Pennsylvania’s Decades of Broken Promises on Mental Health

But first, meet Jennifer Randal-Thorpe. She runs Meaningful Minds United, a nonprofit providing peer support services for people struggling with mental illness and addiction. Her continued existence is part of her motivation. After surviving six suicide attempts, the Lafayette, Louisiana native now says she lives to help save others. “After all those times, I knew I had a purpose,” she told The Current. “Recovery is possible for everyone.” 

The human costs of a state’s broken mental health promises

The Commonwealth of Pennsylvania knew it had problems with its psychiatric hospitals for decades – in the 80s, a former patient even described one as “a Nightmare Warehouse.” That’s when  the state began closing them. In 1991, the Community Hospital Integration Projects Program, or CHIPP, promised to change everything. Hospitals would close, and their funding would be redirected to provide quality mental health care in communities. “The promise was a transformed mental health system, where getting care for depression, or bipolar disorder, or schizophrenia would be like getting care for bronchitis, or lupus, or cancer,” Spotlight PA reports. 

That’s how it seemed to be going – the inpatient population fell from just under 40,000 in the 1950s  to 3,000 by the turn of the millennium, and it has been under 1,500 since 2011. But there were clear problems brewing. In a federal court ruling 20 years ago, Judge Max Rosenn wrote that Pennsylvania’s plans, while admirable in their intent, were “amorphous” in their goals. He described the state’s “failure to set forth reasonably specific and measurable targets for community placement.” His concerns materialized – the state effectively voided its word. Mental hospitals shuttered, but weren’t fully replaced with community-based care, forcing a vulnerable population into homelessness, addiction, and prison.

Sue knows all about it. Her son, Robert, lived 20 idyllic years before showing signs of serious mental illness. The change was gradual until it wasn’t, she said. His once meticulous hygiene habits became loose and he developed a suspicion of the microwave. Becoming a father his freshman year of college ramped up his stress. But Sue feels it was grief from the sudden, tragic loss of his cousin that really set Robert on a downward spiral.

After years of trying everything to help him, Sue has started to wonder if it’s all futile. “I just play this over and over in my mind. Maybe I shouldn’t have taken that knife out of his hand,” she said, remembering the moment in 2022 when she stopped her son from ending his life. Rather than send him to emergency treatment, the incident landed him in jail, where he languished for more than a year, including months in solitary confinement. The joy following his release – which Sue could only secure through a backdoor connection – was short-lived. Pain meds prescribed to Robert after oral surgery induced another psychosis, and Sue lost him again. When he turned up last year at her mother’s house, Sue was desperate to get her son help, and called 911, requesting a crisis intervention team per instructions she’d received from various officials throughout the years. “I don’t care who told you what,” the dispatcher who took her call said. “I’m telling you, we have nothing like that here.”

The system’s present failures connect directly to massive 2013 cuts to the state’s mental health funding. That’s when Republican Gov. Tom Corbett chose to fill gaps in the state’s budget with money once allocated to community-based mental health care. His successor, Democratic Gov. Tom Wolf, did not replace it. And though Pennsylvania’s current Gov. Josh Shapiro, also a Democrat, has infused $40 million into community mental health and is proposing $20 million more, it doesn’t amount to what was cut 12 years ago – adjusted for inflation, state-provided mental health funding is at $205 million today compared to $284 million just before the cut.

The fallout has been catastrophic. Fewer hospitals and fewer dollars for the services to replace them has left those in need unsupported – since 2017, services have reached about 85,000 fewer people.

In lieu of treatment, many end up being held in jail or prison. “The Department of Corrections and county jails have unintentionally become the largest providers of behavioral health services in the Commonwealth and are not sufficiently prepared and resourced to meet this population’s needs,” reads a 2022 report from the state’s Behavioral Health Commission. From 2014 to 2022, the number of incarcerated people on suicide watch per 1,000 more than doubled. Within the same time frame, the number of those jailed and on psychiatric meds leapt from under 25% to nearly 40%. 

Counties across the state – tasked to do more with less funding – continue to struggle. “We make these promises to these people that are coming out of these institutions, and we’re given a pittance to be able to support them in the community,” said Miki Drutchal, mental health administrator for Lackawanna County. An official for Greene County told reporters they have to beg health care providers to come to their rural community. And mothers like Sue, left with nowhere to turn, continue to wonder if there is anything at all they can do.

How one small California rehab facility is fighting back against a giant insurer

The Lakes Treatment Center, a small, family-owned rehab in rural Calaveras County, California is reared back, facing a giant. Their adversary? Anthem, the state’s second largest health plan, which intends to remove the facility from several of its provider networks. Bernadette Cattaneo, The Lakes’s founder, told CalMatters that she thinks Anthem’s withdrawal is retaliation for repeated successful appeals for coverage. With help from center staff, patients at The Lakes won 90% of their appeals through California’s Department of Managed Health Care in the year up to June 2023, forcing Anthem to pay for treatment it initially denied. While the insurer says its choice to terminate the relationship with The Lakes is “necessary to sustain Anthem’s ability to offer these network products,” other facilities across the state back up Cattaneo’s claims. 

“The Lakes works tirelessly to provide stellar treatment and this was literally a slap in the face,” she said. The move could bankrupt the center, Cattaneo added, and she has contacted state regulators and filed a lawsuit against Anthem. The case raises questions about insurer compliance with California’s mental health parity laws, which as of 2020 mandate coverage for medically necessary substance use disorder care. 

