Consumers and providers say there aren't enough mental health services to go around.

        Employers say there isn't enough proof that mental health services work.

MENTAL HEALTH TRENDS

Spending nationwide on behavioral health services has dropped 55 percent in a decade, from $154 per covered person in 1988 to $69 per person in 1998.    About 536,000 people in Ohio have a mental illness, yet 60 percent get no care.    Ohio has the sixth -largest mental health need among states, yet ranks 29th in per-capita spending on health care.    Sources: Employer Health Care Alliance, Health Improvement Collaborative of Greater Cincinnati and the Health Foundation of Greater Cincinnati.

        And policymakers say continuing stigma about mental illness helps keep funding and quality issues off the front burner.

        As a result of these and other factors, the state of behavioral health care in Greater Cincinnati is poor and getting worse, according to a report issued Tuesday by the Health Improvement Collaborative of Greater Cincinnati and the Employer Health Care Alliance.

        The report, based on in-depth interviews with 23 consumers, psychiatrists, insurers, employers, judges, school administrators and others familiar with the mental health care system, reached this conclusion:

        “Cost is a major driver of both public and private behavioral health care services in the Greater Cincinnati region. As a result, services are insufficient, dwindling, and are difficult and frustrating for consumers and providers to access. Resources are more restricted than for physical health due to both the stigma frequently associated with behavioral health and the lack of defined measurable outcomes.”

        For those familiar with the mental health care system, such findings come as little surprise. People inside the field have complained for years that mental illnesses, from depression to schizophrenia, have not been given nearly the same levels of research, care and insurance coverage as other types of medical care.

        The potential value of this report is that it brings the issue closer to home for employers, policy makers and other leaders in the health care industry, said Allen Daniels, chief executive of Alliance Behavioral Care, whose company helped pay for the report.

        “We hope the information will lead to other projects and action items,” he said.

        The report contends that a historical lack of convincing data about effective methods of care have combined with the overall stigma that surrounds mental illness to allow employers and public policymakers to view paying for mental health services as a pure cost issue.

        So, private coverage for mental health services has been slashed for the vast majority of Tristate residents and public programs continually face budget cuts rather than expansions. The result: Fewer providers stay in the business, waiting times for care get longer, and the hassles getting coverage for care get worse.

        In Ohio, 60 percent of people with mental illnesses get no care at all, according to the report.

        Many of the issues outlined in the report reflect national trends. But some are local.

        A few years ago in Greater Cincinnati, waiting times to see a psychiatrist were as short as one month for some practice groups, but have since grown to three or four months, the report states. And while the lack of mental health services for Tristate children has made headlines in recent years, the longer waiting times are affecting people of all ages.

        Some blame employers for setting lower benefit limits on mental health services than for other medical care. But employers say they, too, are frustrated.

        “We want to reward quality. The problem is that I see cost increases (for mental health services) but I don't see what I get for that,” said Beth Hallgren, health care manager for GE Aircraft Engines and a former president of the Employer Health Care Alliance.

        At GE, a recent analysis showed that fewer less than 30 percent of employees with behavioral health problems were getting treatment from the mental health care system.

        Instead, most got care from their primary care physicians, and none of those cases appeared to follow national treatment guidelines, Ms. Hallgren said.

        Another problem: wide variations in state and local public support for mental health care. While Hamilton County has had a mental health care tax levy for years, most areas don't.

        As a result, Hamilton County spends more than three times as much per capita on mental health services than counties just across the river in Northern Kentucky.

        It remains crucial to reduce the fragmented ways that mental health care services are provided and funded, said Patricia O'Connor, vice president of the Health Foundation of Greater Cincinnati.

        That's because when mental health services go under-supported, society pays in many other ways, including lost productivity in the workplace, poor school performance, more dependence on welfare programs, and increased criminal justice costs, she said.

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