‘Mental Illness Feels Like’ States Ought to Remove Barriers to Telehealth

Published June 2, 2016

Consumer Power Report #507

Editor’s Note: This issue of the Consumer Power Report is posted to The Heartland Institute’s Mental Health Awareness Month page, featuring news and analysis of federal and state mental health policy by Heartland staff during and after National Mental Health Awareness Month in May 2016.

One obstacle preventing Americans suffering from mental illness from obtaining the treatment they need is a stigma associated with having a sullied bill of mental health.

States can overcome this obstacle in part by expanding digital access to mental health care providers. This would allow patients to obtain preventive and maintenance mental health care from the convenience and comfort of their homes.

The stigma surrounding mental health problems is prevalent on a webpage hosted by the educational nonprofit group Mental Health America aggregating social media posts with the hashtag #mentalillnessfeelslike.

“The struggle of having illness is speaking up about what is affecting you,” Alondra Sanchez posted on May 18. “The want to tell people but yet to hide it is suffocating.”

“Shame prevents people from reaching out for support,” Cara Wykowski posted to the site via Twitter the same day. “You are not alone!”

Indeed, mental health patients are not alone. Approximately 61.5 million Americans, or one out of four adults, experience mental illness in a given year, and 13.6 million, or one out of 17, suffer from schizophrenia, major depression, bipolar disorder, or another serious mental illness, according to the National Alliance on Mental Illness (NAMI).

The ubiquity of mentally ill patients notwithstanding, only “60 percent of adults, and almost one-half of youth ages 8 to 15 with a mental illness received no mental health services in the previous year,” according to NAMI.

It is reasonable to attribute some of this lack of treatment, directly or indirectly, to stigma associated with mental illness. “Stigma can result in lower prioritization for public resources allocated to mental health services and poorer quality of care delivered to people with mental illness,” states a 2012 study coauthored by the Centers for Disease Control and Prevention and other organizations.

If mental illness stigma leads to decreased access and quality of mental health care, expanding telemental health opportunities and increasing patient access to high-quality mental health care providers could reduce the felt effects of this stigma.

Successfully treating patients with mental illnesses often requires patients to take prescribed medications consistently. Regular visits with a psychiatrist, psychologist, or other certified counselor are also commonly called for. Neither of these treatment components derives its inherent value from the patient and counselor’s physical presence in the same room.

Although on-site presence with one’s mental health care provider all or some of the time may be the best form of treatment for some patients, other patients would benefit from being able to access their providers’ expertise through audio/visual teleconferencing and obtain certain prescriptions, or at least prescription renewals, as a result of a digital doctor appointment.

Making telehealth and telemental health treatment so widespread that they are commonplace for qualified patients would result in more consistent care. It could also reduce the incidence of communication breakdowns between providers and their mentally ill patients, such as Molly Cornelius (@MollyMandlin) of The Bronx, New York, was experiencing on May 16, according to her tweet:

“Miserable. Out of 4 meds. Dr. Completely incommunicado. Withdrawl [sic] from medicine that treats both #fibromyalgia pain & #depression. So sick.”

Although not strictly a mental illness – unlike depression, which Cornelius also mentioned – fibromyalgia is characterized by widespread musculoskeletal pain, fatigue, and memory and mood complications, according to an October 1, 2015 post by Mayo Clinic staff.

Cornelius’ tweet was reposted to Mental Health America’s dedicated site the same day by a sympathizer who chose to remain anonymous when he or she replied, “#mentalillnessfeelslike your safety net is made of wet toilet paper.”

No one can guess the backstory behind Cornelius running out of medication, being unable to reach her doctor, or resonating with a fellow patient experiencing mental illness. Nevertheless, lawmakers can improve upon “wet toilet paper” safety nets in their states by ensuring policy environments conducive to the growth of telehealth and telemental health services.

Twenty-eight states plus Washington, DC have enacted full parity laws, which require private insurers to cover telemedicine-provided services comparable to services offered by in-person providers, according to a report by the American Telemedicine Association (ATA) published in January 2016.

States should not necessarily require private insurers to cover telehealth or telemental health services, a decision best left to competitive markets. The Affordable Care Act (ACA) has amply demonstrated that insurance costs rise when governments mandate private insurers to provide care beyond what they can afford.

Nevertheless, only 22 states plus DC of the 28 states earned “A” ratings from ATA indicating parity laws authorizing statewide coverage without provider or technology restrictions. This means six of the states with parity laws either restrict private insurers from reimbursing providers for telehealth or telemental health services, or restrict providers from treating patients through telehealth. An additional 22 states either lack parity laws or have “numerous artificial barriers to parity,” the ATA report states.

Individuals with mental illness have less of an incentive to make room in their everyday lives for consistent treatment by an in-person provider if doing so mires them in stigma. Although mental telehealth treatment seems a natural alternative, providers have less of an incentive to treat mentally ill patients remotely if the insured’s plan does not extend to telehealth coverage.

Lawmakers should make sure their state laws ensure a free market in which providers and insurers can multiply telehealth and telemental health treatment options for patients.

— Michael Hamilton



In recognition of May 2016 as National Mental Health Awareness Month, and the 62 million Americans who experience mental illness in a given year, The Heartland Institute was pleased to gather up-to-the-minute writings by Heartland research fellows, policy advisors, editors, and reporters touching the subject of mental health care.

