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2007-04-17 issue:

To the least of our neighbors

by Stuart W. Showalter

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Joe and Barbara Miller, a Mennonite married couple in Pennsylvania, always wanted children. The Millers (not their real names) received their first foster child when they were in their mid-30s. Eventually, three other foster children became a part of their household. Now in their 50s, the Millers last year welcomed two grandchildren as members of their family as well.

Along the way, as the children grew older, the family encountered a series of serious mental and behavioral problems. One teenager physically abused his sibling. Other children in the family needed intensive treatment for behavioral illnesses. These conflicts and illnesses took an emotional toll on Joe and Barbara, so they, too, sought mental health services for themselves. As if they had not endured enough pain, Barbara recently developed arthritis in her knees and ankles.

The Miller family has been supported by Joe’s income, but his wages from a job in a manufacturing warehouse barely exceed the poverty level. The family has always wondered how they would stretch Joe’s income to pay basic bills, much less the bills for mental health services not covered by insurance or state aid. For example, the cost of services for the foster children has been covered by medical assistance funds, but the same fund does not cover the cost of services for their grandchildren.
For families like the Millers, the Caring Fund at Philhaven in Mt. Gretna, Pa., has been a godsend. Philhaven’s contributors provide financial support for the Caring Fund. Eligible clients, determined on a case-by-case basis, may apply for support from this fund. Factors determining eligibility include being uninsured, underinsured or having exhausted benefits; an assessment of family income and extraordinary health-care expenses.

Philhaven, as an agency of the Lancaster (Pa.) Conference of Mennonite Church USA, offers a continuum of behavioral health-care services for residents from its region. Its philosophy is to develop treatment plans that integrate the psychological, biological, social and spiritual components of anyone needing mental health services. Philhaven’s Caring Fund has made it possible for the Millers—the “working poor”—to receive services that helped them cope with the stress. For families unable to access services, increased stressors can result in greater dysfunction and even the break-up of the family.

While Philhaven’s Caring Fund provided vital financial support for the Millers, the outcome for millions of other Americans who could benefit from treatment for serious mental disorders is not so hopeful. One cause for concern is the increasing number of people without any health insurance. The Census Bureau reports that 46.6 million residents are without coverage, rising in one year from 15.6 percent of Americans in 2004 to 15.9 percent in 2005. In addition, when individuals do have insurance, they may have to make higher co-payments for treating mental illness than they do for other illnesses. Sometimes insurance benefits for mental health can cover fewer visits when compared with coverage for other medical concerns. Other limitations can apply as well, including annual limits on inpatient treatment days and annual and lifetime ceilings for payments for mental health care.

The prevalence of mental disorders within society—and the church—is a given. The National Institute of Mental Health estimates that in a given year one in four American adults—26.2 percent of everyone 18 years old and older—suffers from a diagnosable mental disorder. NIMH adds that a serious mental disorder afflicts one in 17 adults annually. Further, serious mental disorders are the leading cause of disability for individuals ages 15-44, disrupting educational progress and productive work in the patients’ prime years.

What are some implications for Mennonites? Mennonites from all groups in the United States number roughly 320,000, with approximately 110,000 of these comprising the Mennonite Church USA membership. Extrapolating from the NIMH data, as many as 80,000 American Mennonites experience diagnosable mental illnesses annually, with 18,800 of these cases likely classified as serious. Extrapolating further, nearly 13,000 mentally ill Mennonites (80,000 x 15.9 percent) in America have no insurance to cover the cost of treatment. Those who do have insurance experience the frustrations associated with high co-pays, high deductibles and treatment limitations.

Mennonites, following their experiences as alternative service workers in mental hospitals during World War II, became pioneers in providing humane treatment for mental illnesses. They saw that simple caring and genuine love could help many of their patients move toward wholeness. Today 10 church-related organizations provide mental health services as part of MHS Alliance, which describes itself as “a community of Anabaptist health and human service ministries committed to God’s work of healing and hope in Christ Jesus.” These organizations include well established and highly respected treatment centers such as Philhaven and Penn Foundation in Pennsylvania, Brooklane in Maryland, Oaklawn in Indiana, Prairie View in Kansas and Kings View in California.

Like their secular counterparts, these organizations have seen costs rise, both for themselves as they provide services and for the patients who receive the care. Mennonite-related mental health organizations typically depend on payments for services from the patients’ insurance provided as an employee benefit or from state funds. Emergency rooms at general hospitals are required by law to accept crisis cases, at least on a temporary basis. However, if the patient has no coverage to pay costs, hospitals are not obligated to continue services beyond short-term care.

In recent years, individuals needing mental health care have faced even more daunting challenges. LaVern Yutzy, chief executive officer of Philhaven, notes: “The advent of managed care in the early 1990s has resulted in significantly reduced margins for providers of mental health care. There is less ability to provide charity care than in the past, when operating income generated larger margins.”

Yutzy continues: “The managed care era has also brought the creation of many levels of care, a positive development. Clients now stay shorter periods of time in inpatient services and make the transition more rapidly to community-based services. More funding now exists for these community services than in the past. Sometimes, however, the payors of services want clients to move to less intensive levels of care more quickly than healthcare providers think is appropriate or safe.”

Even the most caring of mental health institutions cannot meet the needs of everyone who seeks treatment. At Philhaven, for every patient admitted for inpatient services, two other patients are turned away. The reasons range from lack of space to not having the capacity to deal with certain types of cases, such as patients with significant medical problems or diagnoses linked primarily to drug and alcohol use. Yutzy says: “Inability to pay is certainly not the most frequent reason for denying access to services, but it can be a complicating factor. Finances sometimes become a major issue during service. An organization such as Philhaven could quickly become inundated with requests for charity care if we publicized the fact that we have a Caring Fund.”

When Philhaven turns away potential clients, staff members attempt to find appropriate services for them elsewhere. Yutzy notes: “Someone who is transient or homeless might be referred to a general hospital, where they will remain until they are stabilized, since no one else can take them. Others, unfortunately, fall through the cracks in the mental-health-care system.”

In a health-care system oriented to justice, everyone would receive mental-health-care benefits in a way that is consistent and fair. Such a system would enable providers to respond to the needs of their clients without regard for their ability to pay. Yutzy also advocates for “more education and prevention so that less money needs to be spent on treatment. Currently payors of services focus their resources on treatment, not education.” Philhaven has launched a special gifts campaign in part to fund new education and prevention initiatives.

Meanwhile, Philhaven keeps exploring ways to create more access for clients needing care, including those without the ability to pay. Since its beginning in 1952, Philhaven has provided charity care, thanks to the generosity of donors. Staff members take extra steps to help eligible patients apply for medical assistance from state and county funds and devise deferred payment schedules. Also, therapists sometimes stretch out appointment schedules to enable patients to keep current with their account.

Philhaven has always maintained its relationship with Lancaster Mennonite Conference. Some congregations have provided direct financial support, sometimes for special programs, such as Recovery of Hope, which counsels couples in distress. Lancaster and Atlantic Coast conferences have contracted with Philhaven to provide an employee assistance program for pastors.

Without a doubt, greater awareness of mental illnesses and decreasing stigma for seeking mental health services have resulted in more individuals wanting access to care. The challenge for the church is to devise the means for its members to access the care available and to be faithful in extending that care, as Jesus would do, to the least of our neighbors near and far.

Stuart W. Showalter is a communication consultant who lives in Kalamazoo, Mich.

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