Crisis Living Rooms

The default destination for someone in a mental health crisis that requires police intervention is a hospital emergency room.  But, as an article in the High Country News focusing on an effort to find alternatives notes, an ER isn't very well suited to addressing mental health crisis events in a proportionate, deescalating way.  The alternative model of a "Crisis Living Room" removes the aspects of an ER that can be counterproductive while having a staff well trained in dealing with a mental health crisis.

The Bigger Picture

While I understand the funding parity interest in equating mental health care and physical health care, ultimately, I don't think that a physical trauma and disease oriented model is a good one for mental health care.

The kind of professionals and institutions that provide mental health care best barely overlap at all with those well suited to physical health care. And, good psychiatric care rarely requires a skill set that can be acquired only by someone with a full fledged M.D. with 95% of the curriculum devoted to physical health conditions that have little or no relationship to mental health conditions, with the very high hourly rate for professional services that comes with it.

A disease model of mental health care for conditions that predominantly are unchangeable aspects of who patients are which need to be managed, rather than something that is "cured" or "fixed" in short order, doesn't make sense either.

And, piggybacking on a health care system that has at its foundation employer provided health insurance which takes a high level of bureaucratic conformity and emotional persistence to manage successfully is ill suited to a population that often has episodic absence from the work force and intrinsic difficult navigating the system is also ill founded.  Proof is in the pudding - the number of in patient psychiatric beds has fallen to ridiculously low levels relative to the need because funding has not been there.

Mental health, more so than physical health apart from contagious diseases, is something we provide not just for the benefit of the patient, but for the benefit of the community, because untreated mental health conditions are externalities that can do great harm.

There is nothing inconsistent or problematic about designing a health care system in which mental health care might be designed on a single payer universal system with a pro-active approach to bringing people into the system, much like the public schools, while physical health care might be handled mostly on a much more patient driven basis under something like the current Obamacare mix of employer provided insurance for people who work for big business, insurance exchanges with incentives for the self-employed and small businesses, Medicaid for the poor, and a single payer system for the elderly.

Even the physical care system already has an institutionally quite different set of arrangements for trauma and acute illness care (for which insurance company preferred network providers are dispensed with) and non-trauma care.

Likewise, the case for establishing universal free or low cost access to reproductive health care in a manner that is largely independent of the employer based health insurance regime and the vagaries of politics, for example, funding it through a long term endowment, might make a lot of sense.

Neither mental health care, nor reproductive health care, make up a particularly large share of the U.S. health care budget.  Mental health care and substance abuse treatment makes up about 7% of the total health care budget.

Comprehensive reproductive health care including birth control, abortion, STD treatment, prenatal and obstetric care, and fertility treatments is considerable less expensive - and the politically most sensitive aspects of it - birth control, abortion and STD treatment - are all quite inexpensive per capita indeed, but if funding for these were "solved" the political barriers to other kinds of government health care mandates and funding could be greatly reduced.

Even in the case of much less controversial reproductive health care services, evaluating reproductive health care needs based upon on per lifetime perspective, rather than a per year perspective, makes much more sense from an insurance underwriting and total health care perspective.  Your prenatal and delivery health care quality should not be a function of the particular economic circumstances you have in the year that a baby is born for an event that happens a relatively small number of times in a lifetime.  This can lead to mischief and inappropriate incentives on the part of both insurance companies and health insurance beneficiaries (who might, for example, have children inappropriately early for themselves in their relationship due to the availability of health care at the moment, or might postpone childbearing due to its lack when it would otherwise be a good time to have children).