Closing of Outpatient Clinics, Change in Insurance Coverage Prompts Mentally Ill To Seek Treatment in Maryland ERs

The closing of many outpatient clinics in Maryland that provide mental health services and the state's "drasti[c]" cutbacks in what mental health services it will cover have forced many mentally ill people turn to emergency rooms for care, the Washington Post reports. Emergency departments, which cannot deny patients treatment but often are "ill-equipped or unwilling" to treat people with mental illnesses, have reported a 17% increase in the number of psychiatric cases from the first six months of 2000 through the same period in 2001. Pegeen Townsend, a lobbyist for the Maryland Hospital Association, said, "Around the state, I'm hearing ERs are being inundated by folks with mental illness, and [hospitals] are finding it very difficult to find a place to put them."

Money 'Root'
The Post reports that "money problems" dating back to 1997 are the "root" of the situation. The state's mental health system is expected to have a $20 million budget deficit this year (Mosk, Washington Post, 2/6). Under the system, people with mental illnesses severe enough to qualify as a disability are eligible for coverage under Medicare. The program covers only half of a psychiatrist's bill and not medications. Until 1996, Maryland had covered the remaining bills for Medicare beneficiaries who were dually eligible for Medicaid because of their incomes. When the state ended that practice, many patients were unable to pay the portion of their bills that Medicare did not cover (Kaiser Daily Health Policy Report, 1/15). Michael Fitzpatrick, director of state policy for the National Alliance for the Mentally Ill, said that the state's situation "mirrors" that of other states which use managed care systems to cover people with mental illnesses. This summer, state officials asked Maryland Health Partners, the state's managed care contractor, to change the way it approved or denied requests for mental health treatment. The contractor thus began "aggressively managing care" and "carefully scrutin[izing] coverage for therapy, life skills training and prescription management," the Post reports. This change resulted in an increase in treatment denials and saved the state $15 million. State mental health officials maintain that the cutbacks have not impacted patient care. "We told MHP we need to make sure people are getting the right level of care," Oscar Morgan, director of the state's Mental Hygiene Administration, said. MHP President Damian Briggs added that patients have not been denied "care they need." Lori Doyle, vice president of Revisions Behavioral Health Systems, said, "Cost containment is happening on the backs of people in dire need. These are folks who hospitalize themselves as a last resort. To just say they don't need these services is putting them at risk" (Washington Post, 2/6).