An Open Letter to Congress on World Mental Health Day (2019)
Dear [Insert Name of Representative],
My name is [insert your name], and I am writing on behalf of the Twitter mental health community about the changes needed to ensure affordable and accessible mental health care and ways to improve remission rates and restore functionality and productivity. As shown by the most recent data released by the CDC, the rates of mental illness continue to climb at an alarming rate. The data unequivocally shows that the current treatment methods and policies are failing those with mental illness. From having navigated the mental health system myself and having solicited feedback from others, I have compiled a list of items where substantial work is needed. While this list is not all inclusive, I feel that it would be a great starting point for the conversation and it touches on some of the largest issues providing barriers to care and workplace productivity.
- Designate the unemployed as a protected class. Unfortunately, many people with mental illness take a medical leave long enough to be separated from their employer, and are then unable to re-enter the workforce due to being `unemployed’ on account of receiving treatment for their illness. Your chances of being able to get a job after being unemployed for 6-12 months approaches nearly 0%. Ironically, most mental health conditions take several months and even years to achieve some level of recovery and stability, thereby putting you in a position where no one is going to employ you. Under current EEOC laws, the unemployed are not a protected class like those who are veterans and those who have disabilities. This gives the unemployed no recourse for discrimination that they encounter in the job search and hiring process. It’s no wonder that 35% of people claiming social security benefits do so as a result of a mental health condition.
- Replacing disability disclosure question with ADA point of contact at the company. On many job applications, there is a self-disclosure question on one’s disability status. The choices are `yes’, `no’, and `I do not wish to disclose.’ For those with a disability, they often feel pressured to choose `no’ in fear of discrimination, although a reasonable accommodation might be needed to do the job. Answering `yes’ opens people up to discrimination, and `I do not wish to disclose’ is likely assumed by the employer as a `yes.’ While discrimination is illegal according to federal law, that doesn’t mean it doesn’t happen, and the way in which it happens makes it impossible for the applicant to have recourse in the event of discrimination. In place of this question, the point of contact at the company for all ADA related matters should be clearly disclosed, in the event an applicant will need reasonable accommodations for the hiring process.
- Long-Term Disability Policies
- Remove pre-existing condition restrictions. Many policies have a clause prohibiting people from claiming benefits for pre-existing conditions. Unfortunately, mental illness is not a curable condition and most people relapse a few times over the course of their lives. This means that people may need to take long-term leave a few times over the course of their lives, while they seek treatment. As it currently stands, once you take a medical leave for your mental illness, and should you relapse in the future to the point where you can’t work, then you will have no safety net. This translates to people never going back to work, because once you leave the safety net, it’s gone due to the pre-existing clause. This puts many people into a horrible financial situation. They are ineligible for long-term disability due to this clause, they might not have enough work credits to qualify for SSDI, and they might be ‘too wealthy’ for SSI and other federal assistance programs. This leaves them no safety net, throwing them right into poverty and homelessness which they likely will not bounce back from.
- Remove 24-month maximum duration limitation. Many long-term disability policies have restrictions in place that limit the duration of benefits for those with mental illness to a maximum of 24 months. For physical ailments, there is no restriction, and benefits can continue until retirement at age 65. This is blatant discrimination at best.
- Health Insurance
- Reduce co-pays and deductibles. Getting treatment for a mental illness costs thousands of dollars annually. Unlike a lot of other chronic illnesses, the appointment frequency is generally higher for those with mental illness. To remain stable, most patients visit a therapist either weekly or semi-weekly, in addition to a psychiatrist for medication management. At this frequency, the costs become quickly unaffordable. Any inpatient hospitalizations or outpatient programs add additional huge cost burdens as well.
- Expand service provider networks. Many health insurance companies provide inadequate service provider networks that contain only a handful of providers. This creates high demand for those that are in-network, which leads to long wait times for patients. Long wait times are unacceptable and dangerous for those in crisis, or struggling with severe mental illness. My driving anxiety turned into a driving phobia which then turned into panic disorder and then agoraphobia because I had to wait 4 months to even get into a psychiatrist. And this is with having some of the best insurance benefits provided by a Fortune 500 company.
