Transcript Slide 1

MENTAL HEALTH
Group D
Trey Perez
Heather Rawls
DJ Reid
Agenda
Mental health overview
Previous Legislation
Current Legislation
Republican and Democratic views
Policy and Fiscal Implications
Proposed Legislation
What is Mental Health
The meaning of being mentally healthy is
subject to many interpretations rooted in value
judgments, which may vary across cultures.
Mental health should not be seen as the
absence of illness, but more to do with a form of
subjective well being, when individuals feel that
they are coping, fairly in control of their lives,
able to face challenges, and take on
responsibility.
Defined by WHO
Mental health is a state of successful
performance of mental function,
resulting in productive activities,
fulfilling relationships with other
people, and the ability to adapt to
change and to cope with adversity
specific to the individual’s culture
(WHO).
What is Mental Illness?
Mental illness refers collectively to all
diagnosable mental health problems that
become “clinical,” that is where a degree
of professional intervention and treatment
is required. Generally, the term refers to
more serious problems, rather than, for
example, a mild episode of depression or
anxiety requiring temporary help (WHO).
History of Mental Health Policy
Mental health has been shaped by cultural
changes and major social policies
designed with other populations in mind as
well as by the efforts of persons working in
the mental health field itself. (Center For Mental
Health Services)
History of Mental Health Policy
There have been significant improvements in
treatment, public attitudes, and services
organization, and enormous growth in mental
health insurance coverage, treatment resources,
episodes of care, and research of all kinds in the
past 50 years.
– Systems have transitioned from largely
psychotherapy for the affluent and custodial
institutional care for all others, to a range of outpatient
services, inpatient care in various settings, residential
care, and housing alternatives
History of Mental Health Policy
The change that is currently transforming
mental health care
– The introduction and growth of managed
behavioral health care
– The work of mental health professionals.
Mental Health Economy:
Past and Present
Resource allocation of mental health care
has been decentralized over the past 35
years.
– 1950’s: 75 percent of episodes of treatment
were provided by public mental hospitals
– 1990’s: less than a quarter of treatment
episodes are provided by publicly owned
mental hospitals
Mental Health Economy:
Past and Present
1950’s through the 1970’s the mental
health system operated as a planned
economy.
Today, there is a market for insurance,
services, and management of mental
health systems.
– The majority of individuals in the United
States acquire their mental healthcare from
private providers who compete for customers.
Disparity of Mental Health Services
With the emergence of dramatic structural
changes in mental health services over the
past 50 years, disparities have been
created, with the biggest disproportion of
services being available to children and
seniors located in rural settings.
Child and Adolescent Mental
Health
The MECA Study (Methodology for
Epidemiology of Mental Disorders in
Children and Adolescents) estimated that
almost 21 percent of U.S. children ages 9
to 17 had a diagnosable mental or
addictive disorder associated with at least
minimum impairment.
Children and adolescents age 9–17 with
mental or addictive disorders,
combined MECA sample, 6-month
(current) prevalence*
* Disorders include diagnosis-specific impairment and CGAS < or
= 70 (mild global impairment)
Child and Adolescent Mental
Health
The mental disorders affecting children and adolescents
include the following (NIMH):
– Attention Deficit Hyperactivity Disorder (ADHD, ADD):
ADHD/ADD, is one of the most common mental disorders that
develop in children. Characterized by impulsiveness, hyperactivity,
and inattention.
– Autism Spectrum Disorders (Pervasive Developmental
Disorders)
Autism Spectrum Disorders (ASD), also known as Pervasive
Developmental Disorders (PDDs), cause severe and pervasive
impairment in thinking, feeling, language, and the ability to relate to
others.
– Bipolar Disorder
Bipolar Disorder, also known as manic-depressive illness, is a
serious medical illness that causes shifts in a person's mood,
energy, and ability to function.
Child and Adolescent Mental
Health
– Borderline Personality Disorder
Borderline personality disorder (BPD) is a serious mental illness
characterized by pervasive instability in moods, interpersonal
relationships, self-image, and behavior.
– Depression
Depression is a disorder that affects an individuals thoughts, mood,
feelings, behavior, and physical health.
– Eating Disorders
Eating disorders involve serious disturbances in eating
behavior, such as extreme and unhealthy reduction of food intake or
severe overeating, as well as feelings of distress or extreme concern
about body shape or weight.
– Childhood-Onset Schizophrenia
Schizophrenia is a chronic, severe, and disabling brain disorder.
