February 10, 2016

Mental Health Department director explains support for Medicaid expansion

The Director of the state’s Mental Health Department says there are several ways Missouri can improve mental health care, but says meaningful improvement will be difficult without Medicaid expansion.

Mental Health Department Director Keith Schafer (photo courtesy; Missouri Department of Mental Health)

Mental Health Department Director Keith Schafer (photo courtesy; Missouri Department of Mental Health)

Keith Schafer says one of the big problems with behavioral health care is that people can’t access his agency’s services without Medicaid eligibility. He says young people with mental illness could take 5 or 6 years to get a disability determination.

He says with expanded eligibility, “It will particularly allow young people 18 to 25, 18 to 30, to reach into our services much more quickly before their situation escalates to the point that it’s extremely expensive and very difficult to resolve.”

Schafer knows more attention is on mental health now, particularly after the shooting at a Connecticut school in December, but he says the mental health field has a long way to go to prevent tragedies.

“The vast majority of people with mental illness … are very vulnerable people who are often taken advantage of, they live in poverty, they struggle mightily with their health. Very small percentages of people with mental illness become dangerous. When they do, we hear about it, obviously.”

He says, “We need to get better, if we can, at detecting what combination of factors cause a young person who’s struggling with mental illness to move into that level of reacting against society … we will never have the ability to fully predict when a person with mental illness or without mental illness becomes violent.”

Schafer emphasizes working more with families of young people with mental health issues through entities like the Missouri chapter of the National Alliance for the Mentally Ill (NAMI).

He also says early intervention funding must be figured out.

“We can not wait until we become a high-end, crisis focused 42-year-old person who has already been through all the crises and has just now become Medicaid eligible. It just doesn’t work that way.”

Some Republican budget makers want to find non-budgetary ways to improve mental health care. Schafer says there are some possibilities, and they begin with public perception.

“The beginning of this process has to address greater understanding on the part of the Missouri public that mental illness can be understood and we can do the right thing when we identify a person who’s having problems. Beyond that, once we create that understanding I think services will come because people then will clamor for those services.”

Schafer says even developing that public perception, however, won’t make mental health care more accessible.

“Let’s suppose I get a lot better with Missouri citizens who are recognizing the need for mental health treatment and actually even talk their loved one into getting treatment but that loved one has no coverage whatsoever. Then the question is, what do we do? We rely almost totally on emergency room services, inpatient services, charity care and none of that is a coordinated, careful approach over time to making sure the individual understands the illness, gets on their medication, stays on their medication.”

Schafer says Republicans raise legitimate issues about accepting federal money to expand Medicaid eligibility.

“I can just tell you from my point of view as the Director of the Department of Mental Health, We need funding streams for young people. We can not wait until they go for years and years until they reach a categorical eligibility and then finally get them in service. If we’re going to make a difference here we’re going to have to reach them earlier.”