Mental Health Care: Past and Present

The history of mental health care in the United States has been spotty at best. Prior to the creation of mental health institutions, most mentally ill individuals were often left to their own fate, which was often not good. Those who did receive care were usually locked away in the family home and hidden from the world.
Mental institutions weren’t much better, however. In the early days, patients were often locked away in dark and dank asylums and forced to live in dangerous and unhealthy conditions. What little care they did receive for their illnesses was more punitive than therapeutic and included beatings and dangerous and debilitating surgical procedures designed to physically remove what was believed to be the root of the illness.
Over time, thanks to the advocacy of individuals like Dorothea Dix, as well as an increased understanding of the mechanisms driving mental illness, including the differences in the way mental illnesses and substance abuse affect men and women. The treatment methods improved, as did some of the conditions under which the institutionalized mentally ill were living.
However, with the advances and improvements in care also came a disturbing new trend: deinstitutionalization.

mental health problem

What is Deinstitutionalization?

Deinstitutionalization is the process of releasing mentally ill patients from institutional inpatient care, back to their families and to outpatient treatment programs.

It was believed that patients believed that patients would fare better if they received treatment in a “warm” family environment, rather than a “cold” institution. Money was also an issue in that many of the institutions in question were state-funded and many of those institutions were either fully or partially decommissioned, and much of their public funding was cut, once the patients were released.
Although one of the goals of deinstitutionalization was to improve patient care, the result was actually the opposite.
Many of the patients released were severely mentally ill and, even with medication, families were often not prepared to handle the needs of the mentally ill, and many of them also didn’t have access to resources or support from the professional psychiatric community. Some patients also did not have supportive homes to return to. As a result, those whose families could not care for them, and who could not afford private mental health care, often faced abuse at home, became homeless, or were incarcerated.
Deinstitutionalization started in the 1950s and continued for several decades. The number of people in state-funded mental institutions was down from 560,000 in the 1950s, to 130,000 in the 1980s. The number continued to drop as institutions continued to lose funding, and insurance companies stopped covering in-patient mental health care.
However, the Affordable Care Act has made some changes in the way insurance companies cover mental health care, which could make it more accessible for all.

The Affordable Care Act and Mental Health Care

Under the Affordable Care Act, treatment for mental health and substance abuse disorders are considered essential services, which means that all health insurance plans must include some type of coverage for these services.
Also, because the Affordable Care Act prohibits insurance companies from denying coverage for pre-existing conditions, this means that people who have been diagnosed and were previously uninsured can now get insurance; as can those who were previously covered under their parent’s insurance and now have to get their own.
Additionally, in states that have expanded Medicaid, this also means that those who might have been ineligible for Medicaid, but unable to afford insurance otherwise, could now qualify for free or seriously discounted coverage.
However, the provisions in the Affordable Care Act are not perfect, and there is still room for people to fall through the cracks. For one thing, the states can determine which services are covered, which means that a state could require an insurance company cover medication and outpatient care, but not inpatient care.

Learning Your Options

If you already have insurance, your best bet is to contact your insurance company for information on which mental health services they will cover. Most Insurance companies, like USH Advisors, have consumer or agent portals where you or your insurance agent can log in and find specific information about your coverage.

If you don’t have insurance coverage, and you are within the enrollment period, you can go to the healthcare marketplace for your state and review the plans that are available to you. Each option should provide a link to more information, including coverages for mental health and substance abuse treatment.

If you do not wish to use the marketplace, you can also go to a site like EHealth Insurance for information on the policies available in your area. However, USHAdvisors and other healthcare companies often have their own websites, where you can also find information on the products available, as well as contact numbers for customer support and coverage information.