James T.R. Jones's blog

University of Miami Law School Talk

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In addition to my talks at the AALS annual meeting in San Diego on January 7 and 8, 2009 I am speaking at the University of Miami Law School on January 23, 2009 as part of a symposium on "Overcoming the Stigma of Disability."  For more information on this program, see http://www.law.miami.edu/studentorg/pppl/pdf/PPP&L_LONG_FLYER.pdf.

 

 

Mental Health Parity Legislation

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Today the following article regarding the new mental health insurance parity law appeared in the Louisville Courier-Journal:

 

Act will improve access to mental health treatment

By Laura Ungarlungar@courier-journal.com • December 22, 2008

 

For decades, insurers have provided less coverage for mental health than for diseases like cancer or diabetes -- often imposing stricter limits on treatment, higher co-payments and higher deductibles.

"It was totally unfair and inappropriate. Frankly, it was a clear demonstration of the stigma people place on mental illness," said James T.R. Jones, a University of Louisville law professor with bipolar disorder. "It was gross discrimination."

But a new federal law, due to go into effect in just over a year, promises to level the playing field for many of the 58 million Americans a year who suffer from mental disorders.

The Mental Health Parity and Addiction Equity Act -- passed as part of this year's bailout legislation -- will require employers and insurers to cover mental health and substance abuse at the same level they cover physical health.

"It will be a great thing," Jones said.

Since 2000, Kentucky has had its own mental health parity law, but it doesn't apply to a key group covered by the new law -- workers at self-insured companies that use their own money to pay health insurance claims. These companies, which are almost always large, employ about a third of Kentuckians who get insurance through their jobs.

Indiana also has a parity law, but both states exempt employers with fewer than 50 workers, as does the new law.

Despite the exclusion for small companies, the new law expands coverage for 113 million Americans, according to the Virginia-based advocacy organization Mental Health America.

Its overall financial impact is unclear, although many mental health experts say it may save money by getting people into care early so they don't wind up in emergency rooms with a crisis. The Congressional Budget Office estimates the law will push up insurance premiums by two-tenths of 1 percent -- or about $23 a year for an average family premium of more than $11,000. And Humana spokesman Jim Turner said costs associated with the new law "will have minimal impact on Humana health-plan members or Humana's operations."

Although no one says the law will cure all problems with mental health care, several patients and professionals said it's a step toward changing the way society views mental illness and making care more accessible to sufferers.

"I think it's one of the most positive things to happen in recent times for mental health," said Michelle Spurlock, vice president of nursing at Our Lady of Peace, a Louisville psychiatric hospital. "I can only hope it breaks down the stigma that still exists."

Cost of treatment

Experts said many Kentuckians and Hoosiers now skip mental health care because of cost.

Nationally, Mental Health America estimates that 67 percent of adults and 80 percent of children needing mental health care don't get it, "in large part because of discriminatory insurance practices."

Many patients also are forced to cut their care short.

Bonnie Rosenblatt said she was getting help at a psychiatric hospital this summer when she reached her health insurance limit -- about 20 days of care. Her doctor wanted her to stay, she said, but she couldn't afford to.

"I felt pretty desperate. I felt sick," said the 60-year-old former teacher from Louisville, who was in an outpatient program to treat her disorders. "I wasn't ready to leave yet."

Insurers not only place limits on days; some also set high co-payments for mental health. Spurlock said she has seen co-payments as high as $500 that must be paid up-front.

Spurlock said Our Lady of Peace keeps hospitalized inpatients as long as medically necessary even if insurance runs out, negotiating payment plans or relying on charity care. But she said people sometimes choose to skip needed outpatient care.

"We've seen some decrease in our outpatients. People are choosing to go for fewer days," she said. And many mentally ill patients wait to seek care until they are seriously ill, resulting in more of them ending up in emergency rooms.

Even before mental health benefits run out, people are finding it increasingly difficult to use them. A growing number of psychiatrists and psychologists, citing low reimbursement rates and problems with claims, are choosing not to take insurance or to only take certain types, said Dr. Jon Marhenke, an Indianapolis psychiatrist and immediate past president of the Indiana State Medical Association.

Rosenblatt said her psychiatrist doesn't take her insurance, and she must pay $95 a month out of pocket for the care. That's part of the $500 a month she pays for mental health care overall.

