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Better mental health care is worth the expense

When more than half of people who need mental health care can’t or don’t get it — as is true in the U.S. — other problems arise. For sufferers, these include physical illness, lost earnings, substance abuse and suicide. For society, there is greater crime and homelessness.

So legislation in the House of Representatives meant to expand mental health care is welcome. The bill, which could soon get a vote, would give mental health issues more weight within the Department of Health and Human Services and improve tracking of wait times for psychiatric beds. It would also provide small grants for suicide prevention, for educating new psychologists, and for training police to better engage with the mentally ill.

Yet mental health services in the U.S. are so inadequate that these changes would still leave many Americans without the care they need.

In the past two decades, mental health services have been shrinking, not growing. From 1992 to 2012, the number of psychiatric beds per capita fell by two-thirds, to just two for every 10,000 people. The U.S. is the only affluent country where the number of psychiatrists per capita fell from 2000 to 2011, even as it spends twice as much as others on health care.

To expand psychiatric care as much as is needed would necessarily increase that spending. Federal money is required to pay for more treatment via Medicaid and Medicare.

For example, the legislation wouldn’t change Medicare’s 190-day lifetime limit on inpatient psychiatric care. That’s especially restrictive for working-age adults on disability; better access to care could help people with mental illness rejoin the workforce. And the law would still limit Medicaid’s ability to pay for inpatient adult psychiatric care.

Sponsors of the House legislation note that their approach won’t add to the federal budget; that may be what it takes to get any bill through this Congress. Certainly, more federal spending isn’t the only way to fill the mental health gap. The legislation will push private health insurers to adequately cover mental illness, as well.

But wider coverage by government health plans is still needed. Adequate spending on mental health would save other social and government costs down the road. Left untreated, mental illness drains the public purse one way or another.

Bloomberg View, June 22

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Politics make Haiti's economic chaos acute

The Caribbean island nation of Haiti is once more in a first-class political mess.

Its previous elected president, Michel Martelly, a former entertainer, stepped down in February with no successor in place. On June 14, the 120-day mandate of the provisional president, Jocelerme Privert, expired, with no permanent or provisional successor lined up. Haiti’s two-house legislature, currently composed of 22 senators and 92 deputies, was supposed to meet either to extend Privert’s term or to choose another provisional president, but it didn’t, two days running.

Therefore, the nation of some 11 million, sharing the island of Hispaniola with the Dominican Republic, is left with no president at all and a clearly dysfunctional legislature, also incapable of governing.

Haiti’s problems remain manifold. It still hasn’t recovered from the 2010 earthquake that claimed an estimated 46,000 to 85,000 lives, originally overstated to be 316,000. That disaster attracted a considerable amount in aid pledges, including more than $4 billion from the United States.

Some of the promises of aid have turned sour. First, many donors have not respected their commitments. A just-released report by the U.S. Senate charges that the American Red Cross, one of the major organizations working in Haiti on earthquake relief, spent a disproportionate amount of its resources on fundraising, salaries and other administrative costs instead of on actual relief — which the American Red Cross denies.

Another major problem is that for years Haiti has depended on regional charity, particularly in the area of petroleum provided by neighboring Venezuela. That country, with the death of President Hugo Chavez, followed in its presidency by Nicolas Maduro, has fallen into disastrous circumstances. Venezuelans, in spite of the country’s oil wealth, are suffering from major shortages of food and medicine, for example, and high inflation, which Maduro is showing no signs of ability to deal with. There is now pressure for a referendum to recall him. Venezuela’s ability to help Haiti has dropped to zero.

Haiti’s first order of business is to put in place an interim president. It is scheduled to hold new elections in October. The political mess is not new for Haiti, but that doesn’t relieve the situation of its very poor population, probably the most miserable in the hemisphere.

​Pittsburgh Post-Gazette, June 22

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