Needless Suffering

The article “AMA Calls for Remedies for Psychiatric-Bed Shortage” in the July 18 issue did an excellent job of outlining the access challenges facing far too many individuals with serious mental disorders and the resulting backlogs occurring in emergency departments.

One way to confront these problems is to encourage Congress to address the impact of the Medicaid Institutions for Mental Disease (IMD) exclusion. There are hundreds of hospitals where payment for needed psychiatric treatment is prohibited. Specifically, Medicaid reimbursement is prohibited by statute to psychiatric hospitals serving adult patients aged 21 to 64, even when treatment is required by the Emergency Medical Treatment and Labor Act. Legislation is currently pending in Congress (S 2406/HR 2050) that would allow Medicaid patients who receive care in psychiatric hospitals to have coverage under Medicaid, and the measure would compensate psychiatric hospitals for these essential services.

The legislation would result in patients' receiving the right care, at the right time, and in the right setting instead of prolonged stays in emergency rooms. The measure is backed by a broad coalition of organizations, including APA, the National Alliance on Mental Illness, the American College of Emergency Physicians, and many others.

With access to inpatient psychiatric beds a growing problem, this is an important time to urge action to address outmoded and antiquated provisions, such as the IMD exclusion. Health care reform will be on the national agenda as Washington, D.C., prepares for a new administration and Congress. An important part of overall health care reform is ensuring that mental health care is treated on par with all other health services, including access to all levels and sites of care.