Reported Mental Health Concerns:
Gender and School Level
* School Mental Health Services in the United States.
2006. http://projectforum.org/docs/SchoolMentalHealthServicesintheUS.pdf
The Tragedy
Most children and adolescents with psychiatric disorders
do not get the help they need. If left untreated, the
physical, emotional, social and intellectual development
of children with mental disorders will be severely stunted,
if not crippled.
These children are at a heightened risk for school failure
and dropout, drug abuse, and many other difficulties - all
of which can be prevented by timely evaluation and
appropriate treatment.
Elderly Adult Mental Health
Mental health issues affect seniors
differently than other age groups due to
loss, physical health concerns, and
economic and social changes acting either
individually or in combination.
Up to 25% of people over the age of 60
experience some kind of mental illness,
particularly depression.
Elderly Adult Mental Health
The lack of attention to the mental health
problems of the elderly may be attributed
to:
– ageism
– inadequate training of health care providers
– the shortage of geriatric specialists
– the need for more knowledge and research,
Medicaid Coverage of Mental
Health Treatment
There are certain mental health services
that are mandatory under federal law and
must be offered to all Medicaid
beneficiaries in all states.
– Inpatient and residential treatment
– Outpatient physician and hospital services
– Early and Periodic Screening, Diagnosis and
Treatment (EPSDT)
Requires coverage of all optional services when
necessary for a child.
Medicaid Coverage of Mental
Health Treatment
Mandatory eligibility covers pregnant women
and children up to age 6 in families with incomes
up to 133 percent of the federal poverty level
and older children up to 100 percent of poverty.
States can opt to raise these income limits to
185% or 133% of poverty respectively. States
also have the option to cover children who
qualify for the State Child Health Insurance
Program (S-CHIP), whose families can have
incomes as high as 250 percent of poverty
Medicaid Coverage of Mental
Health Treatment
A large number of individuals with mental
disorders on Medicaid are eligible because
they receive federal disability benefits.
Over a quarter of those receiving
Supplemental Security Income (SSI)
disability benefits, 1.4 million, are people
with psychiatric disabilities. Generally, SSI
recipients fall within the mandatory
eligibility category.
Medicaid Coverage of Mental
Health Treatment
Medicaid also offers coverage of
individuals who have high medical costs
and who can qualify as “medically needy.”
– These individuals must still meet the eligibility
standards of some category of Medicaid (such
as by being disabled), but need not meet the
Medicaid income test
Medicare Coverage of Mental
Health Treatment
Hospitalization: Medicare covers care in specialized
psychiatric hospitals which only treat mental illness when
in-patient care is needed for active psychiatric treatment.
– pays for necessary in-patient hospitalization for up to 90 days
per benefit period.
Partial hospitalization programs offer intensive
psychiatric treatment on an outpatient basis to
psychiatric patients, with an expectation that the patient’s
psychiatric condition and level of functioning will improve
and that relapse will be prevented so that
re-hospitalization can be avoided
Medicare Coverage of Mental
Health Treatment
Medicare covers needed diagnostic and treatment
services provided by physicians, including psychiatrists,
as well as clinical psychologists, social workers,
psychiatric nurse specialists, nurse practitioners and
physicians assistants.
Medicare pays for home health services for individuals
who require skilled care on a part-time or intermittent
basis and who are confined to the home. People with
mental health needs who meet these eligibility criteria
are eligible for care in their home, even if they have no
physical limitations
Medicare Coverage of Mental
Health Treatment
LIMITATIONS:
– Reimbursement for certain psychiatric
services differs from the usual Medicare
reimbursement rules.
Medicare Part B generally reimburses doctors at
80% of the approved amount; the patient pays the
remaining 20% coinsurance amount.
When a claim is for mental health services,
Medicare makes an initial deduction of 37½ %
before paying 80% of the charge. As a result, the
Part B reimbursement is, on average, about 50%
of the charge.
Medicare Coverage of Mental
Health Treatment
It is recommended that individuals need to
consider carefully how to supplement their
Medicare coverage
– Medigap policy
– Retiree health policy
– Through Medicaid
Previous Legislative Efforts:
Keeping Families Together Act of 2007
To amend the Public Health Service Act to establish a State family
support grant program to end the practice of parents giving legal
custody of their seriously emotionally disturbed children to State
agencies for the purpose of obtaining mental health services for
those children.