Leaders of other treatment centers corroborate Cattaneo’s characterization, stating that many insurers, including Anthem, set up obstacles threatening their ability to stay in business. CalMatters identified more than a dozen such instances in lawsuits, state regulatory filings, and interviews, claiming that insurers regularly deny their patients’ medically-necessary claims for coverage and also apply punitive measures to prevent centers from receiving full reimbursements. The tactics often result in patients being discharged from treatment too soon, or left laden with debt. Insurers pressure facilities to accept lower rates, or simply don’t pay, leaving facilities to absorb the costs of care. “What we’re hoping is that our fight becomes a fight for the whole industry,” Cattaneo said.

Anthem isn’t the only major insurer with questionable payment practices, according to treatment facilities, but CalMatters found that the company was the most likely to have its denials for all forms of health care overturned by state regulators, with almost two-thirds of their decisions reversed following patient appeals. After Cattaneo’s initial response to Anthem’s intent to terminate The Lakes from its provider network, the insurer withdrew its decision, resorting instead to reducing or withholding payments, according to court documents. In a court declaration, Anthem claimed the actions to be an administrative error. Later on, the insurer sent a new notification about cancelling their contract with the center – just later than originally planned.

The ruckus has done great harm to Cattaneo’s business, much like other treatment facilities in related disputes. In addition to laying off several staff, she’s had to cut the hours of those remaining by 20%. As she gears up to enter arbitration, her lawyer, Meiram Bendat, argues the Department of Managed Health Care shouldn’t allow insurers to force out-of-court action like this. Insurers invoke confidentiality clauses that allow details of the disputes to be shielded from public view. More broadly, he says, the department is “not really stepping up to ensure that providers aren’t terminated for improper reasons.” 

In a letter to the Department of Managed Health Care last year, Cattaneo pleaded for “urgent regulatory intervention.” She said they could not “turn a blind eye to Anthem’s brazen betrayal of the health care system.”

In other news…

Women get better at managing anger with age – even though they feel more of it: New research published in Menopause suggests that as women age and progress through the different stages of their reproductive lives, they feel more anger, but express less. Examining the health and menstrual data of more than 500 women aged 35 to 55, as part of the  Seattle Midlife Women’s Health Study, researchers found that feelings of anger increased with age, but so did control of those feelings. The tendency to suppress anger – keep anger bottled up – stayed the same. Feelings of anger and anger proneness peaked just before perimenopause, then fell with each successive reproductive aging stage. It suggests something you’ve maybe noticed experientially: Women, like many others, develop better control over their emotions with age, making a big shift from midlife onwards, particularly through perimenopause and menopause. Previous studies on women and anger have found connections between anger and conditions including depression, hypertension and heart disease. 

“The mental health side of the menopause transition can have a significant effect on a woman’s personal and professional life,” Monica Christmas, associate medical director for The Menopause Society, said in a press release. “This aspect of perimenopause has not always been acknowledged and managed… Educating women about the possibility of mood changes during these vulnerable windows and actively managing symptoms can have a profound effect on overall quality of life and health.”

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State budget cuts threaten mental health warm line in California: The San Francisco Mental Health Association stands to lose over two-thirds of its workforce in less than two months, due to a severe reduction in state funding, the San Francisco Examiner reports. Layoffs would primarily impact employees running the 24/7 California Peer-Run Warm Line, which provides callers experiencing a mental health crisis with peer support and an alternative to 911. The line, which launched in 2014, first received funding from the California Department of Health Care Services in 2019. Tens of millions in state dollars have been allocated to fund the line in the years since, helping counselors manage a call load of up to 40,000 per month. But this year, Gov. Gavin Newsom has set aside a maximum of $4.5 million for the hotline, amounting to a near 75% cut in funding. Mark Salazar, the nonprofit’s executive director, has been campaigning against the cut, and is holding onto hope that the state changes its mind. In the meantime, he’s working with the state to keep the line operational, at least some of the time.

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A former content moderator at a live-streaming porn site alleges the job gave him PTSD. The former employee is suing Chaturbate in a class-action lawsuit, claiming that negligence caused him to develop post-traumatic stress disorder “and other severe emotional injuries,” 404 Media reports. Neal Barber, who joined the company five years ago, said that Chaturbate, its parent company, Multi Media LLC, and a contractor, Bayside Support Services, failed to provide content moderators with proper mental health support, despite the deluge of graphic and disturbing sexual content they were required to consume. Barber suffers “vivid nightmares, emotional detachment, panic attacks,” and other symptoms, requiring ongoing therapy and medical care, according to the lawsuit. 

“Because platforms like Chaturbate host vast amounts of live, unfiltered, and sexually explicit content, content moderators are essential,” the lawsuit states. Even with advances in AI, human moderators “serve as the first line of defense against child exploitation, non-consensual content, violent content, obscene content, self-harm, and other violations,” the complaint says. The suit highlights industry protective measures like “content filters, wellness breaks, trauma-informed counseling, or peer support systems” – none of were implemented for Barber. ”Had Defendants taken even the minimal precautions adopted by companies in Defendants’ industry,” the suit charged, “Plaintiff would not have suffered these injuries.”