By Gerald Beallor, ACSW Co-chair Health Care and Policy Practice Network, Barbara Brenner, Dr. PH, Chair Managed Care Coordinating Committee, HCPPN

(October 2000)

The need and demand for mental health services for survivors and surviving family and friends in New York City, following the September 11 terrorist attacks on the World Trade Center, continues. Social workers in New York City, working with disaster victims and their families, report trauma experienced by survivors, rescuers and surviving family members or friends; and, widespread generalized grief, anxiety and fear. Those with a history of past trauma and loss are at greater risk for a reoccurrence of anxiety, problems with sleep and concentration, uncontrolled anger and other behavioral problems in response to this disaster.

A major issue for our local communities and nation is the adequacy of private and public health and behavioral health insurance plans to address the ongoing mental health care needs that are expected to increase among both adults and children. At the moment, the mental health professions, both agency based and individual practitioners, are volunteering to provide crisis intervention and immediate grief counseling to individuals and families. As the immediacy of the disaster and volunteer staffing fades, current mental health care supply and financing problems will mitigate against appropriate mental health care of individuals and families.

Access to mental health services for adults and children eroded during the 1990's, with increasing reliance by employers, insurance companies and Medicaid on managed behavioral health plans. The managed behavioral health strategy has sought to reduce the cost of mental health care by reducing provider supply, placing limits on the duration and kind of mental health care provided and establishing a bureaucratic infrastructure to monitor and some would say "second guess" the mental health professional. Thus, mental health provider panels are limited or very difficult to join. This creates a shortage of providers that individuals can select from. The setting of arbitrary limits on the number of treatment visits or hospital days set in advance also reduces services. Furthermore, the treating professional is required to spend significant time in appealing to and negotiating with insurance companies for permission to provide necessary treatment. While New York State and other states have adopted patients' bills of rights, the person with a stress related or other emotional disorder is often unable to initiate an appeal or argue for more care with an insurance company or employer. Examples are the patient whose benefit package permits only three mental health treatment visits, or the provider whose application for mental health provider status on a panel takes from 7-10 months to be processed.

The present managed health benefits system had already created problems of access and extent of mental health care. The numbers of persons requiring mental health services to recover from this disaster now intensifies those problems.

The Health Care Policy and Practice Network (HCPPN) has identified two issues that must be addressed in public debate and public policy in order to meet this challenge.

1. Inadequate recognition that emotional health is as important as physical health. Inadequate recognition that mental health treatment, through skilled professional counseling, pharmacology or a combination thereof, does help adults and children cope with situation induced stress, anxiety, depression and other behavioral disorders as well as more chronic mental health problems. Preventing emotional dysfunction or breakdown and restoring individuals to a steady or "coping" state is as essential to our well being and productivity and that of our children as early detection or prevention of major physical problems such as heart attacks or cancer. Perhaps we can use the communal pain and anxiety that many will experience as a means to lower the stigma associated with emotional problems and their treatment.

2. The need for the business community and government to support adequate access to mental health services provided by qualified professionals - whether social workers, psychologists, psychiatrists or other trained mental health professionals.