a dollar-for-dollar basis these vitally needed services beyond 1993 levels. As you correctly point out, so-called “independent living” solutions are unlicensed and unregulated, and they typically lack the structure and support necessary for clients to make it on their own. They are cheaper short-term solutions, but without support, monitoring and a rehabilitative focus, clients frequently decompensate and ultimately require much more expensive inpatient care, resulting at best in the revolving-door phenomenon and, at worst, in incarceration or, as you suggest, even death.

Kenneth A. Parker

Clinical Prof. of Psychiatry USC

Mary Czech

Director of Operations

Transitional Living Centers

for L.A. County, Lawndale