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Medication Access Key To Treatment

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By RICK WAGNER

Published: September 18, 2007

Untreated mental illness is a far more serious problem in our state than most people realize. The signs of untreated serious 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.

Of our 50 states, Florida falls second to last in per-capita mental-health spending. Sadly, that ranking could slide another notch (or two) if deeper cuts 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 Pharmacy and Therapeutics Committee, which has supported unrestricted access to medications for Medicaid recipients with severe mental illnesses.

In some states, health care administrators choose which mental health medications are put on preferred drug lists based primarily on costs. Florida established such a list in 2001, but thus far, all drugs used to treat bi-polar disorder and schizophrenia have remained on the list.

This sound public policy translates into recovery for many people. It gives physicians the flexibility and freedom needed to effectively treat people with mental illnesses who are difficult to manage. But now that could change. The committee will soon recommend what the state's future policy on access to mental health medications should be.

New atypical antipsychotic drugs have revolutionized the treatment of mental illnesses. They are the new front lines in the battle against chronic 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 considered in treatment decisions. And what works can change over time.

Allowing open access to all mental health medications helps prevent the very high costs associated with destabilization and 'decompensation.' A person with serious mental illness who 'decompensates' falls apart mentally and emotionally, signaling the onset of psychosis.
Decompensation is not a temporary setback. Each downward spiral results in an irrecoverable loss of functioning and stability. People who are not stabilized 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 mental health centers and cutting Medicaid spending, it is only shifting costs. These costs will be borne many times over elsewhere for high-cost crisis care.

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.

Rick Wagner is chair of the Mental Health America Public Policy Council of Florida and current president of Mental Health America of Greater Tampa Bay.

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