Thursday, November 07, 2013

Mental health claims could scuttle Obamacare model for young people

USA Today is reporting concerns that the “young and healthy” could scuttle the actuarial models for Obamacare if they use mental health services a lot, as in a USA Today story this morning by Kelly Kennedy, link here.
   
The problem is that young adults need mental health services more than was realized.  The recent epidemic of rampages has drawn attention to the fact that young adults seem at risk for schizophrenia or other breakdowns during the college years, and there may be physiological reasons.  The brain finishes its “prurning” and ability to “see around corners” during those years.  There have been a few notorious cases where apparently intellectually gifted students did break down during those years.  The worst example may be James Holmes, who seems to have gone into neuroscience knowing that something dark lay ahead for him  (New York Daily News story from July 2013 here.)  He obviously was planning his attack as early as March of 2012 and was probably unwound long before that.
  
But generally there doesn’t seem to be any indication that teens with unusual talents, as shown in high school years, are more likely to break down than others.  Still the whole concept of the story, and the widespread need for mental health services, is disturbing.
  
In the latter half of 1962, when I was 19, I was an inpatient at NIH in a program for those with “adjustment difficulties” in college – part of the whole Cold War effort.  The women in the program tended to be there for “family” difficulties and were often less intact.  My “hospitalization” may have been more motivated old-fashioned ideas about homosexuality.  But during the therapy, “they” were very concerned about my “fantasy” material and my apparent unwillingness to bond with others whom I saw as “flawed” as I had been viewed.  They seemed more concerned about the existential consequences of what they perceived as my beliefs (as derived by the culture I had grown up in) than about me.  I did have a period of individual therapy in 1964 – in those days, the rate was $20 to $25 an hour – which I don’t discuss in detail but which I see as related to the coercion I had faced.  I even remember a day being bitten on the leg by a neighbor’s dog waiting for the bus to go into therapy – a real indignity. 


Update: November 9

The New York Times has reported and opined on the details of how tjee mental health care rules under Obamacare will really work, here.

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