Meds

Continued access to mental-health meds is critical for patients

Untreated mental illness is a far more serious problem than most people realize. The signs of untreated serious mental illnesses are very visible in our communities. All you have to do is visit a county jail or prison, sit in a courtroom for one day, walk through a downtown park or volunteer at a homeless shelter. naplesnews.com
Guest commentary: Continued access to mental-health meds is critical for patients

PETRA JONES, Special to the Daily News

Saturday, September 1, 2007

Untreated mental illness is a far more serious problem than most people realize. The signs of untreated serious mental illnesses are very visible in our communities. All you have to do is visit a county jail or prison, sit in a courtroom for one day, walk through a downtown park or volunteer at a homeless shelter.

Florida�s failure to adequately fund mental-health treatment is a national embarrassment. Of our 50 states, Florida falls second to last in per-capita mental-health spending. Sadly, that abysmal ranking could slide another notch (or two) if deeper cuts still are made to community mental-heath centers and services.

The one bright spot in Florida�s mental-health landscape has been the leadership of the Agency for Health Care Administration�s Pharmacy and Therapeutics Committee (P&T) which has afforded Medicaid recipients with severe mental illnesses unrestricted access to medications. They�ve kept open access despite unrelenting pressure to cut the costs of Medicaid spending on mental-health medications. In some states, health-care administrators pick and choose which mental-health medications are put on preferred drugs lists based primarily on costs. Florida established such a list in 2001, but thus far, all drugs used to treat bipolar disorder and schizophrenia have remained on the list.

This sound public policy translates into recovery for many people who had lost hope, because it gives physicians the flexibility and freedom necessary to effectively treat people with mental illnesses that are notoriously difficult to manage. But now that could even change.

On Sept. 12, the P&T Committee will recommend what the state�s future policy should be regarding open access to mental-health medications.

Newer generation atypical antipsychotic drugs have revolutionized the treatment of serious mental illnesses. But as the name suggests, atypical antipsychotic medications are not therapeutically interchangeable. They vary in molecular structure; dosing strengths and formulations; side effects; efficacy and safety. They are the new front lines in the battle against chronic mental illnesses, and without them, many patients will not recover.

While mental illness is treatable, it�s very complex: People with the same diagnosis often respond very differently to the same medication. Onset and severity of symptoms, age, gender and even race must be factored into treatment decisions. And what works can change over time, requiring an adjustment or switch to another medication.

Allowing open access to all mental-health medications helps prevent the very high costs associated with destabilization and �decompensation.� To �decompensate� is a word that has become part of our lexicon, but most people don�t understand what the word really means and how serious it is. A person with serious mental illness who decompensates falls apart mentally and emotionally, signaling the onset of psychosis.

Decompensation is not a temporary setback for a person with a serious mental illness; each downward spiral results in an irrecoverable loss of functioning and stability. People with serious mental illnesses who are not stabilized on the appropriate medication often require services in crisis centers and hospital emergency rooms and may well become an expensive burden for law enforcement, the courts and jails.

When the state talks about cutting services to community mental-health centers and Medicaid spending to realize savings, they are only shifting the costs, and then some. These costs will be borne many times over elsewhere for high-cost crisis care. Continued underfunding places barriers to treatment, leaving the care for some of our state�s most vulnerable citizens in the hands of those who admittedly are the least equipped to deal with them: police officers and prison guards.

Florida�s policy of open access is good medicine and good economics. Full access to medication is the least expensive and by far the most humane treatment option for people with serious mental illnesses. All available treatments should remain on the table.

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Petra Jones, of Naples, is the executive director of the Mental Health Association of Southwest Florida.

� 2007 Naples Daily News and NDN Productions. Published in Naples, Florida, USA by the E.W. Scripps Co.

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