Introduced by Rep. Jim Ramstad (R-MN3)
PURPOSE: To assist States in eliminating the practice of parents
giving custody of their seriously emotionally disturbed children to
State agencies for the purpose of securing mental health care for
those children
Referred to the House Committee on Energy and Commerce
Previous Legislative Efforts:
Mental Health Parity Act of 2007
To amend the Public Health Service Act with respect to
mental health services for elderly individuals.
Introduced by Sen. Pete V. Domenici (R-NM)
STATEMENT OF PURPOSE- To provide parity between
health insurance coverage of mental health benefits and
benefits for medical and surgical services.
Referred to Committee on Health, Education, Labor, and
Pensions
Previous Legislative Efforts:
Seniors Mental Health Access Improvement
Act of 2007
To amend the Social Security Act to provide for
the coverage of marriage and family therapist
services under part B of the Medicare Program,
and for other purposes.
Introduced by Rep. Edolphus Towns (D-NY).
– Co-Sponsored by Rep. Charles W. Pickering (R-MS3)
Effective: The amendments made by this Act
apply with respect to services furnished on or
after January 1, 2008 .
Bill S. 633 of the 110th Congress
Title
“Working Together for Rural Access to
Mental Health and Wellness for Children
and Seniors Act”
– Introduced by Sen. Norm Coleman (R-MN)
– February 15, 2007
– Referred to Committee on Health, Education,
Labor, and Pensions
Findings
In rural areas, where specialized mental health services
are scarce, accessing mental health professional
services is difficult.
Rural primary care providers have experienced an
increase in mental health issues recently
Surgeon General estimates 21% of children experience
mental health systems, which left untreated can lead to
school failure, drug abuse, and often incarceration
The Department of Health and Human Services
estimates 1 in 5 children and adolescents have
diagnosable disorders, yet close to 80% receive no help
Findings continued…
Few schools have the resources and funding available to
implement a full range of mental health interventions
Mental health is a fundamental cornerstone to ensure
children have the opportunity to be successful in school
Promoting and expanding telemental health
collaborations to strengthen delivery of mental health
services in remote and underserved areas is needed
Telemental health is effective at diagnosing and treating
mental health disorders and can provide better access
and care to rural areas
– Telemental health is the use of videoconferencing or similar
means of electronic communication to provide mental health
services
Grant Program Continued…
Amount of Funding:
The Secretary shall award a grant to a State under this
section in an amount that is based on the respective
number of critical access hospitals (as defined in section
1861 (mm)(1) of the Social Security Act (42 U.S.C.
1395x(mm)(1)) in the State as such compares to the
total number of critical access hospitals in all States that
are awarded grants under this section
Purpose
Provide assistance to rural schools, hospitals, and
communities through collaborative efforts to secure
progressive and innovative systems to provide mental
healthcare access and treatment for youth, seniors, and
families
Increase access to elementary and secondary schools to
mental health services in rural areas through the use of a
mobile health services van program
Increase access to individuals of all ages to mental
health services in rural areas by utilization of telemental
health services established in the areas
Grant program
State grants shall be awarded by the
Secretary of Health and Human Services
for the purpose of issuing subgrants to
carry out the purposes of this act
Eligibility:
States shall be deemed eligible by submitting an
application with all pertinent information required,
establishing a lead agency, and submitting a state plan
State Lead Agency
The governor of each state shall be responsible
for selecting a Lead agency (other than the State
Office of Rural Health) to administer the State
programs
The lead agency shall administer directly or
through other agencies the awarded funding
The lead agency will also be responsible for
forming the state plan which will coordinate the
expenditures in consultation with state and local
representatives of educational agencies, rural
mental health providers, and the state hospital
association
The State Plan
1.
2.
Establish lead agency
Assure that the state will use funding in the following
areas:
1.
2.
3.
4.
Provide mobile van services for elementary and secondary
education students
Provide telemental health services to individuals of all ages in
rural areas, and cover all administrative costs associated with
these grant recipients
Assure that the grant benefits will be available
throughout the entire state
Assure the lead agency will consult mental health
providers and state hospital associations to assess
appropriate fund utilization
Eligibility
Located in or serving a rural area
Government owned or non-profit hospital
Community mental health facility
Primary care clinic
Other non-profit agency providing mental health services
Selection will be based on an applicants need to improve
mental health care access within a community and the
extent to which it will serve rural low-income populations.
All applicants must submit a comprehensive outline of all
procedures, evaluations, measurements, and must keep
a record and reports available to the Secretary at all
times for oversight.