- Require all mental health professionals to accept health insurance and car accident claims. The vast majority of mental health professionals do not accept any health insurance plans. They also tend to charge extortionist prices ($200-$400)/hour. And for those with mental health conditions arising from a car accident, most mental health professionals will not even see you because they do not accept payment from a car insurance claim. And then there are those that even if your health insurance will pay the bill, they won’t see you knowing that you have been in a car accident. So what should’ve been covered therapy, is now going to cost thousands extra. And there is an additional issue in New York State where medical expenses from a car accident are paid according to the workman’s comp fee schedule. So, instead of paying for the whole $200 appointment, they’ll pay $40 and you are stuck with the rest.
- Develop walk-in mental health clinics. Obtaining adequate medical care quickly for mental illness is almost impossible. Between long wait times, and not being able to get to the appointment because of mental illness, this is a serious problem. In addition to forcing insurers to cover a larger network of mental health professionals, lowering co-pays to make treatment more affordable, another way to increase accessibility is to create walk-in mental health clinics. These clinics could provide in-person crisis, grief, or stress counseling, and help the patient find a long-term therapist and psychiatrist and book the appointments and transportation right there on the spot. Also, require doctors to provide the first few appointments virtually, if the patient is initially unable to make it to the appointment due to their mental illness or other transportation difficulties.
- Require disclosure of rights under the ADA on first day of employment, yearly reminder trainings, and mentioning it at the first sign of productivity loss. Unfortunately, most people with mental illness are not aware of their rights under the ADA. On the first day of employment, the employee should be educated about their rights under the ADA, and examples of illnesses (both physical and mental) that might be covered. A leaflet with additional resources and the company point of contact for ADA related issues should also be given out. In the event that an employee is showing signs of productivity loss, open the floor for discussion about the reasons. If the employee discloses productivity loss as a result of an illness, a discussion about the ADA should be initiated by the employer to see if reasonable accommodations can be made so that the employee can carry out the essential functions of their job.
- Require paid mental health sick days. Calling in sick or leaving the office early for a sick day, generally has many negative repercussions. It can lead to discrimination by bosses and co-workers, and can result in firing. Employers should be mandated to provide an allotment of paid (unlike and in addition to, FMLA) mental health sick days that employees can use. Any discrimination or retaliation by the employer as a result of use of the mental health sick days should result in substantial fines.
- Remove medication restrictions. Some companies maintain a list of medications that are not allowed to be used when working or when out traveling on business. Nearly all of the medications used to treat mental illness appear on this list. Meaning that the treatments that are used to keep those with mental illness stable are banned from use, making it impossible for those with mental illness to be able to work. This feels like an ADA violation to me, as many mental illnesses are a protected disability. I am not sure how employers are allowed to enforce this.
- Require all employers to provide telecommuting options for applicable jobs. Unfortunately, mental illness flare-ups are impossible to predict. However, all mental illnesses are easier to handle and manage while at home. A telecommuting arrangement allows for the employee to maintain productivity, while also allowing them to effectively manage their condition. Many employers are still vehemently against telecommuting arrangements, despite the numerous advantages to both the employee and the employer.
While this list is not all inclusive, I feel that it is a great starting point for revamping the mental health care system and the discussion surrounding mental health. People with mental illness deserve respect, effective and affordable medical treatment, and a fair chance at returning to their lives and becoming a productive member of society. I know just how bad the system is, because even with having top health insurance and the financial resources to get help, I still fell through the cracks. Even with the best resources, you don’t have a fighting chance once you develop mental illness. I will face insurmountable challenges in obtaining employment, despite having a PhD in a top engineering field from an Ivy League, because of mental illness sustained from a car accident, which can happen to anyone.
Please make mental health legislation a higher priority for our nation. By working together, we can reverse the trend of increasing rates of mental illness and give people a chance at living productive and fulfilling lives. Thank you for your time and consideration and please feel free to contact me if you would like to discuss these issues further. I would be happy to elaborate on these items, or be a sounding board for any ideas that you may have.
[insert your name]