Heartland covers mental health care from two angles, with patients at the center. The first promotes innovation in reaching, treating, and improving the quality of care for mentally ill Americans. The second identifies solutions to public policies obstructing innovation and delivery of mental health services.

Mentally ill patients and their families ought not, and cannot afford, to languish in a tug-of-war between innovation and public policy. We offer these resources as arguments and evidence the surest path to a free mind is a free market. …

SOURCE: Mental Health Month, The Heartland Institute


The state plans to streamline its mental health and substance abuse programs for children. A number of states, including Maine and Massachusetts, have turned to a so-called “system of care” model for young people with mental health issues in recent years.

New Hampshire has been studying the approach for several years, through a group called the New Hampshire Children’s Behavioral Health Collaborative.

Last week the House sent Governor Hassan a Senate-backed bill directing the Department of Health and Human Services and other state agencies to better integrate care across agencies and make it easier for patients and their families to navigate the mental health system. …

SOURCE: Brady Carlson, New Hampshire Public Radio


Major health insurers have already begun to propose significant premium increases for next year in an attempt to cover their higher than expected costs on the Affordable Care Act’s exchanges.

In Oregon and Virginia, the first two states to propose rate hikes for 2017, insurers are asking regulators for premium increases of 30 and 20 percent, respectively. This news comes on the heels of last month’s announcement by United Healthcare that it is essentially exiting the ACA exchanges after losing more than $1 billion in 2015 and 2016. Other major insurers like Health Care Service Corp. and Highmark also lost hundreds of millions of dollars in 2015.

To try to compensate for such losses, insurers have hiked prices by double-digit percentages year after year. That’s despite the fact that the ACA was promised to lower premiums by up to $2,500 per year for a typical family. It’s clear that the ACA in its current form is unsustainable. Its promise to provide “more choice, more competition and lower costs” has resulted in less choice, less competition, and higher prices.

The debate over whether to repeal or reform the ACA, featuring politicians more interested in partisanship than improving health care, will surely rage on. But while Capitol Hill bickers, Main Street innovates.

Health entrepreneurs around the country are quietly experimenting with ways to offer good care for a cheap price. They are tapping into the market created by the proliferation of ACA-induced, high-deductible health care plans, which have turned compliant patients into discerning shoppers trying to find the best price for their tests, X-Rays, MRIs and doctor’s visits.

Consider Dr. Keith Smith, who runs the Surgery Center of Oklahoma. He took the radical step (in the health care industry, anyway) of posting his prices online. This allows patients to shop for health care services like any other industry. Such transparent pricing caused patients to flock to him, forcing providers from as far away as Wichita to do the same. Next came the price war among providers, which has contributed to this region having some of the cheapest procedure prices in the nation. Markets and small business ingenuity did what the ACA has been unable to do: actually lower health care prices for consumers.

Or look at the boom in telemedicine, where entrepreneurship and technology allow people to see a doctor over Skype or FaceTime, cutting out one of the major inefficiencies in health care: waiting rooms. Even better, Doctors on Demand is bringing back doctor house calls – a relic of a bygone time – for the general population for about $100 a pop. This “Uber for doctors” business model is exactly what the outdated and bureaucratic health care industry needs. …

SOURCE: Alfredo Ortiz, The Orange County Register


Veterans Affairs Secretary Robert McDonald on Monday compared the length of time veterans wait to receive health care at the VA to the length of time people wait for rides at Disneyland, and said his agency shouldn’t use wait times as a measure of success because Disney doesn’t either.

“When you go to Disney, do they measure the number of hours you wait in line? Or what’s important? What’s important is, what’s your satisfaction with the experience?” McDonald said Monday during a Christian Science Monitor breakfast with reporters. “And what I would like to move to, eventually, is that kind of measure.”

McDonald’s comments angered House Speaker Paul Ryan, who tweeted out Monday afternoon, “This is not make-believe, Mr. Secretary. Veterans have died waiting in those lines.”

McDonald faced questions at the breakfast about the VA’s lack of transparency surrounding how long veterans must wait to receive care at VA facilities around the country. The agency has weathered controversy over the past several years due to its struggle to provide timely care for many patients.

The VA secretary said most veterans report being satisfied with their care and argued that the average wait time for a veteran seeking VA treatment is only a matter of days.

He said he did not believe a measure called the “create date,” which gauges a veteran’s wait time by counting from the day the veteran first requests care, was a “valid measure” of a veteran’s VA experience. …

SOURCE: Sarah Westwood, Washington Examiner


More than $85 million in federal funding will be made available to help states combat the spread of the Zika virus.

As of May 11, more than 500 Zika cases have been reported in the U.S., with more than 1,200 cases throughout the country and its territories since January 2015, according to the Centers for Disease Control and Prevention.

The agency is allocating $25 million to the hardest-hit regions. Funding will go to areas where Aedes aegypti and Aedes albopictus, the two types of mosquitoes known to carry and transmit the virus, are most prevalent. The money will help state health officials identify, investigate and respond to any possible outbreaks.

Applications are due by June 13 and will be available through July 17. …

SOURCE: Steven Ross Johnson,