Fund Utilization
Mobile vans
– Offset all costs incurred after Dec. 31, 2007
– Purchase or lease of vehicle
– Repairs and maintenance
– Purchase or lease of communication
equipment
– Education and training of staff using the van
– Professional staff employment
Fund Utilization Continued…
Telemental health services
– Offset all costs incurred after Dec. 31, 2007
– Purchasing, leasing, maintaining, and
repairing all telemental health equipment
– Telecommunications, utility, and software
upkeep and purchase
– Education and training to telemental health
service staff
– Professional staff employment
Limitations
$10,000,000 in appropriations for the program
for each fiscal years 2008 to 2010
Each subgrant shall not exceed $300,000 for
one fiscal year
The Secretary shall review and monitor State
compliance with the requirements of this section
and the State plan and will be able to suspend
payments to states if compliance is not
satisfactorily met
Republicans vs. Democrats
Issues with mental healthcare
Parity of mental health care
Major issue is that mental health is not cost
beneficial
Mental health problems cost too much since they are chronic
Myth?
What about heart disease, diabetes, asthma? Chronic
physical diseases.
Substance abuse and rehabilitation
Should treatment medications be covered by
Medicare/Medicaid?
Democrats
Democratic Party view on
mental health
Want healthcare to be available and
affordable to everyone and provided by
the state
Democrats believe that mental healthcare
is needed for veterans.
War costs are not just bullets and guns, but taking
care of returning veterans both physically and
mentally.
Republicans
Republican view on mental
healthcare
Increase the number of citizens with health
insurance
Make private insurance more affordable
Move away from government funding
Limit mental healthcare by providers,
especially Medicare and Medicaid
Republicans (cont.)
“senior House Republicans and business groups
are staunchly opposed to the deal”
-Deal was to include coverage of mental
healthcare in insurance
“The compromise would outlaw disparities in
coverage between mental and physical illness
under group health plans sponsored by
employers with more than 50 workers”
Similarities
Both consider mental health as an important part
of a healthy life
Both parties want to end discrimination in the
work place (insurance discrimination)
Both want equitable mental healthcare
98% of Americans think mental health should be
covered by insurance
83% of Republicans and 92% of Democrats want equitable
health insurance
89% of both employees AND employers want mental health
care coverage
Similarities (cont.)
“That movement has galvanized Congress.
Senators Pete V. Domenici, Republican of
New Mexico, and Paul Wellstone,
Democrat of Minnesota, have, for more
than five years, led a campaign to
translate the idea of parity into law.”
-- Robert Pear, New York Times Dec. 2001
Similarities (cont.)
''It's a real battle,'' Mr. Specter said
Bush says people should have the access to the
care they need.
But is concerned with increasing costs of
healthcare
Dilemma
Policy and Fiscal
Implications
The Presidents New Freedom Commission on
Mental Health: Achieving the Promise,
Transforming Mental Health Care in America
(2003)
Final report by President Bush’s Freedom
Commission on Mental Health
Recognizes the critical role schools can
play in the continuum of mental health
services
Emphasizes building a mental health
system that is evidence-based, recoveryfocused and consumer- and family-driven
Freedom Commission on Mental Health
15 member commission appointed by Bush in
2003 to examine the Mental Health System in
the U.S.
Over the course of a year through public
hearings, site visits, written and oral testimony
from experts, and comments and concerns
received through the Internet the committee
concluded “the system was in shambles.”
Analysis of all the reports and findings
suggested that the only way to create an
effective and efficient mental health system was
to fundamentally transform the system.
Findings of the Commission
The principle findings emphasized the mental health systems need
to be equivalent to the public health system
– better access for all, equity in treatment and funding, and a reduction of
stigma.
MHS was built around a delivery and payment system instead of the
needs of MHS recipients and their families, frequently resulting in
unsatisfactory outcomes.
The public mental health system failed to employ evidence-based
practices or the newest technologies and the commission confirmed
that a person’s race, ethnicity, or geographical location could
compromise his or her access to services.
The Commission recommended the creation of a comprehensive
mental health plan in each state.
New Freedom Commission on
Mental Health (NFC)
Focusing on State
activities related to six
goals for transforming
mental health
systems from the
President’s New
Freedom Commission
Report.