"I'd like them to treat mental health issues like they do physical problems," Rosenblatt said. "It's not equal."

Changing coverage

The new law -- which takes effect January 2010 -- will change coverage in many ways, affecting treatment limits, out-of-pocket costs, co-payments, co-insurance (the percentage people pay toward care) and deductibles. It applies to substance abuse treatment as well as mental health.

It's still unclear exactly how many people in each state will be newly covered because it's difficult to calculate the number who would be affected beyond those working for self-insured companies. Several mental health advocates said the law is not a panacea. Besides not applying to small businesses, there are no requirements about which conditions must be covered. There's also a "cost exemption" if a health plan can prove that parity raises its total plan costs by more than 2 percent the first year and 1 percent afterward.

Some insurers, such as Humana and Anthem Blue Cross and Blue Shield, have expressed support for the law, as have advocates.

"It is a huge step forward in terms of improving access to treatment," said Ramona Johnson, CEO of Bridgehaven Mental Health Services, where Rosenblatt said she's now getting good care. "It hopefully will change our culture's attitude about mental illness."

Reporter Laura Ungar can be reached at (502) 582-7190.

Mental Health Parity Legislation

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Today the following article regarding the new mental health insurance parity law appeared in the Louisville Courier-Journal:

 

Act will improve access to mental health treatment

By Laura Ungarlungar@courier-journal.com • December 22, 2008

 

For decades, insurers have provided less coverage for mental health than for diseases like cancer or diabetes -- often imposing stricter limits on treatment, higher co-payments and higher deductibles.

"It was totally unfair and inappropriate. Frankly, it was a clear demonstration of the stigma people place on mental illness," said James T.R. Jones, a University of Louisville law professor with bipolar disorder. "It was gross discrimination."

But a new federal law, due to go into effect in just over a year, promises to level the playing field for many of the 58 million Americans a year who suffer from mental disorders.

The Mental Health Parity and Addiction Equity Act -- passed as part of this year's bailout legislation -- will require employers and insurers to cover mental health and substance abuse at the same level they cover physical health.

"It will be a great thing," Jones said.

Since 2000, Kentucky has had its own mental health parity law, but it doesn't apply to a key group covered by the new law -- workers at self-insured companies that use their own money to pay health insurance claims. These companies, which are almost always large, employ about a third of Kentuckians who get insurance through their jobs.

Indiana also has a parity law, but both states exempt employers with fewer than 50 workers, as does the new law.

Despite the exclusion for small companies, the new law expands coverage for 113 million Americans, according to the Virginia-based advocacy organization Mental Health America.

Its overall financial impact is unclear, although many mental health experts say it may save money by getting people into care early so they don't wind up in emergency rooms with a crisis. The Congressional Budget Office estimates the law will push up insurance premiums by two-tenths of 1 percent -- or about $23 a year for an average family premium of more than $11,000. And Humana spokesman Jim Turner said costs associated with the new law "will have minimal impact on Humana health-plan members or Humana's operations."

Although no one says the law will cure all problems with mental health care, several patients and professionals said it's a step toward changing the way society views mental illness and making care more accessible to sufferers.

"I think it's one of the most positive things to happen in recent times for mental health," said Michelle Spurlock, vice president of nursing at Our Lady of Peace, a Louisville psychiatric hospital. "I can only hope it breaks down the stigma that still exists."

Cost of treatment

Experts said many Kentuckians and Hoosiers now skip mental health care because of cost.

Nationally, Mental Health America estimates that 67 percent of adults and 80 percent of children needing mental health care don't get it, "in large part because of discriminatory insurance practices."

Many patients also are forced to cut their care short.

Bonnie Rosenblatt said she was getting help at a psychiatric hospital this summer when she reached her health insurance limit -- about 20 days of care. Her doctor wanted her to stay, she said, but she couldn't afford to.

"I felt pretty desperate. I felt sick," said the 60-year-old former teacher from Louisville, who was in an outpatient program to treat her disorders. "I wasn't ready to leave yet."

Insurers not only place limits on days; some also set high co-payments for mental health. Spurlock said she has seen co-payments as high as $500 that must be paid up-front.

Spurlock said Our Lady of Peace keeps hospitalized inpatients as long as medically necessary even if insurance runs out, negotiating payment plans or relying on charity care. But she said people sometimes choose to skip needed outpatient care.

