[Az. Mike]

If you have read my previous posts, you'll see that I am specifically against govt. testing, across the board, of all Americans for 'mental illness'. But those who need help should receive it.

[k2blader]

I based my response only on your #121, assuming those statements stood on their own. Didn't they?

That you're specifically against government testing across the board is irrelevant to my point.

When you say "those who need help should receive it", who will determine who needs "help", what exactly is this "help", and who will pay for it?

[kcvl]

President Bush is only trying to get the state and federal government agencies to work together to get the most out of our tax dollars which already pay for over half of the cost of help for the mentally ill. He is not trying to screen everyone for a diagnosis of mental health and put us all on medication. This article is incorrect and stupid, to say the least.

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Medicaid doesn’t cover treatment costs for people between 21 and 64 years old if they are living in mental institutions, but it does cover much of the expense if they are under community care. This has left some states with a two-tiered approach, under which more mental health services are available to Medicaid recipients than to the non-eligible population. As the number of mentally ill receiving treatment in the community grows, so does Medicaid’s portion of the payer pie — and its control over the programs.

Richard Frank, professor of health economics at Harvard Medical School, says the dynamic between Medicaid and state mental health agencies is one of the major issues facing the entire mental health field today. “Now that the state mental health authority isn’t the biggest show in town anymore,” he asks, “who has stewardship for the care of the mentally ill?”

In many states, it’s hard to find an answer. Medicaid foots the bill, while housing agencies, corrections agencies and an assortment of others arrange for care. In most states, the least involved are the state mental health agencies, which often are little more than conduits of cash as opposed to planners or quality-control centers. They’re responsible only for plans that address their small federal block grants, and are largely left out of other agencies’ decision making.

Comprehensive planning that involves all the parties responsible for providing mental health services has the potential to reduce fragmentation, but it’s rare. Instead, planning tends to take place within individual agencies, leading to uncoordinated — and sometimes contradictory — service delivery. “There is a need for broader-based planning to address those silos,” says Robert Glover, executive director of the National Association of State Mental Health Program Directors.