1) Organization and Structure Component: to
whom the SMHA commissioner/director is
accountable; responsibility for a variety of mental
health services, including State mental hospitals,
community mental health programs, and forensic
programs; ways in which community-based mental
health services are funded
2) Policy Component: Contains information on
priority clients and mandates for core services; other
service system requirements, standards, and future
directions; activities relating to downsizing, closing,
or consolidating State mental hospitals; privatizing
components of the public mental health system; and
major legal issues involving the SMHA
3) Client Component: Contains aggregated data
characterizing individuals served by the SMHA in State
mental hospitals and community-based programs.
4) Services Component: Describes the nature of the
service system supported by each SMHA in three broad
areas. (1) SMHA service system issues include the types
of services offered by the SMHA in State hospitals and
community programs, the definitions of these services,
linkages of services among institutions and communities,
and the role of different services within the SMHA’s
desired service system. (2) Linkages to other State
services systems include information about the linkages
between the SMHA mental health system and other
State agencies that provide services for individuals with
mental illness. (3) Information on the implementation of
various evidence-based practices by SMHAs is a new
focus in this component.
5) Forensic Component: Contains information
about the organization and delivery of services
to forensic clients by the SMHA and the
relationship of the SMHA to the criminal justice
systems in each State.
6) Workforce Component: Staffing levels of
State-operated and State-funded mental health
services provider organizations; minority
workforce issues; client to staff ratios;
recruitment, training, and retention of staff;
salary levels; and workers’ compensation.
7) Financial Component: Includes the forms
and information necessary to complete the
annual SMHA-controlled Revenues and
Expenditures Study plus information about the
resources available to the SMHAs and the
States to fund the delivery of mental health
services.
8) Managed Behavioral Health Care: The use
of managed care to deliver public mental health
services, the roles of Medicaid waivers, and how
traditional SMHA-funded providers interact with
managed care organizations.
9) Research and Evaluation Component:
Organizational locus of the research and
evaluation functions and their funding and
staffing levels.
10) Information Management Component:
Current status of the information management
function and its development over time. The
component provides for a systematic compilation
of the organizational placement of information
management functions, the level of integration of
these functions, and their funding and staffing.
The Need for Early Intervention
3-5% of school age children diagnosed with
ADHD
13% of kids 9-17 diagnosed with variety of
anxiety disorders
Most Frequent Reported Barriers to
Mental Health Services
Financial Constraints of Families
– Lack of Insurance
– Inability to afford private pay services
Limited school and community-based
resources
“No Child is Left Behind.”
With effective schoolwide programs, support
and funding, many
teachers could strengthen
their focus on the
academics, problemsolving and critical
thinking skills essential
for students to acquire
and spend less time
managing difficult
behaviors.
What are our schools doing to help?
87% of schools reported providing behavioral/emotional
assessments, behavior management consults and crisis
intervention as primary mental health services,
only 59% of schools reported using curriculum-based
programs to enhance social and emotional functioning
15% reported conducting school-wide screening for
behavioral or emotional problems.
If schools placed greater focus on school-wide behavior
prevention and social-emotional early intervention
programs, perhaps there would be less need for
individually focused services of behavior assessments,
management consultations and crisis intervention.
Burden of Disease
Data developed by the
massive Global Burden of
Disease study conducted
by the World Health
Organization, the World
Bank, and Harvard
University, reveal that
mental illness, including
suicide, accounts for over
15 percent of the burden
of disease in established
market economies, such
as the United States.
Controlling costs
Public mental hospitals have been reduced or downsized from
560,000 resident patients in 1955 to fewer than 60,000 clients today,
despite sizable population growth.
Most acute inpatient care is now in general hospitals; and although
case-mix and co-morbidity are more complex, average length of stay
has fallen steadily to less than 10 days, and continues to fall.
In the period 1988 to 1994, some 12.5 million days were reduced in
mental hospital care with only small compensation in days of care in
the general hospital sector (Mechanic, McAlpine, & Olfson, 1998).
The introduction of managed care in the private sector has reduced
expenditures of some large corporate purchasers by as much as
30–40 percent, with most of these reductions achieved by large
reductions in average length of stay (Feldman, 1998; Mechanic &
McAlpine, 1999).
Socioeconomic status has one of the
strongest associations with the prevalence
of mental disorders
Social policies have a
major role in making
treatment available.
Persons with serious and
persistent mental illness
remain perhaps the most
disadvantaged and
neglected group in our
society and suffer from
the failures of American
health care policy.
Decision processes do
not sufficiently sensitize
the seriousness and
complexity of mental
illness, and the patients
with the most severe
illnesses appear to do
worse under present
managed care
arrangements as
compared to fee-forservice practice.
