APA, NAMI, NMHA Call Upon States to Preserve Access to Psychotropic Medications

Jan 31 2003

Washington, D.C.  - Of the 24 states that have restricted access to medications in their Medicaid program, only ten have taken steps to protect psychotropic medications. Restrictions on access to psychotropic medications not only jeopardize consumer health, they also fail to reduce health care costs over the long run. As states consider their scarce budget resources in 2003, the National Alliance for the Mentally Ill (NAMI), the American Psychiatric Association (APA), and the National Mental Health Association (NMHA) unite in urging policy makers to work with the mental health community to find solutions that do not come at the expense of people with mental illnesses.

Science has advanced our understanding of mental illness and made possible new opportunities for people living with mental illness. With appropriate treatment and support, people with mental disorders can now lead full and productive lives. For many, the newest and most effective medications are a critical component of services that enable them to succeed as integrated members of their communities.

As healthcare expenditures grow, however, many state public health programs are responding to the need to cut costs by increasing restrictions on access to medications. Some states have developed limited lists of medications, which contain the only drugs that can be accessed without complicated prior approval polices. Other programs are increasing prescription and dispensing limits or are increasing co-payments for some of our most vulnerable citizens. In the end, such policies not only risk consumer health, but can actually increase total health care costs by creating new expenses for such services as hospitalization, emergency rooms visits, and even incarceration.

"Just as our three national organizations have joined together, we call on policy makers to collaborate with the mental health community to find solutions that do not risk the lives of people with mental health needs," said Michael M. Faenza, President and CEO of NMHA. "We cannot solve our current budget crisis by restricting access to a critical component of our nation’s already vulnerable system of care. We must continue to expand mental health services for millions of vulnerable Americans living with mental health needs ranging from depression and anxiety disorder to schizophrenia and bipolar disorder," said Michael M. Faenza, President and CEO of NMHA.

"Policymakers must not balance state budgets on the back of its most vulnerable citizens. Access to medications is essential for recovery from mental illness to be a realistic goal of treatment. Attempts to contain costs in Medicaid by restricting access to the new generation of medications may lead to some short-term budget gains. Policymakers must weigh the risks inherent in this strategy and who will bear them. The cost of this neglect and abandonment will not only be counted in human suffering, but it will reappear in other areas of state budgets and/or in other levels of government. The cataclysmic consequences of failing to provide children and adults with necessary medications will result in increased deaths, homelessness, incarceration in jails, prisons, and juvenile justice systems and immeasurable suffering. We must work together to assure that people with mental illnesses are not cast away in the fiscal storm that states are experiencing," said Richard C. Birkel, Ph.D., Executive Director of NAMI.

"The attempt to control Medicaid costs by restricting patients’ access to the most effective drugs is not only bad medicine, it’s doomed to failure as a cost-saving measure. Psychiatrists must be able to prescribe the drugs that are most appropriate for their patients’ specific needs if we are to be able to keep treatment for mental disorders community based. Psychotropic medications are very different from other medications in the time it takes to be able to judge whether they’ve been effective and in the idiosyncratic reactions patients have to them. Only the patient’s physician should make the decision which drug to prescribe. Patients who do not receive the right treatment at the right time often experience an intensification of their symptoms and may require more intensive, institutional-based care that will cost the tax payers far more than even the most expensive psychotropic drugs," said APA President Paul S. Appelbaum, M.D.

APA, NAMI, and NMHA recognize that the budget crisis facing state policy makers requires difficult decisions. The members and affiliates of all three organizations stand ready to work with state Medicaid Directors and mental agency officials to develop solutions that address issues of Medicaid and medication costs in ways that will improve chances for consumer health rather than jeopardize them.

The American Psychiatric Association is a national medical specialty society, founded in 1844, whose 38,000 physician members specialize in the diagnosis, treatment and prevention of mental illnesses including substance use disorders. For more information, visit www.psychiatry.org.

With more than 220,000 members and 1,200 state and local affiliates, NAMI is the nation's largest grassroots organization dedicated to improving the lives of people with severe mental illnesses. Funding sources for NAMI programs include hundreds of state and local governments and foundations; ten of thousands of individual donors; and a growing number of corporations. NAMI's greatest asset, however, is its volunteers-who donate an estimated $135 million worth of their time each year to education, support and advocacy. NAMI does not endorse any specific medication or treatment. For more information, visit www.nami.org.

The National Mental Health Association is the country’s oldest and largest nonprofit organization addressing all aspects of mental health and mental illness. The NMHA works to improve the mental health of all Americans through advocacy, education, research and service. For more information, visit www.mentalhealthamerica.net.