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How Mental Health Care Is Changing Under Obamacare

Teresa Colby takes a lot of medications. Most are for her diabetes. Some, like the generic version of Zoloft, are for the depression that she says goes hand in hand with her Asperger’s.

“I have difficulty with social relationships and as part of my disability, and I just didn’t have the network to help me with anything. It was a really difficult time, it really was,” Colby says as she wipes away tears.

Several years ago Colby’s depression got so bad, she knew she had to do something fast. With no insurance and no access to mental health services, she sought help at IU Health Bloomington Hospital.

“I walked in one day and I said I’m afraid I’m going to hurt myself and had what was essentially a nervous breakdown,” Colby says.

Colby says the care she got–while it kept her from committing suicide–did not help her deal with her depression long term.

“They do emergency stop-gap care but they don’t do anything to address the long-term situation and there’s no follow-up care,” she says. “So basically it scared me into thinking I can’t be mentally ill because I’ll get locked up.”

Why There Isn’t Enough Preventative Care

Hospitals are seeing more patients like Colby for mental health issues now that the Affordable Care Act is in place.

A joint study from Indiana University and Purdue found hospitals nationwide are seeing a 9 percent increase in patients ages 19 to 25 who are being admitted because of situations like Colby’s.

Researchers looked at that age group, because they received additional coverage under the part of the Affordable Care Act that went into effect in 2010, allowing young adults to stay on their parents’ plans until they are 25 years old.

Researchers don’t know exactly why those patients are going to hospitals instead of independent counselors, but many they say, are likely in the same position as Colby. They don’t have access to mental health services.

Jeanne Scallon, the executive director at Meadows Hospital in Bloomington, says many of her patients commute two or more hours to be seen. Since the hospital largely provides emergency care, Scallon says her staff tries to make sure the patients are getting care where they live. so that they don’t end up back in the hospital.

“We wouldn’t want that,” Scallon says. “That’s like having multiple heart attacks.”

It’s a complicated problem – there aren’t enough clinics in part because there aren’t enough doctors who study mental health.

“If there hasn’t been good funding for services that affect people who have these conditions than the supply doesn’t necessarily grow,” says Kosali Simon, one of the Indiana University professors on the joint-study. “It’s hard for people who are in medical school to go into areas that are underserved if it appears really hard to break even because there’s no source of funding.”

With the newest part of the Affordable Care Act going into effect this year, researchers expect hospitals will see even more newly insured patients.

Providers, however, also expect  to receive additional funding from insurance companies that are now  required to cover mental health services at approximately the same rate of other medical care.

How The Affordable Care Act Covers Mental Health Care

Teresa Colby signed up for insurance through the federal marketplace.

“I was really excited. Yay! I’m going to have insurance!” she says, reenacting her emotions when she first got on the exchange. “I can even get a full time job and do more and get my income up there and be productive.”

But she says it falls short of expectations and she doesn’t believe it will be the magic bullet that improves access to mental health services for everyone.

For example, her insurance plan only covers 12 counseling sessions per year.

“The way I look at it, it’s sort of like say you’re starving and they say we’re going to give you 12 meals and after 12 meals. That’s all you get and you’re going but what do I do after that?” Colby says.

Under the law, therapists can request the insurance company pay for additional sessions but it must be deemed “medically necessary.”

Colby also has to pay a $40 co-pay for each counseling session and she says she simply can’t afford that so she hasn’t been to any counseling since she got insurance.

Her primary care physician still provides her with medication for her depression though and she’s found support though through the College Internship Program–an organization that helps students with learning disabilities to succeed in college and live independently.

A job agency helped her find employment here and she says working with people who don’t judge her and being able to help other students who have the same kinds of struggles helps her cope with her own insecurities.

“To really heal from mental health issues, it needs to be a comprehensive approach that involves your family, your community, a certain acceptance it’s not take this pill and five days later you’re well. It is a lifelong struggle for a lot of people,” Colby says

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