How shortsighted funding and reimbursement warps mental-health care in America

[HM2VikingRN, RN]

It may seem arcane, but the reimbursement and spending priorities of government health agencies can literally have life and death consequences for people with mental illness. Just ask the family of Carolyn Howard, who was bludgeoned to death in 2005 on her front lawn by her adult son Keith, who suffers from paranoid schizophrenia.

The tragedy unfolded after the Florida Medicaid program abruptly dropped Zyprexa, the expensive antipsychotic medication upon which Keith Howard had depended, from its formulary of approved drugs. As a result, Howard was hospitalized twice in the two months before the killing, having heard voices telling him his mother conspired with murderers like Lee Harvey Oswald. An investigation by The Orlando Sentinel last year found that Howard was prescribed substitute medications but that they didn't help. Today, compelling federally funded studies question, in general, the effectiveness of such "second generation" antipsychotic medications as Zyprexa; these drugs, although they may work for certain individuals like Howard, also pose health risks like diabetes while boosting Medicaid's antipsychotic drug costs 10-fold in barely a decade. But Florida's inflexible, ham-handed approach to cost cutting, as opposed to more humane cost-effectiveness strategies in a few other states, shows the devastating impact of shortsighted budgetary policies.

at http://prospect.org/cs/articles?article=follow_the_money