Out of Sight, Out of Mind, Yet Expensive
A Justice Department
study estimated that
in midyear 1998,
there were more than
280,000 persons with
mental illness in jails
and prisons, and
more than a half
million more on
probation (Ditton,
1999).
Olmstead vs. L. C: a possible
solution?
(ADA) and the U.S. Supreme Court
decision which required the State of
Georgia to provide community care to
persons with mental illnesses and mental
retardation who could function in such less
restrictive settings without placing an
undue burden on the State or requiring
that the State establish a particular type of
program.
Mental Healthcare Provider
Rural Incentive Act
Target Groups
Children
Seniors
Medicare recipients
Undeserved/low income
Those on Medicaid
Rationale and Purpose
Improve access to mental health care in
rural communities.
Incentives for doctors to work in rural
settings
Mechanism
Mental health doctors/psychiatrists will commit
to work in a rural community for a minimum of
two years. They must commit at least 12
hours per week for 50 weeks of the year in a
rural community mental health clinic or facility.
In return, doctors will be offered grants
1.
Categorical grant - for up to 4 years of work
- Must be spent to repay loans
2.
Block grant
- Meant to provide doctor with startup capital for private
practice or clinic.
Mechanism
Lead Agencies will determine the
communities that will qualify as “rural” and
areas that qualify doctors for these
incentives
Lead Agency established from Bill S. 633 Working together for rural access to mental health
and wellness for children and seniors act
Financing
Up to $100,000 in Categorical Grant
– Approx. $25,000 per year for first four years in
qualifying rural setting
– Must be used to repay loans used for
educational purposes
Financing
Up to $100,000 in other grants for fulfilling rural
work obligation to help with “start up” costs.
– $20,000 block grant minimum
Can be used as doctor sees fit; i.e. pay off additional debt,
start up practice, etc.
– Up to $100,000 in project-like grant for private uses
To be used for establishing practices in rural communities
Larger grants will be given on an as-needed basis (for
example in those communities where startup costs may be
higher) but will not exceed $100,000
Financing
Services rendered will be covered by Medicare,
Medicaid, and private insurance
– Mental Health Parity Act of 2007 (S. 558), states that
all insurance must provide equity in the care and
treatment of mental and physical illnesses
– “the financial requirements applicable to such mental
health benefits are no more restrictive than the
financial requirements applied to substantially all
medical and surgical benefits covered by the plan”
Outcomes
Increase access to mental health care for
populations in rural settings
To eliminate healthcare (particularly
mental healthcare) disparities among rural
and urban and suburban communities
– Provide better care and treatment for the
children, seniors and impoverished
populations
Summary
Eliminate disparities for mentally ill in rural
areas by encouraging psychiatrist and
other mental health related physicians to
work in these settings
Incentives are monetary in forms of grants
to pay off loans and to provide capital to
establish local practice in a rural
community
References
Treatment of Children with Mental Disorders. 2006.
http://www.nimh.nih.gov/publicat/adhd.cfm
School Mental Health Services in the United States. 2006.
http://projectforum.org/docs/SchoolMentalHealthServicesintheUS.pdf
Mental Health, United States 2000: Chapter 7. 2000.
http://mentalhealth.samhsa.gov/publications/allpubs/SMA013537/chapter7.asp
Mental Health, United States 2000: Chapter 8. 2000.
http://mentalhealth.samhsa.gov/publications/allpubs/SMA013537/chapter8.asp.
Geriatric Mental Health Foundation.
http://www.gmhfonline.org/gmhf/consumer/factsheets/depression_latelife.ht
ml
References
Republican And Democratic Voters Overwhelmingly Support Fair Mental Health
Insurance Coverage. Medical News Today. Jan 16, 2007.
http://www.medicalnewstoday.com/medicalnews.php?newsid=60847
Democrats Working to Expand Veterans Mental Health Care. Democratic National
Committee. 2007. http://www.democrats.org/a/2005/06/democrats_worki.php
Making Healthcare Affordable for Everyone. Republican National Committee. 2007.
http://www.gop.com/Issues/HealthCare/.
The Olmstead Decision. March 22, 2007
http://www.workworld.org/wwwebhelp/the_olmstead_decision.htm
The National Institue of Mental Health. 2007.
NIMH.gov
Mental Health, United States 2000: Chapter 7. 2000.
http://mentalhealth.samhsa.gov/publications/allpubs/SMA06-4195/chapter11.asp