"We've seen some decrease in our outpatients. People are choosing to go for fewer days," she said. And many mentally ill patients wait to seek care until they are seriously ill, resulting in more of them ending up in emergency rooms.

Even before mental health benefits run out, people are finding it increasingly difficult to use them. A growing number of psychiatrists and psychologists, citing low reimbursement rates and problems with claims, are choosing not to take insurance or to only take certain types, said Dr. Jon Marhenke, an Indianapolis psychiatrist and immediate past president of the Indiana State Medical Association.

Rosenblatt said her psychiatrist doesn't take her insurance, and she must pay $95 a month out of pocket for the care. That's part of the $500 a month she pays for mental health care overall.

"I'd like them to treat mental health issues like they do physical problems," Rosenblatt said. "It's not equal."

Changing coverage

The new law -- which takes effect January 2010 -- will change coverage in many ways, affecting treatment limits, out-of-pocket costs, co-payments, co-insurance (the percentage people pay toward care) and deductibles. It applies to substance abuse treatment as well as mental health.

It's still unclear exactly how many people in each state will be newly covered because it's difficult to calculate the number who would be affected beyond those working for self-insured companies. Several mental health advocates said the law is not a panacea. Besides not applying to small businesses, there are no requirements about which conditions must be covered. There's also a "cost exemption" if a health plan can prove that parity raises its total plan costs by more than 2 percent the first year and 1 percent afterward.

Some insurers, such as Humana and Anthem Blue Cross and Blue Shield, have expressed support for the law, as have advocates.

"It is a huge step forward in terms of improving access to treatment," said Ramona Johnson, CEO of Bridgehaven Mental Health Services, where Rosenblatt said she's now getting good care. "It hopefully will change our culture's attitude about mental illness."

Reporter Laura Ungar can be reached at (502) 582-7190.

AALS Speech

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On January 8, 2009, Professor Elyn R. Saks of the Gould School of Law at the University of Southern California and I are the featured speakers at the Law and Disability Section/Law and Mental Disability Section program at the Association of American Law Schools annual meeting In San Diego.  The talk is from 8:30-10 AM and is entitled Law Professor Narratives of Mental Illness.  In it Professor Saks and I will address being successful legal academics with schizophrenia and bipolar disorder, respectively.

Spalding University Talk

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I received the folowing correspondence:

 

Dear Professor Jones:

 

I wanted to again extend my sincere thanks for your presentation to our psychology and social work faculty and students on October 29, 2008.

 

Your presentation on the Stigma of Mental Illness was both informative and entertaining.  I have received numerous comments from those in attendance about the positive impact your talk had on them and their perceptions of those suffering from mental illness.  I think the personal sharing embedded in your talk made it especially powerful.

 

Thank you for your willingness to share your experiences and insights with us.  Hopefully, we can have you back again in the coming years.

 

Sincerely,

 

Brenda Nash, Ph.D.

Director Adult Emphasis Area

School of Professional Psychology

Spalding University

ICORPS Talk

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Today I received the following correspondence regarding my talk last Thursday:

 

Professor Jones,

 

Thank you so much for speaking at ICORP's luncheon Thursday, November

6th, 2008. Your presentation was exactly what I had hoped it would be

and it was very well received. Your story is one that should be shared

not only with professionals such as myself and my colleagues, but also

with individuals who have a psychiatric disability so that they may be

inspired by your accomplishments. You should know that several people

approached me following your presentation and shared that they thought

your presentation was "just as good, if not better than" Dr. Frese's.

It seems the fact that you are new to this (speaking out against stigma)

was not obvious to those in attendance.

 

Once again, thank you for your wonderful presentation.

 

Brianne Lott, MRC, CRC

Employment Consultant

Business Empowerment Team

ICORPS Talk and WFPL Program

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On November 6 I spoke at the annual meeting of the Indiana Conference of Rehabilitative Psychiatric Services (ICORPS) in Columbus, Indiana on "Severe Mental Illness, Stigma, and the Value of Treatment."  On November 7 I appeared on "State of Affairs," a program on WFPL radio in Louisville, with The Honorable Susan Schultz Gibson, Jefferson Circuit Court, Division 12 and Elizabeth A. Garcia-Gray, M.D. and Marsha D. Wilson, C.S.W. of Seven Counties Services, Inc. where we spoke on "Living With a Mental Illness."  These were my fourteenth and fifteenth presentations on being a successful professional with a severe mental illness since March 11, 2008.

