Analysis: Mental health snags still exist

By OLGA PIERCE, UPI Health Business Correspondent   |   March 29, 2006 at 11:41 PM

WASHINGTON, March 29 (UPI) -- Social stigma and lack of funding are still preventing progress in the areas of veterans' health, suicide and mental health in the workplace,experts said Wednesday.

Three years after President Bush convened the first New Freedom Commission on Mental Health, the commissioners met again to assess progress on the recommendations in their original report.

"Our main area of progress has been spreading a message of hope and recovery that has been grabbed onto by people around the country," commission chair Michael Hogan told United Press International. "In many states, people have been very actively working to improve resources, even while budgets are in trouble."

But at the federal level, there has been a lack of leadership, that has made local work more difficult, Hogan said. "The grassroots response has been better than the national response."

Mental health advocates spoke of the continuing need for increased resources and outreach for individuals suffering from mental illness.

Stefanie Pelkey described the ordeal of her husband Michael, who began displaying symptoms of post traumatic stress disorder (PTSD) after he returned from fighting in Iraq.

He had trouble accessing military mental health services, and his officers and wife -- who was also in the army -- did not realize the severity of his symptoms. He ultimately committed suicide by shooting himself in the chest, leaving behind his wife and a baby son.

After her husband's death, Pelkey said she had trouble accessing benefits because her husband had not been diagnosed with PTSD by an official military psychiatrist.

The families of returning soldiers need to be better educated on the symptoms of PTSD, Pelkey said, and services need to be made more widely available and for a longer period after troops return from war.

"I feel the lessons have not been learned," she said. "I have traveled and seen programs that work, but they are different from post to post and sometimes not available at all. It needs to be centralized so all soldiers can access them.

Pelkey added, "Until the senior leaders of our country start recognizing these deaths outside the theatre of operations, soldiers will not come forward with their own battles with PTSD."

Frances Murphy, deputy under-secretary for health and health policy coordination at the Department of Veterans' Affairs outlined changes the agency is undertaking to help the estimated 18 percent of soldiers who served in Iraq and the 11 percent who fought in Afghanistan who have PTSD.

The steps include instituting face-to-face sessions for returning troops, longer term post-deployment screening, and a "no wrong door" policy that offers veterans many entry points to access the VA mental health system.

But more expansion is needed, Murphy said, to treat the ever-increasing number of veterans who need help. In the past three months, the VA has seen a 30 percent increase in PTSD diagnoses, she noted.

To perform its mental health function well, said Joy Ilem of the Disabled American Veterans, the VA system needs to be better funded and better integrated with community and follow-up care options, and the period of eligibility for VA services needs to be extended from two to five years.

In the area of suicide prevention, panelists said, much work has taken place at the grassroots level, but many mentally ill individuals still lack access to care because of finances or distance.

Marley Prunty-Lara described her struggles coping with bipolar disorder in rural South Dakota. Ultimately, her parents were forced to mortgage their home to afford to send her to a hospital 350 miles away, in another state.

In 2003, more than 31,000 people committed suicide and 410,000 were treated in emergency rooms for suicidal behavior, said Ileana Arias of the Centers for Disease Control and Prevention.

Efforts to combat suicide, however, are often foiled by tight budget constraints and reluctance to publicly discuss the topic.

Testimony by Calvin Nunnally, Sr., suicide prevention manager at the Virginia Department of Health, illustrated the constraints local governments face when trying to lower suicide rates.

The department requested $800,000 for youth suicide prevention, but was allocated $75,000. Later, the budget was reduced even further to $21,000. With its limited resources, the department has focused on providing training to individuals and groups that work with youths.

Increased public dialogue will help eliminate the stigma associated with mental illness, panelists said. Increased funding will help make more resources available.

At the federal level, limits on Medicaid rehabilitation services threaten to exacerbate existing access problems, Hogan said. At the individual level, employers can improve the mental health of their employees and their bottom lines by offering the same insurance coverage for mental illness that is offered for physical ailments.

Currently, health plans often offer a more limited range of mental health services and charge much higher co-payments.

Ron Finch, vice president of the National Business Group on Health, agreed that businesses should pursue mental health parity by offering the same coverage for mental and physical treatments. "The one thing employers know is that treatment works," Finch said.

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