By Rimal B. Bera, MD
I’ve been working with a patient, a male in his late 20s, for a few years now. He showed some early signs of schizophrenia in high school but worked through them and went to college across the country. It was there, away from everything familiar, that he had his first symptoms of psychosis. He left school and moved home.
Early on, with family support, we all agreed together that he could benefit from medication and started him on an oral treatment. It worked well. So well, in fact, that he stopped taking it. His psychotic and cognitive symptoms re-emerged. In a panic, his mom began sneaking or forcing him take it. That would work, then the cycle would repeat itself.
For this reason, I thought he’d be an ideal candidate for a long-acting medication: a once-a-month injectable. No longer would his mother be burdened every day to convince her son to take his medications. Her life could return to some normalcy. The son was on board. So, it was a huge blow when his insurance denied coverage.
His schizophrenia wasn’t severe enough, they said. In their minds, he wasn’t sick enough to receive the medication because he hadn’t been hospitalized due to his illness.
It pains me to think of it. His insurance was waiting for his condition to devolve before they would approve a medication that could keep him stable.
This young man’s story is, unfortunately, common.
For nearly 30 years, I have seen the tremendous difference the right medication can make in the lives of people who live with a mental illness. Yet these patients often face obstacles accessing treatment.
Sometimes it’s a matter of insurance providing coverage to see a mental health specialist. Other times, insurance will pay for the visit, but not want to cover the treatment.
People with mental illness who have a history of antipsychotic use provide one example.
Regular use of some antipsychotic medications, particularly older ones, can cause tardive dyskinesia, a movement disorder characterized by involuntary, repetitive body movements. It’s one of the most burdensome side effects of treatment.
We now have medications for tardive dyskinesia. Despite the debilitating nature of the movement disorder, however, insurance companies sometimes deny coverage for those treatments. It is frustrating for patients and their families, and for me as their health care provider.
While access issues have always been important, treatment has taken on a new relevance during the COVID-19 pandemic. Now we are transitioning into a potentially more long-term pandemic, that of mental health.
I’m concerned for all the patients who will courageously seek mental health care, then get denied access to treatment. Will they have the wherewithal to fight for it? Will their provider have enough time to help? One hopes the physician remains persistent, but hope alone is not enough. It’s never a good idea when insurers interfere in the decision-making process between patients and their doctor.
Mental Illness Awareness Week, October 4-10, provides an opportunity to raise awareness about the access challenges faced by people with mental illness. A valuable step would be passing commonsense laws to limit insurance practices that block access to prescribed treatments. One wonders how my young patient with schizophrenia would be doing today if there was no insurer interference in choosing the best treatment available.
Americans need access to mental health providers and to the treatments they prescribe. Now is the time for policymakers to make both available to those who need them.
Rimal B. Bera, MD, is a clinical professor of psychiatry at the University of California Irvine School of Medicine and a member of the Alliance for Patient Access.