 

 

Elyn Saks Visit

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On October 26 and 27, Professor Elyn R. Saks of the Gould School of Law at the University of Southern California appeared in Louisville courtesy of NAMI Louisville.  On October 26 she spoke to an enthusiastic crowd of NAMI supporters in the Strickler Hall auditorium on the U. of L. campus, while on October 27 she spoke to an equally enthusiastic group at the Louis D. Brandeis School of Law.  Special thanks to Brandeis IT stalwarts Jim Becker and Joe Leitsch for helping make both events successful.

 

In connection with the October 26 event, NAMI Louisville Board Member Katharine R. Dobbins reported the following:

 

A hearty thank you to Jim Jones for all his work to bring Elyn Saks to

Louisville. It was a great evening! This is exactly the kind of thing

NAMI-Louisville needs to be doing. Not only did we have an outstanding

speaker with an incredibly important story to tell but we had a very nice

crowd. Between Elyn Saks, Susan Gibson, and Jim Jones presentations, we have

touched a lot of people in our community, introduced some people to NAMI,

reinforced the good reputation of NAMI-Louisville to others, and gotten the

word out that treatment works and recovery is possible. I am certainly proud

to be associated with NAMI-Louisville and so appreciative of Jim's efforts

in making last night a very memorable experience.

Kathy

 

Katharine R. Dobbins, LCSW

 

Mental Illness Awareness Week Talk

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I received the following from Robert B. McFadden, M.A., Ph.D., President of NAMI Louisville:

 

 

October 22, 2008

 

Dear Jim,

 

I am writing to thank you for your presentation at our Mental Illness Awareness Week event on October 6, 2008.  Without a doubt, this was our most successful advocacy and awareness activity ever.  The courage and clarity with which you told your story was inspiring to everyone there--and there were five, repeat five, empty seats, with more people than that standing at the door--all members and friends of NAMI Louisville, which is a family and consumer oriented organization.  The contrast between your experience and that of Judge Gibson gave great emphasis to our fundamental message:  treatment works and stigma causes tragedy.

 

We are grateful for your support and proud of it.  You are a most welcome member of NAMI and a splendid advocate for what we all believe in:  that stigma must be overcome and treatment must be provided.

 

Yours sincerely,

 

Bob

 

 

Elyn Saks Program on October 26 or 27.

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University of Southern California Law Professor Elyn R. Saks will be speaking at 7:30 PM on Sunday, October 26 in the Strickler Hall auditorium on the U. of L. Belknap Campus.  The title of her talk is "The Center Cannot Hold:  My Journey Through Madness," the story of a life of tremendous achievement while suffering from severe schizophrenia with a poor prognosis.  She will speak for 45 minutes, followed by 15 minutes for questions.  Then, she will autograph copies of her book, which will be on sale outside the auditorium, with a portion of the sale proceeds going to NAMI Louisville, which is paying for her visit to Louisville.  Those who already have copies of her book can also get them autographed.  The talk is free, and parking will be available either in the Speed Museum parking garage for $3 or in surface parking lots for free.  Reservations may be made for Professor Saks' address by calling the NAMI Louisville office at 245-5287, and they are strongly recommended.  Reservations will be held until 7:15 on the night of the speech. 

 

Professor Saks will repeat her address on Monday, October 27 at 12:00 in Room 275 of the Brandeis School of Law, with the program scheduled to end at 1 PM and book sales and autographing to follow.  Parking will be more of a problem then, but anyone who wishes to attend her free speech on Monday can contact the parking office for assistance.  Reservations are not being taken for the Monday talk.  Courtesy of the Diversity Committee, lunch is being served at the Monday event.

Professor Saks is the Associate Dean for Research and Orrin B. Evans Professor of Law, Psychology, and Psychiatry and the Behavioral Sciences at the Gould School of Law at the University of Southern California;  Adjunct Professor of Psychiatry at the University of California, San Diego, School of Medicine;  and Research Clinical Associate at the New Center for Psychoanalysis in Los Angeles