Tragic California Case Exposes Failings in Our Mental Health Care System

Rusty Selix
Executive Director, Legislative Advocate
California Council of Community Mental Health

In April 2012, Fred Paroutaud, a California man with no history of mental illness, experienced a psychotic episode. Mr. Paroutaud was hospitalized and diagnosed with bipolar disorder. Just 72 hours after he was admitted, and despite the fact that he was still experiencing hallucinations, he was discharged and referred to outpatient group therapy. Because his condition remained unstable he requested alternate therapy and one-on-one sessions with a psychiatrist. He was denied both by his health plan and his condition deteriorated.

Concerned by his worsening depression, his wife appealed to the health plan again and again. She pleaded that her husband required more supervised and personalized treatment. While waiting for an appointment with his psychiatrist, and just two months after his first psychosis, he died by suicide.

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Mr. Paroutaud’s widow is convinced that if more intensive and timely care had been available, her husband would still be alive. In October 2013, she and two other plaintiffs filed a class-action lawsuit against the health plan claiming they were harmed by its systemic denial of timely access to mental health services.

Why this story sounds familiar
While Mr. Paroutaud’s story is unique, his circumstances were not. Upon his release from the hospital, he needed intensive, monitored care. That’s not what he got. Generally speaking, commercial health plans limit coverage to two levels of care: level one is a once a week therapy visit for mild to moderate problems and medication management; and level two is hospitalization.

Those two narrow levels of care are appropriate for many people, but not all, and certainly not for all stages of mental illness. The absence of those critical, in-between levels of care is one of the ways that our mental health system falls short and where it fails people like Fred Paroutaud and his family.

When someone is in the midst of a manic episode or considering suicide, hospitalization can provide the opportunity to stabilize the condition. Upon discharge, many patients require medically monitored care in a residential facility or highly personalized care in a medically-monitored outpatient setting. Unfortunately, that level and type of care is almost impossible to find in commercial health plans.

There is another way
My hope for a health system that offers comprehensive mental health services to better address the needs of individuals with a mental health condition is not pie-in-the-sky wishful thinking. In fact, this model of care, with multiple levels and degrees of intensity, already exists within the California Medicaid system. In our public programs, care ranges from community-based health management through low-intensity community-based services, high-intensity community-based services, medically-monitored non-residential services, medically-monitored residential services, and medically-managed residential services (i.e., inpatient treatment).

This structure, with six levels of care, is the backbone of the mental health system under California’s Medicaid system, and it provides a complete, stepped approach to rehabilitation.

This type of care should not be exclusive to the Medicaid population. One of the 10 essential health benefits under the Affordable Care Act is rehabilitation; another is mental health care. This means that rehabilitation for mental health care is an essential benefit, and all Americans in commercial health plans are entitled to more rehabilitation-focused mental health services.

What you can do now
Fred Paroutaud was denied access to stepped treatment and his story is tragic. It is thanks to his widow and her persistence that we know about it at all. Unfortunately, many people suffer similar situations and denials of care, but we do not hear about them.

With increased national attention on access to mental health care, now is the time to tell us about the problems you are having in accessing the care you need. We want to know what services you were denied and the barriers you faced, such as unaffordable out-of-pocket costs, transportation issues, or lack of trained providers in your plan’s network, etc.  We also need to know what you did or didn’t do in response and how this impacted your or your family member’s recovery. As advocates and advocacy organizations, we are positioned and prepared to knock on the door of government regulators and health plans and point out the disparity in care and demand access to appropriate rehabilitative services.

Many commercial insurers don’t cover rehabilitation services because they don’t believe they have to. And if no one demands otherwise, they are unlikely to ever change. Share your story. Don’t take ‘no’ as the only answer. Let’s realize the parity we deserve.

Questions

  • How have you been denied equal insurance coverage for a mental health condition? Tell us your story.
  • What levels of treatment are available to you under your health plan? Are they sufficient?

Bio

Rusty has been Executive Director and Legislative Advocate for CCCMHA since 1987. He is co-author of California’s Mental Health Services Act, a tax on personal incomes over $1 million to expand community mental health care. At CCMHA, he has been instrumental in moving forward a variety of critical mental health-related initiatives, including ensuring the implementation of the federal Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program to serve children with severe emotional disturbances. He also serves as Executive Director of the Mental Health Association in California.

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1 comments
Stinger89
Stinger89

What I find the most disturbing is there is no help available and patient to Psychiatrist ratio is outrageous.Thus after a chapter 51 hold they are released into the streets even if the Psych said this patient should be in a 6 month program, and Social Service worker can have more control then a doctor? They will say they will keep track nope they don't, no one monitors the patient or the medication side effects. they put if off on the family who doesn't have any training at all. NAMI chapters, sure but they are not in every town. The local jails and prisons are full right? Because we lack facilities that are specialized with intense cognitive and behavioral therapy in addition to medications.  I am so sick of hearing how the parents are to blame when tragedies occur, this is a society is built on criminalizing mental health disorders. It should come as no surprise that the US is ranked dead last in comparison to modernized countries in the quality of health care. When families reach out they are given a crumb, and treated absolutely horrible. You will hear the patient doesn't qualify, I'm so sorry their are no opening for you, we only take inpatients, no therapist available for months even when they try to avoid ended up suicidal or in psychotic state.. If they are blessed to get help there is no continuity in patient care. Absolutely Nothing but continuous gaps and no funding.  Once I discovered scattered among 5 other prescription bottles, two of the exact same prescriptions bottles by two different Psychiatrist for the exact same medication for lithium that my child was provided in a poorly run group home, are you kidding me? I called the facility immediately, well you have to call the other one,The soonest appointment  was for six months and regular doctor didn't want to deal with it this not his speciality.  In the meantime my son couldn't even tie his shoe he was so over medicated. Of course they don't want to take those meds and I know exactly why. Had someone had the time to monitor him and see how they are going to work with his bodies chemistry you might find the right cocktail. But if  you don't give them a chance to be monitored, and it takes three months and expect them to remember the who, what, when and where you better starting educating yourself asap. Do people realize what happens to a persons brain and how long it takes to recovery from each episode of a psychosis my guess probably not. I suppose we could have that same attitude: Not your child, so it's not your circus right? Until there is another horrible tragedy involving a member of your family..again and again we hear it on the news...We as a society, in the USA are responsible for these tragedies. "A healthy society is a happy society." Last time I checked it didn't include mental health as a priority. Family Physicians are not prepared to deal with this speciality nor should they have to. Can we have any accountability when we discuss mental health issues  because they don't wait for months...