The Magic Pill, Part 1: The Good, The Bad, The Open Questions

Nov 11, 2013

This story is the first installment in a five-part series on mental health care. Click here for the entire series.

Katia Crosby at her kitchen table in Ellicott City
Katia Crosby at her kitchen table in Ellicott City
Credit Mary Rose Madden

Millions of Americans who need mental health care don’t get it. And that creates a public health nightmare – for jails, homeless shelters, emergency rooms, and most importantly, for the individuals themselves. 


Katia Crosby has an MBA, a townhouse in Ellicott City, a daughter and a mental illness.

She was diagnosed with bipolar disorder when she was 22 and had her first manic episode when she was 35. Three years ago she lost her job as a senior IT project manager, her health insurance and much of her family and friends, “They see with a different lens now – the trust factor isn’t there – they can’t trust my stability.  Therefore, I’m untrustworthy.”   Crosby, 38, sits at her kitchen table, lights off on a rainy day, her braids fall around her face.  She sounds angry, but determined. “I still have to go on,” she says, “I suffer from the repercussions of that exacerbation.  It still comes with a cost.”   

The costs were both emotional and financial. She couldn’t pay the mortgage without a roommate and she couldn’t find health insurance; not with that “pre-existing condition.” In the past three years, she’s been to hospital emergency rooms five times for mental health care.

Crosby is among 45.6 million adults in the country with some form of mental illness. Estimates say less than half get the treatment they need. 

So, advocates, patients, and doctors are asking if the ACA, also known as “Obamacare,” is good for mental health care.

Mark Komrad, a psychiatrist in private practice and the chairman of ethics at Sheppard  Pratt Hospital in Towson, says there are a lot of things that are good and some that are problematic and they will lessen the good.

Among the good things:  mental health care is one of the “essential health benefits” that must be included in every plan offered on Maryland’s Health Exchange, right along with mammograms and annual check-ups. And it must be offered with the same level of visits and deductibles as other medical treatments.   Komrad says, “that’s huge because of the years I’ve seen people who thought they had care, had insurance, but it turns out it did not cover mental health services.”  

Here’s another thing: No one can be denied coverage because of a “pre-existing condition,” so people like Katia Crosby are now eligible. 

And Medicaid will expand in Maryland to cover more people.

Andrew Sperling from NAMI, National Alliance on Mental Illness, says the cost offset is clear, “we know – we are absolutely certain – that the costs of untreated mental illness are enormous.”  Providing more access to mental health care is a VERY smart thing to do, he explains, “When someone with schizophrenia is not getting access to treatment and they become acutely psychotic, the burden is shifted to other systems:  criminal justice, the homeless service system, emergency medical services – all types of systems bear the brunt of those costs of untreated mental illness.” 

But there are other problems the ACA doesn’t tackle. Analysts with the federal government say there’s a serious shortage of mental health care professionals. And only a fraction of those actually accept health insurance.

Carolyn Quattrocki,  from the Governor’s Office of Healthcare Reform, says the ACA is a start, but there’s still a long way to go to delivering mental health care to the one in five families who need it.   She says her work is nowhere near done, “access to coverage does not always mean access to care”. She says they need the right kind of providers in the right place at the right time to have a chance.